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Clinical Pathology > 59 Hepatobiliary diseases > Flashcards

59 Hepatobiliary diseases Flashcards

1
Q

When is jaundice visible?

A

When bilirubin >40umol/l.

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2
Q

Simply describe the metabolism of bilirubin:

A

Unconjugated bilirubin is produced in RBC breakdown.
Conjugated in the liver and excreted in bile.
Some is reabsorbed by the gut - enters the enterohepatic circulation.

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3
Q

What is pre-hepatic jaundice?
2 causes:
Sign?

A

Too much bilirubin produced.
Haemolytic anaemia, Gilbert’s syndrome.
Yellow skin + sclera.

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4
Q

What is hepatic jaundice due to?
3 causes:
Signs:

A

Too few functioning hepatic cells.
Acute liver injury, chronic liver disease, inborn.
Jaundice + dark urine.

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5
Q

What is post-hepatic jaundice?
Causes:
Signs:

A

Bile duct obstruction.
Stone, stricture, tumour.
Jaundice, pale stools, dark urine.

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6
Q

Why do ALT + AST rise in hepatic injury?

What is seen in acute vs chronic?

A

Leak from damaged hepatocytes.

Very high= acute. Mildly high= chronic.

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7
Q

What produces a raised Alk Phos?

A

Leak from injured bile duct cells.

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8
Q

Which histological change is seen first in obstructive jaundice?

A

Bile in parenchyma.

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9
Q

What are the later histological changes in obstructive jaundice? (4)

A

Portal tract expansion.
Oedema.
Ductular reaction: proliferation + fibrosis.
Bile salt + copper accumulation.

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10
Q

How is jaundice investigated? (2)

A

Ultrasound to check for dilated ducts.

If none seen - liver biopsy.

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11
Q

What are most cases of non obstructive jaundice due to?

A

Acute hepatitis.

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12
Q

What is the clinical spectrum of acute hepatitis? (6)

A 
Asymptomatic
Malaise
Jaundice
Coagulopathy
Encephalopathy
Death
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13
Q

What are the causes of acute hepatitis? (4)

A

Viral.
Drugs (paracetamol).
Autoimmune.
Alcohol.

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14
Q

What histological changes are seen in acute hepatitis? (4)

A

Heapocyte disarray (apoptosis).
Inflammatory cells.
Confluent panacinar necrosis (all cells dead).
Bridging necrosis (cells die between vascular structures).

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15
Q

What are the causes of chronic hepatitis? (7)

A 
Viral.
Autoimmune.
Drugs.
Fatty liver disease.
Non-alcoholic fatty liver disease.
Alcohol.
Iron, copper, α1-antitrypsin.
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16
Q

What is a biopsy used for in chronic hepatitis?

A

Determine cause.

Assess stage.

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17
Q

Describe the four stages of chronic liver disease histology:

A

Normal.
Portal fibrosis.
Bridging fibrosis.
Cirrhosis.

18
Q

Who is Hep D seen in?
How is Hep E spread?
Name three causes of Hepatitis in immunocompromised:

A

Preinfected with Hep B.
Waterborne.
EBV, CMV, HSV.

19
Q 
Hep A:
Route:
Acute jaundice?
Progression to chronic?
Treatment?
Prophylaxis?
A 
Faecal-oral.
acute? Common.
progression? Never.
Rx? None.
Prophylaxis? Vaccine, Ig.
20
Q 
Hep B:
Route:
Acute jaundice?
Progression to chronic?
Treatment?
Prophylaxis?
A 
Parenteral.
jaundice? Common.
progression? 10% 
Rx? IFN + lamivudine.
Prophylaxis? Vaccine, Ig
21
Q 
Hep C:
Route:
Acute jaundice?
Progression to chronic?
Treatment?
Prophylaxis?
A 
Parenteral.
jaundice? Uncommon.
progression? >70% 
Rx? IFN + ribavirin.
Prophylaxis? None.
22
Q

What changes are seen in the liver with alcohol? (3).

Histological changes in FLD + NAFLD? (2)

A

Fatty change.
Alcoholic steatohepatitis.
Cirrhosis.

Ballooned hepatocyte with mallory body.
Pericellular fibrosis.

23
Q

What is non-alcoholic fatty liver disease associated with? (4)

A

Obesity.
Diabetes.
Hyperlipidaemia.
Drugs.

24
Q

Name a intrinsic and idiosyncratic hepatotoxic drug:

A

Paracetamol.

Amoxicillin.

25
Q

What are the criteria for drug induced liver injury? (4)

A

Onset of abnormal LFTs 5-90 days after drug.
50% reduction after stopping, under 30/180 days.
Alternative causes excluded.
Increase in LFTs by 100% on re-challenge.

26
Q

What pattern of cell death is seen in paracetamol hepatotoxicity?

A

Uniform zonal necrosis.

27
Q

How does paracetamol toxicity occur?

A

Safe metabolism by glucuronyl transferase + sulphotransferase. Then…
CYP2E1 converts drug to NAPQI. NAPQI levels higher than glutathione -> necrosis.

28
Q

Why does alcohol exacerbate paracetamol toxicity?

A

Induces CYP2E1 enzymes.

29
Q

How is paracetamol toxicity treated?

A

IV N-acetyl cysteine, which restores glutathione levels.

30
Q

Define cirrhosis:

A

Diffuse hepatic process of fibrosis and conversion of normal liver architecture into structurally abnormal nodules (regenerating tissue surrounded by fibrosis).

31
Q

What are the autoimmune causes of cirrhosis? (3)

A

Autoimmune hepatitis,
Primary biliary cirrhosis
Primary sclerosing cholangitis

32
Q

What are the complications of cirrhosis?

A

Portal hypertension -> oesophageal varices.
Liver cell failure -> oedema, bruising, muscle wasting, decreased detox, ascites.
Jaundice + itching.
Reticulo-endothelial cells -> infection.

33
Q

Why does cirrhosis lead to ascites? (3)

A

Low albumin production.
Portal hypertension.
Aldosterone related fluid retention.

34
Q

What is α1-antitrypsin deficiency?
Histological stain?
Sequelae? (2)

A

Abnormal enzyme can’t be exported from cells.
PAS +ve globules in hepatocytes.
Accumulation -> cirrhosis.
Lack in blood -> active neutrophil enzymes + emphysema.

35
Q

What is haemochromatosis?
Histological stain?
Rx?

A

Inborn error of iron metabolism leads to deposition in organs.
Perl’s blue.
Venesection.

36
Q

What are the effects of haemochromatosis? (5)

A 
Liver cirrhosis.
Diabetes.
Pigmented skin.
Arthritis.
Cardiomyopathy.
37
Q

What is wilson’s disease?
Stain?
Effects? (3)
Rx?

A

Inborn error of copper metabolism.
Rhodanine stain (brown).
Cirrhosis, Kayser-Fleischer rings, ataxia.
Chelation.

38
Q

What are the physical signs of cirrhosis? (6)

A 
Ascites
Muscle wasting
Bruising
Gynaecomastia
Spider naevi
Caput medusa  (varies from umbilicals)
39
Q

What are the complications of portal hypertension? (3)

A

Splenomegaly – low platelets
Oesophageal varices – haemorrhage
Piles (perianal varices)

40
Q

What causes pre-sinusoidal portal hypertension? (3)

A

Portal fibrosis.
Sarcoid.
Schistosomiasis.

41
Q

What causes sinusoidal portal hypertension?

A

Cirrhosis.

42
Q

What causes post sinusoidal portal hypertension?

A

Hepatic vein thrombosis

= Budd Chiari syndrome

Clinical Pathology (66 decks)

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