Alcoholism, Alcoholic Liver Disease and Foetal Alcohol Syndrome

Question 1

How does cirrhotic liver appear macroscopically?

Answer 1

Nodular capsule surface

May be green due to cholestasis

Question 2

List some causes of cirrhosis

Answer 2

Alcoholic liver disease
NASH
Chronic viral hepatitis B and C
AI hepatitis
Chronic biliary disease
Metabolic (e.g. haemochromatosis, Wilson's, a1-antitrypsin deficiency)
Drugs (e.g. methotrexate)

Question 3

Describe the pathogenesis of cirrhosis

Answer 3

In chronic inflammation, stellate cells in the space of Disse become activated and express a myofibroblast phenotype
Active stellate cells deposit ECM, produce scar tissue
Inflammation also causes remodelling of vascular supply

Question 4

List the 3 major classifications of complications of cirrhosis and the symptoms resulting from each

Answer 4

Liver failure: hepatic encephalopathy, jaundice, coagulopathy, hypoalbuminaemia
Endocrine complications: gynaecomastia, spider naevi, testicular atrophy
Portal hypertension: oesophageal varices, splenomegaly, ascites

Question 5

What cancers are seen in cirrhosis?

Answer 5

Hepatocellular carcinoma

Very rare to get metastases in a cirrhotic liver

Question 6

What are the 3 causes of portal hypertension? Give examples

Answer 6

Pre-sinusoidal, e.g. portal vein thrombosis
Sinusoidal, e.g. cirrhosis
Post-sinusoidal, e.g. thrombosis of hepatic veins

Question 7

Describe the pathogenesis of portal hypertension in cirrhosis

Answer 7

Fibrosis causes contraction of smooth muscle and stellate cells
Hepatic vein compressed by nodules
Small portal vein branches trapped, narrowed and distorted by scar tissue
Hepatic arterial blood shunts into portal vein via arteriovenous anastamoses (remodelling) in fibrous septa