4) The Liver

Question 1

Name the cells of the liver and their basic function:

Answer 1

Hepatocytes - liver function
Endothelial cells - sinusoidal circulation
Kupffer cells - ‘filter’ portal blood
Stellate cells - extracellular matrix

Question 2

What are the functions of the liver?

Answer 2

Metabolism of glucose, protein and lipids
Protein synthesis
Bile production
Drug and toxin metabolism

Question 3

How is the liver involved in protein synthesis?

Answer 3

Major site of plasma protein synthesis

Albumin, lipoproteins, coagulation factors, acute phase proteins

Question 4

What are the functions of albumin?

Answer 4

Oncotic pressure in plasma
Transport of bilirubin
Transport of drugs

Question 5

What are the function of bile salts?

Answer 5

Solubilise fat
Increase access of lipases
Facilitate absorption

Question 6

How is bilirubin excreted?

Answer 6

Stercobilin in faeces

Urobilinogen/urobilin by kidneys

Question 7

What signs are associated with obstructive jaundice?

Answer 7

Dark urine - conjugated bilirubin excreted by kidneys

Pale stools - no stercobilin

Question 8

How is alcohol metabolised?

Answer 8

Alcohol dehydrogenase

CYP enzymes

Question 9

How is paracetamol metabolised?

Answer 9

Conjugated by glutathione or sulphate

Question 10

What can cause toxic injury to the liver?

Answer 10

Drug induced
Industrial/environmental toxins
Alcohol

Question 11

What inherited condtions can affect the liver?

Answer 11

Haemochromatosis
Alpha-1-antitrypsin deficiency
Wilson’s disease

Question 12

What is liver cirrhosis?

Answer 12

Nodular regeneration of liver surrounded by scarring

Question 13

What are some causes of liver cirrhosis?

Answer 13

Alcoholic liver disease
Non-alcoholic fatty liver disease
Chronic hep C
Autoimmune and hereditary causes

Question 14

How does alcoholic liver disease affect the liver?

Answer 14

Steatosis -> hepatocyte injury -> stellate cell activation -> cirrhosis

Question 15

What are some systemic effects of liver cirrhosis?

Answer 15

Hepatic encephalopathy
Varices
Ascites
Splenomegaly

Question 16

What are Mallory Bodies?

Answer 16

Inclusions in cytoplasm of hepatocyte - damaged intermediate filaments
Associated with alcoholic hepatitis and cirrhosis

Question 17

What is fulminant hepatitis?

Answer 17

Acute liver failure with onset of encephalopathy within 8 weeks

Question 18

What are the outcomes of hepatitis C infection?

Answer 18

Chronic hepatitis (85%) -> stable disease (80%), cirrhosis (20%)
Resolution (15%)
Fulminant hepatitis

Question 19

What autoimmune diseases can affects the liver and biliary tract?

Answer 19

Primary biliary cholangitis/cirrhosis

Primary sclerosing cholangitis

Question 20

Describe the features of primary biliary cholangitis/cirrhosis:

Answer 20

Chronic destruction of bile ducts in liver
More common in females
Fatigue, itching and jaundice
Anti-mitochondrial antibodies often present

Question 21

Describe the features of primary sclerosing cholangitis: (include associated condition)

Answer 21

Cholangitis with periductal fibrosis
Asscoiated with UC
pANCA often positive
Definitive treatment is transplant

Question 22

Describe the features of hereditary haemochromatosis:

Answer 22

Autosomal recessive
Abnormal deposition of iron in liver, myocardium and pancreas
Fatigue, malaise, joint pain
Will develop into cirrhosis eventually

Question 23

How is hereditary haemochromatosis diagnosed?

Answer 23

Transferrin saturation >50%

Genetic testing