8: Aetiologies and pathophysiology of chronic liver disease

Question 1

What is chronic liver disease?

Answer 1

Liver disease lasting longer than 6 months which leads to cirrhosis

Question 2

What is the end-stage of chronic liver disease if untreated?

Answer 2

Cirrhosis

Question 3

What hepatic cells become activated to start fibrosis?

Answer 3

Hepatic stellate cells

Question 4

Lots of liver diseases are chronic.

What is the official definition of chronic liver disease?

Answer 4

A disease lasting > 6 months WHICH LEADS TO CIRRHOSIS

Question 5

What is NAFLD?

Answer 5

Non-alcoholic fatty liver disease

Question 6

Which diseases cause NAFLD?

Answer 6

Hypertension

Hyperlipidaemia

T2 diabetes

Obesity

Question 7

NAFLD / NASH is a fatty liver in the (presence / absence) of other causes.

Answer 7

absence

Question 8

What is NASH?

Answer 8

Non-alcoholic steatohepatitis

Fat in the liver AND inflammation

Question 9

Triglycerides are stored in pockets away from the mitochondria of hepatocytes (NAFLD). What happens when these triglycerides are exposed to oxidative stress?

Answer 9

NASH

non-alcoholic steatohepatitis, i.e inflammation

Question 10

How is NAFLD diagnosed?

Answer 10

Ultrasound / Liver biopsy if required

Question 11

How is NAFLD treated?

Answer 11

Weight loss

Exercise

Question 12

How is NASH diagnosed?

Answer 12

Liver biopsy

Question 13

The end stage of NASH is ___.

Answer 13

cirrhosis

Question 14

How is NASH treated?

Answer 14

Exercise and weight loss

Experimental drugs

Question 15

What type of liver disease is primary biliary cholangitis?

Answer 15

Autoimmune

Question 16

What tissue is affected by autoantibodies in PBC?

Answer 16

Biliary tree tissue

Question 17

Who tends to get PBC?

Answer 17

Middle aged women

Question 18

What are some symptoms of PBC?

Answer 18

Fatigue

Itch without rash

Xanthelasma / Xanthomas

Question 19

How is PBC treated?

Answer 19

Ursodeoxycholic acid

Question 20

PBC involves the immune system attacking the ___ ducts.

Answer 20

bile

Question 21

What is radical treatment for PBC?

Answer 21

Liver transplant

Question 22

Who tends to be affected by autoimmune hepatitis?

Answer 22

Young women

Question 23

How would autoimmune hepatitis be described by a pathologist?

Answer 23

Chronic hepatitis with piecemeal necrosis and lobular involvement

Question 24

What can trigger autoimmune hepatitis?

Answer 24

Viruses

Toxins

Drugs

Question 25

How is **autoimmune** **hepatitis** treated?

Answer 25

**Corticosteroids** (prednisolone) **Immunosuppressors** (azathioprine, steroid-sparer)

Question 26

Eventually, those with autoimmune hepatitis will go on to develop \_\_\_.

Answer 26

**cirrhosis** but 13-20% of patients have spontaneous resolution

Question 27

What is **primary sclerosing cholangitis**?

Answer 27

**Autoimmune disease of LARGE bile ducts** primary biliary cholangitis affects the small bile ducts

Question 28

What IBD is associated with **primary sclerosing cholangitis**?

Answer 28

**UC**

Question 29

What investigations are used to diagnose **primary sclerosing cholangitis**?

Answer 29

**MRCP** **ERCP**

Question 30

What is **haemochromatosis**?

Answer 30

**Autosomal recessive** disease of **iron overload**

Question 31

Patients with haemochromatosis lay down iron in their skin. What sign is associated with this?

Answer 31

**Bronzed skin**

Question 32

What are some complications of haemochromatosis?

Answer 32

**Cirrhosis** **Cardiomyopathy** **Pancreatic failure** **Bronze diabetics**

Question 33

Is **Wilson's disease** autosomal dominant or recessive?

Answer 33

**Autosomal recessive**

Question 34

Which copper-carrier loses its function in Wilson's disease?

Answer 34

**Ceruloplasmin**

Question 35

Which metal is deposited in the tissue in Wilson's disease?

Answer 35

**Copper**

Question 36

What are **Kaiser Fleisher** rings?

Answer 36

**Rings of copper in the eyes**

Question 37

What is the liver outcome of untreated Wilson's disease?

Answer 37

**Cirrhosis**

Question 38

alpha 1 anti-trypsin deficiency is another example of a chronic liver disease **lung emphysema**, **cirrhosis** slide doesn't make any sense

Question 39

What is **Budd-Chiari syndrome**?

Answer 39

**Thrombosis of hepatic veins** blood can't drain from the liver, causing cirrhosis

Question 40

What are the symptoms of Budd-Chiari syndrome?

Answer 40

**Jaundice** **Tender hepatomegaly** **Ascites**

Question 41

Which **immunosuppressant** is toxic to the liver and causes cirrhosis?

Answer 41

**Methotrexate**

Question 42

What is **cardiac cirrhosis**?

Answer 42

**Incompetent tricuspid valve causes backflow of blood to the liver** **Liver can't drain blood - cirrhosis**