Acute Liver Failure, Fulminant Hepatic Failure, Chronic Liver disease Flashcards
Antibiotics that can cause acute liver failure
NSAID, co-amoxiclav, flucloxacillin
Remember penicillin and ‘fat burner’ and ‘protein powders’ can also cause drug induced liver disease
Pathology of chronic liver disease
Recurrent inflammation and repair with fibrosis and regeneration
What can chronic liver disease progress to?
Cirrhosis
What can methotrexate cause?
Cirrhosis/liver disease
Methotrexate is used to treat cancers
What is described as having a two hit paradigm?
Non alcoholic fatty liver
First Hit-excess fat acculumation
Second Hit-intrahepatic oxidative stress, lipid peroxidation, TNF-alpha, cytokine cascade
Who is most commonly affected by primary biliary cirrhosis?
Middle aged women
PBC is T-cell mediated
(In autoimmune hepatitis, women are also more commonly affected than men)
Symptoms of primary biliary cirrhosis
Usually asymptomatic but fatigue, itch without rash, xanthelasma, xanthoma
Urseo doxycholic acid used to treat what?
Primary biliary cirrhosis
Raised IgM or IgG in PBC?
Raised IgM in PBC. Raised IgG is more characteristic of hepatitis.
Interface hepatitis?
Autoimmune hepatitis!!
Oxyphenistatin, methyldopa, nitrofurantoin, diclofenac, minocycline and statins may trigger what kind of hepatitis?
Autoimmune hepatitis
“the bronzed diabetic”
Haemochromatosis
- Cirrhosis
- Cardiomyopathy
- Pancreatic insufficiency
Signs of Wilson’s Disease
Neurological: chorea-atheitoid movements
Hepatic: Cirrhosis or sub-fulminant liver failure
Kaiser Fleisher rings
Treatment: copper chelation drugs
Clinical signs of Alpha 1 anti trypsin deficiency
Lung emphysema
Mutant protein deposited in liver
(treatment is supportive)
Protein C or S deficiency leads to a what tendency?
Thrombotic tendency
Congenital Webs (protein C/S deficiency)
Budd Chiari
What is methotrxate used to treat?
Rheumatoid arthritis and psoriasis
can cause liver fibrosis
Problems with methotrexate?
Can cause liver fibrosis
Treatment: Stop the treatment
Loss of function or a mutation in caeruloplasmin could lead to what?
Wilson’s disease
Acetoaminophen toxicity could lead to what?
Acute liver failure
What kind of jaundice may be seen in pregnant women?
Hepatic jaundice
Macronodular or microdnodular cirrhosis associated with alcoholic?
Micronodular
Cause of spider naveii and gynaecomastia
Hyperestrogenism
Cause of purpura and bleeding in liver failure
Reduced production of clotting factors
Why is infection common in liver failure?
Reduced Kupffer cell number and function
What is manifested by the production of Mallory’s hyalin?
Alcoholic liver disease
Hepatitis C virus type 3 could cause what?
Fatty liver (diabetes could do this also)
Mallory bodies seen in what?
Alcoholic hepatitis
What can be seen in alcoholic fibrosis?
Collagen
What could you use to stain a liver to see alcoholic cirrhosis?
Massons trichrome
Ebstein virus could cause what?
Viral hepatitis
Yellow fever virus could cause what?
Viral hepatitis
Herpes simplex virus could cause what?
Viral hepatitis
Cytomegalovirus could cause what?
Viral hepatitis
Delta agent could cause what?
Viral hepatitis
Delta agent is hepatitis D LOL
Piecemeal necrosis seen in what?
Hepatitis
What is a council man body?
A hepatocyte undergoing apoptosis
Antibodies in primary biliary cirrhosis?
Autoantibodies to mitochondria
Chronic portal inflammation
Bile ducts inflamed
Granulomas around duct…?
Primary biliary cirrhosis
Autoimmune hepatitis more common in males or females?
Females
PBC also more common in females
Antibodies to smooth muscle, nuclear or LKM seen in what?
Autoimmune hepatitis
Raised IgG as well and numerous plasma cells
What is primary sclerosing cholangitis associated with?
Ulcerative colitis
Onion-skinning fibrosis?
Primary sclerosing cholangitis
Method of inheritance of Haemochromatosis?
Autosomal recessive
Worse in homozygotes, men
What does haemochromatosis predispose to?
Maignancy (hepatocellular carcinoma)
Also causes diabetes, cardiac failure and impotence
Perls stain confirms what?
Iron!
Where does copper accumulate in Wilson’s disease?
Liver and brain (basal ganglia)
What does Wilson disease cause?
Chronic hepatitis and neurological deterioration
What does alpha-1 anti-trypsin deficiency cause?
Emphysema AND cirrhosis
“Cytoplasmic globules of unsecreted globules of protein in liver cells”
Alpha-1 anti-trypsin deficiency
What is a hepatoma?
Hepatocellular carcinoma
Paracetemol in liver disease, gutathione stores?
Reduced
P4502E1 in alcoholics?
Increased
