11 - Liver Pathology Flashcards
What are some general symptoms of liver disease?
- Nausea/vomiting
- Fatigue
- Anorexia
- Abdominal pain
What are some specific symptoms of liver disease?
What is hepatic encephalopathy?
Decline in brain function due to severe liver disease, liver not removing toxins so building up in the blood stream
What are some causes of acute liver failure?
- Paracetamol OD
- Medications like aspirin in children and tetracycline
- Acute viral infections like EBV and CMB
- Acute excessive alcohol intake
What happens to the liver in chronic injury?
- Cirrhosis which develops over years and is irreversible
- Fibrosis, hepatocyte necrosis and nodules
What are some causes of cirrhosis?
How does the alcoholic liver disease progress?
- Fatty change due to alcohol metabolism (weeks, reversible)
- Alcoholic hepatitis (years, initially reversible)
- Cirrhosis (irreversible)
Though to be due to a build up of acetaldehye
What are some symptoms of alcoholic liver disease?
- Could be asymptomatic or general
- Fatty liver: hepatomegaly
- Hepatitis: jaundice, tender hepatomegly (RUQ pain), oedema, ascites, splenomegaly
What are some causes of viral hepatitis and what can they cause an increased susceptibility to?
- Hep B (no cure but vaccine) or C (cure but not vaccine)
- Lead to cirrhosis and risk of hepatocellular carcinoma
What is non-alcoholic fatty liver disease (NAFLD) and how can we prevent it?
- Similar pathogenesis to alcoholic liver disease but stimuli is related to obesity, diabetes and metabolic syndrome
- Non-alcoholic steatohepatitis
- Reduce risk factors so modify lifestyle and catch early
What are two diseases of excess deposition that lead to cirrhosis?
Very rare and both affect other body systems
What are some autoimmune disorders that can lead to cirrhosis?
- Autoimmune hepatitis: affects hepatocytes, ASMA, ANA
- PBC and PSC: affect biliary ducts. PBC is AMA positive and PSC is AMA negative
What is Budd-Chiari syndrome?
- Occlusion of one of the hepatic veins that drains the liver
- Triad of ab pain, ascites and liver enlargement
- Can lead to cirrhosis
What is the portal vein made up of?
What can cause portal hypertension?
- When blood flow into the liver from the portal vein is restricted, e.g from cirrhosis
What are some things that can occur when you have portal hypertension?
- Fibrotic liver not expansive so compresses veins and increases hydrostatic pressure in portal venous system leading to ascites and splenomegaly
- Blood can shunt from portal system to systemic venous circulation via portosystemic anastomoses not usually used so distension of veins leading to varices
Where are the common areas of portosystemic anastomoses that lead to varices?
- Lower oesophagus: mucosal varices between oesophogeal and left gastric vein can bleed torentially leading to haematemesis
- Anorectal: between superior (to portal) and middle/inferior (to internal iliac) rectal veins, typically painless as above pectinate line and rarely pleed
- Umbilical: Not as common, ligament teres reopens and can lead to caput medusa
What is hepatorenal syndrome?
- Development of AKI in the presence of cirrhosis
- All factors in flow chart lead to decrease in renal blood flow so injury
Label the biliary tree.
What are gallstones due to?
- Cholesterol and bile pigments coming out of bile solution to form a solid
- Radiolucent so won’t show up on x-ray unlike renal calculi
What are some risk factors for developing gall stones?
- High cholesterol diet
- Overweight
- Age (40-50s)
- Being a woman
- Being pregnant due to stasis
- Pre-exisiting liver disease
What are some complications of gallstones and how do they present differently?
- Can be asymptomatic or can cause conditions if move from gallbladder to biliary tree
- Also acute pancreatitis
What is biliary colic and how is it managed?
- Temporary obstruction of cystic duct with RUQ pain, no associated inflammation
- Pain few hours after eating fatty meal due to CCK release
- Analgesia or elective cholecystectomy
What is acute cholecystitis and how is it detected and managed?
- Initially similar to biliary colic, impaction of stone in cystic duct so inflammatory features
- On ultra sound there is a thick wall of the gallbladder due to inflammation and Murphy’s sign positive
- Conservative then cholecystectomy
What is Murphys sign?
What is acute (ascending) cholangitis and how is it managed?
- If a gall stone moves into the CBD and becomes impacted, can lead to obstruction and infection
- Charcot’s triad: jaundice, fever, RUQ pain
- IV antibiotics, fluids, relieve obstruction
How can gallstones lead to acute pancreatitis and what is the presentation of this?
- Gall stone impacts in distal biliary tree
- Pro-enzymes become prematurely activated so autodigestion of pancreas by amylases and lipases and inflammation
- Epigastric pain radiation to back, vomiting, Cullen’s and Grey Turner sign
What are some causes of acute pancreatitis?
How can you diagnose and manage acute pancreatitis?
- CT/MRI to detect necrosis, raised lipases, history has abdominal pain
- Fluids, manage gall stones, organ support
