4. Liver Disease and Cirrhosis Flashcards
What are the causes of macrovesicular steatosis?
Alcohol Metabolic syndrome Starvation Bariatric surgery Amiodarone
What does microvesicular steatosis show?
Metabolic upset in liver mitrochondria
What are the causes of microvesicular steatosis?
Pregnancy
Tetracycline toxicity
Acute liver failure
How is a diagnosis of steatosis made?
Ultrasound
Transaminases
Liver would be pale at autopsy
What is steatohepatitis?
Pattern of inflammation, necrosis and fibrosis in lobules near branch of hepatic vein
What is the primary inflammatory cell in steatohepatitis?
Neutrophils
What may be seen in the cytoplasm of hepatocytes in alcoholic fatty liver?
Mallory’s hyaline
What ways does alcohol damage the liver?
MEOS pathway generates free radicals
Fat synthesis is stimulated and fat oxidation inhibited
Acetaldehyde is toxic
What are the symptoms and signs of alcoholic hepatitis?
Malaise, jaundice, low fever, hepatomegaly, high WCC
Features of decompensated liver disease
AST/ALT >2
What is haemochromatosis?
Excess iron deposits in tissue
Hereditary: defect in HFE gene > hepcidin deficiency
Secondary: iron overload eg. transfusions
What effect does haemochromatosis have on:
- Liver
- Pancreas
- Myocardium
- Pituitary
- Fibrosis and cirrhosis
- Secondary diabetes
‘bronze diabetes’ as iron also deposited in skin - Dilated cardiomyopathy
- Hypogonadism and impotence
What causes arthropathy in haemochromatosis?
Calcium pyrophosphate deposition
Where is iron absorbed?
Small intestine
What molecule transports iron?
Transferrin
Where is iron stored?
Ferritin and haemosiderin
What is hepcidin?
Hormone secreted by the liver
Inhibits ferroportin to block iron entry into circulation
What causes anaemia of chronic disease?
Prolonged inflammatory stimulation of hepcidin
How is haemochromatosis diagnosed?
> 55% transferrin saturation
Ferritin
Genetic testing
Perls’ stain on biopsy
How is haemochromatosis treated?
Venepuncture
What are the autoimmune causes of liver disease?
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
What patient profile is most commonly associated with autoimmune hepatitis?
Females, 40-60
Other autoimmune diseases
What biomarkers are present in type 1 and type 2 autoimmune hepatitis?
- ANA/SMA
2. anti-LKM
What is primary biliary cirrhosis?
Destruction of intra-hepatic bile ducts, causing chronic cholestasis and liver damage
May have granulomas
What are the signs of primary biliary cirrhosis?
Very high alk phos
High IgM
Bilirubin rises late
AMA
What is the treatment for primary biliary cirrhosis?
Ursodeoxycholic acid
What is primary sclerosing cholangitis?
Fibro-obliterative destruction of bile ducts, both intra and extra hepatic
What is the patient profile associated with primary sclerosing cholangitis?
Male
IBD or ulcerative collitis
What biomarker is present in primary sclerosing cholangitis?
pANCA
What symptoms of cirrhosis are derived from the liver’s inability to inactive oestrogen?
Spider naevi
Palmar erythema
Gynaecomastia
Testicular atrophy
What is used to understand the prognosis of cirrhosis?
Decompensation
Child-Pugh score
MELD score for transplant
