4. Liver Disease and Cirrhosis

Question 1

What are the causes of macrovesicular steatosis?

Answer 1

Alcohol
Metabolic syndrome
Starvation
Bariatric surgery
Amiodarone

Question 2

What does microvesicular steatosis show?

Answer 2

Metabolic upset in liver mitrochondria

Question 3

What are the causes of microvesicular steatosis?

Answer 3

Pregnancy
Tetracycline toxicity
Acute liver failure

Question 4

How is a diagnosis of steatosis made?

Answer 4

Ultrasound
Transaminases
Liver would be pale at autopsy

Question 5

What is steatohepatitis?

Answer 5

Pattern of inflammation, necrosis and fibrosis in lobules near branch of hepatic vein

Question 6

What is the primary inflammatory cell in steatohepatitis?

Answer 6

Neutrophils

Question 7

What may be seen in the cytoplasm of hepatocytes in alcoholic fatty liver?

Answer 7

Mallory’s hyaline

Question 8

What ways does alcohol damage the liver?

Answer 8

MEOS pathway generates free radicals
Fat synthesis is stimulated and fat oxidation inhibited
Acetaldehyde is toxic

Question 9

What are the symptoms and signs of alcoholic hepatitis?

Answer 9

Malaise, jaundice, low fever, hepatomegaly, high WCC
Features of decompensated liver disease
AST/ALT >2

Question 10

What is haemochromatosis?

Answer 10

Excess iron deposits in tissue
Hereditary: defect in HFE gene > hepcidin deficiency
Secondary: iron overload eg. transfusions

Question 11

What effect does haemochromatosis have on:

1. Liver
2. Pancreas
3. Myocardium
4. Pituitary

Answer 11

1. Fibrosis and cirrhosis
2. Secondary diabetes
   ‘bronze diabetes’ as iron also deposited in skin
3. Dilated cardiomyopathy
4. Hypogonadism and impotence

Question 12

What causes arthropathy in haemochromatosis?

Answer 12

Calcium pyrophosphate deposition

Question 13

Where is iron absorbed?

Answer 13

Small intestine

Question 14

What molecule transports iron?

Answer 14

Transferrin

Question 15

Where is iron stored?

Answer 15

Ferritin and haemosiderin

Question 16

What is hepcidin?

Answer 16

Hormone secreted by the liver

Inhibits ferroportin to block iron entry into circulation

Question 17

What causes anaemia of chronic disease?

Answer 17

Prolonged inflammatory stimulation of hepcidin

Question 18

How is haemochromatosis diagnosed?

Answer 18

> 55% transferrin saturation
Ferritin
Genetic testing
Perls’ stain on biopsy

Question 19

How is haemochromatosis treated?

Answer 19

Venepuncture

Question 20

What are the autoimmune causes of liver disease?

Answer 20

Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis

Question 21

What patient profile is most commonly associated with autoimmune hepatitis?

Answer 21

Females, 40-60

Other autoimmune diseases

Question 22

What biomarkers are present in type 1 and type 2 autoimmune hepatitis?

Answer 22

1. ANA/SMA

2. anti-LKM

Question 23

What is primary biliary cirrhosis?

Answer 23

Destruction of intra-hepatic bile ducts, causing chronic cholestasis and liver damage
May have granulomas

Question 24

What are the signs of primary biliary cirrhosis?

Answer 24

Very high alk phos
High IgM
Bilirubin rises late
AMA

Question 25

What is the treatment for primary biliary cirrhosis?

Answer 25

Ursodeoxycholic acid

Question 26

What is primary sclerosing cholangitis?

Answer 26

Fibro-obliterative destruction of bile ducts, both intra and extra hepatic

Question 27

What is the patient profile associated with primary sclerosing cholangitis?

Answer 27

Male

IBD or ulcerative collitis

Question 28

What biomarker is present in primary sclerosing cholangitis?

Answer 28

pANCA

Question 29

What symptoms of cirrhosis are derived from the liver’s inability to inactive oestrogen?

Answer 29

Spider naevi
Palmar erythema
Gynaecomastia
Testicular atrophy

Question 30

What is used to understand the prognosis of cirrhosis?

Answer 30

Decompensation
Child-Pugh score
MELD score for transplant