7.1 Liver Pathology 1 Flashcards
What are the 3 main functions of the liver
storage
synthetic
metabolic
what is stored in the liver?
glycogen
vitamins
iron
copper
what is synthesised in the liver
glucose lipids/cholesterol bile clotting factors albumin
what is metabolised in the liver?
bilirubin ammonia drugs alcohol carbohydrate lipids
What is decompensated liver disease?
Acute liver failure with no previous history of liver pathology
what can cause acute liver failure?
alcohol
paracetamol
viral - EBV, CMV, Hepatitis
Medications
what are symptoms of liver disease?
jaudice
oedema/ascites
bleeding/easy bruising
confusion
why do patients with liver disease appear confused?
impaired ability to metabolise ammonia, hyperammonemia
what is cirrhosis?
permanent irreversible liver damage
what happens to the appearance of a liver with cirrhosis?
nodules on surface due to strict bands of fibrous tissue formed by repeated inflammation.
what are the 5 main differentials for liver cirrhosis?
drugs infection deposition of fat autoimmune other
what drugs cause cirrhosis?
medications (iatrogenic) - aspirin in children
alcoholic liver disease
paracetamol overdose
what is the difference between alcoholic liver disease and alcoholic hepatitis?
alcoholic liver disease can occur in week and may be reversible. Alcoholic liver disease can lead to Alcoholic hepatitis if not resolved.
Alcoholic hepatitis takes years to occur and is irreversible. Can see presence of inflammatory cells in liver and cirrhosis
what are the presenting symptoms of alcoholic liver disease?
hepatomegaly
fatty deposits on liver
what are the sings/symptoms of alcoholic heptitis?
RUQ pain, jaundice, hepatomegaly, ascites, oedema
what infections cause cirrhosis
Hep B
Hep C
EBV
whats the most common transmission route for Hep C in the UK?
Intravenous drug use
name 3 things that can be deposited in the liver?
copper
iron
fat
what 3 things can lead to fat accumulating in the liver
Alcoholic fatty liver
non-alcoholic fatty liver disease
non-alcoholic steatohepititis
What is non-alcoholic steatohepatitis?
deposition of fat in the liver leading to inflammation and cirrhosis
what is NAFLD
non-alcoholic fatty liver disease. deposition of fat in the liver, resulting from insulin resistance
What is hereditary haemochromatasis?
increase absorption of iron at the small intestine resulting in iron deposition in the liver. Increased risk of developing hepatocellular carcinoma. Autosomal recessive. Venesection
What is Wilsons disease?
decreased copper secretion from the biliary system into circulation. Increased deposition of copper in tissues. Decreased ceruloplasmin on blood test (seizures/CNS problems. Autosomal recessive
why does excessive alcohol consumption result in a fatty liver?
Increased acetyl-CoA production (from acetate) cannot be oxidised due to low NAD+ levels, increased synthesis of fatty acids and ketones. Fatty acids transformed to TAG as beta oxidation cant take place.
TAGs not transported due to lower lipoprotein synthesis in the liver. TAGs deposited on liver tissue resulting in a fatty liver
What autoimmune diseases cause cirrhosis?
autoimmune hepatitis
primary biliary cirrhosis
primary sclerosing cholangitis
what is PSC?
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.
What ‘other’ causes are there for cirrhosis?
alpha1 antitrypsin deficiency
glycogen storage disorders
budd chiari syndrome
how do we treat patients with alcohol dependence?
reduce alcohol intake. disulfiram. CBT
