Acute Liver Failure, Fulminant Hepatic Failure, Chronic Liver disease

Question 1

Antibiotics that can cause acute liver failure

Answer 1

NSAID, co-amoxiclav, flucloxacillin

Remember penicillin and ‘fat burner’ and ‘protein powders’ can also cause drug induced liver disease

Question 2

Pathology of chronic liver disease

Answer 2

Recurrent inflammation and repair with fibrosis and regeneration

Question 3

What can chronic liver disease progress to?

Answer 3

Cirrhosis

Question 4

What can methotrexate cause?

Answer 4

Cirrhosis/liver disease

Methotrexate is used to treat cancers

Question 5

What is described as having a two hit paradigm?

Answer 5

Non alcoholic fatty liver
First Hit-excess fat acculumation
Second Hit-intrahepatic oxidative stress, lipid peroxidation, TNF-alpha, cytokine cascade

Question 6

Who is most commonly affected by primary biliary cirrhosis?

Answer 6

Middle aged women
PBC is T-cell mediated
(In autoimmune hepatitis, women are also more commonly affected than men)

Question 7

Symptoms of primary biliary cirrhosis

Answer 7

Usually asymptomatic but fatigue, itch without rash, xanthelasma, xanthoma

Question 8

Urseo doxycholic acid used to treat what?

Answer 8

Primary biliary cirrhosis

Question 9

Raised IgM or IgG in PBC?

Answer 9

Raised IgM in PBC. Raised IgG is more characteristic of hepatitis.

Question 10

Interface hepatitis?

Answer 10

Autoimmune hepatitis!!

Question 11

Oxyphenistatin, methyldopa, nitrofurantoin, diclofenac, minocycline and statins may trigger what kind of hepatitis?

Answer 11

Autoimmune hepatitis

Question 12

“the bronzed diabetic”

Answer 12

Haemochromatosis

• Cirrhosis
• Cardiomyopathy
• Pancreatic insufficiency

Question 13

Signs of Wilson’s Disease

Answer 13

Neurological: chorea-atheitoid movements
Hepatic: Cirrhosis or sub-fulminant liver failure
Kaiser Fleisher rings
Treatment: copper chelation drugs

Question 14

Clinical signs of Alpha 1 anti trypsin deficiency

Answer 14

Lung emphysema
Mutant protein deposited in liver
(treatment is supportive)

Question 15

Protein C or S deficiency leads to a what tendency?

Answer 15

Thrombotic tendency

Question 16

Congenital Webs
(protein C/S deficiency)

Answer 16

Budd Chiari

Question 17

What is methotrxate used to treat?

Answer 17

Rheumatoid arthritis and psoriasis

can cause liver fibrosis

Question 18

Problems with methotrexate?

Answer 18

Can cause liver fibrosis

Treatment: Stop the treatment

Question 19

Loss of function or a mutation in caeruloplasmin could lead to what?

Answer 19

Wilson’s disease

Question 20

Acetoaminophen toxicity could lead to what?

Answer 20

Acute liver failure

Question 21

What kind of jaundice may be seen in pregnant women?

Answer 21

Hepatic jaundice

Question 22

Macronodular or microdnodular cirrhosis associated with alcoholic?

Answer 22

Micronodular

Question 23

Cause of spider naveii and gynaecomastia

Answer 23

Hyperestrogenism

Question 24

Cause of purpura and bleeding in liver failure

Answer 24

Reduced production of clotting factors

Question 25

Why is infection common in liver failure?

Answer 25

Reduced Kupffer cell number and function

Question 26

What is manifested by the production of Mallory's hyalin?

Answer 26

Alcoholic liver disease

Question 27

Hepatitis C virus type 3 could cause what?

Answer 27

``` Fatty liver (diabetes could do this also) ```

Question 28

Mallory bodies seen in what?

Answer 28

Alcoholic hepatitis

Question 29

What can be seen in alcoholic fibrosis?

Answer 29

Collagen

Question 30

What could you use to stain a liver to see alcoholic cirrhosis?

Answer 30

Massons trichrome

Question 31

Ebstein virus could cause what?

Answer 31

Viral hepatitis

Question 32

Yellow fever virus could cause what?

Answer 32

Viral hepatitis

Question 33

Herpes simplex virus could cause what?

Answer 33

Viral hepatitis

Question 34

Cytomegalovirus could cause what?

Answer 34

Viral hepatitis

Question 35

Delta agent could cause what?

Answer 35

Viral hepatitis | Delta agent is hepatitis D LOL

Question 36

Piecemeal necrosis seen in what?

Answer 36

Hepatitis

Question 37

What is a council man body?

Answer 37

A hepatocyte undergoing apoptosis

Question 38

Antibodies in primary biliary cirrhosis?

Answer 38

Autoantibodies to mitochondria

Question 39

Chronic portal inflammation Bile ducts inflamed Granulomas around duct...?

Answer 39

Primary biliary cirrhosis

Question 40

Autoimmune hepatitis more common in males or females?

Answer 40

Females | PBC also more common in females

Question 41

Antibodies to smooth muscle, nuclear or LKM seen in what?

Answer 41

Autoimmune hepatitis | Raised IgG as well and numerous plasma cells

Question 42

What is primary sclerosing cholangitis associated with?

Answer 42

Ulcerative colitis

Question 43

Onion-skinning fibrosis?

Answer 43

Primary sclerosing cholangitis

Question 44

Method of inheritance of Haemochromatosis?

Answer 44

Autosomal recessive | Worse in homozygotes, men

Question 45

What does haemochromatosis predispose to?

Answer 45

Maignancy (hepatocellular carcinoma) | Also causes diabetes, cardiac failure and impotence

Question 46

Perls stain confirms what?

Answer 46

Iron!

Question 47

Where does copper accumulate in Wilson's disease?

Answer 47

Liver and brain (basal ganglia)

Question 48

What does Wilson disease cause?

Answer 48

Chronic hepatitis and neurological deterioration

Question 49

What does alpha-1 anti-trypsin deficiency cause?

Answer 49

Emphysema AND cirrhosis

Question 50

"Cytoplasmic globules of unsecreted globules of protein in liver cells"

Answer 50

Alpha-1 anti-trypsin deficiency

Question 51

What is a hepatoma?

Answer 51

Hepatocellular carcinoma

Question 52

Paracetemol in liver disease, gutathione stores?

Answer 52

Reduced

Question 53

P4502E1 in alcoholics?

Answer 53

Increased