Biliary Tract and Liver diseases

Question 1

What is liver cirrhosis?

Answer 1

Scarred shrunken liver microscopically as a result of chronic liver disease

Question 2

What is liver cirrhosis defined as histologically?

Answer 2

Presence of fibrous collagenous bands between nodules of hepatocytes

Question 3

What are the commonest causes of liver cirrhosis?

Answer 3

Alcohol
Obesity
Heb B + C

Question 4

Acute causes of chronic liver disease?

Answer 4

Drugs
Alcohol
Virus - Hep A,B,E, COVID
Vascular - Hepatic vein thrombosis (Budd chiari)
Ischaemic liver disease
Wilson's disease

Question 5

Chronic causes of liver disease

Answer 5

Alcohol
Fatty liver disease
AI disease - Hepatitis, primary biliary cirrhosis
Primary sclerosis cholangitis
Virus - Hep B+C
Haemochromatosis of Wilson's disease
A1AT deficiency

Question 6

what are the four stages of liver damage?

Answer 6

Normal
Fatty
Fibrosis
Cirrhosis

Question 7

What are the main symptoms of liver failure?

Answer 7

Jaundice (failure to clear bilirubin)
Coagulopathy (failure to produce clotting factors)
Hypoalbuminaemia (failure to produce protein)
Encephalopathy (Failure to get rid of toxins)
Ascites

Question 8

How are varices treated?

Answer 8

Endoscopic banding
Beta blockers
TIPSS (Trans intrahepatic portosystemic shunt)
Surgery (Venous shunts)

Question 9

How is bilirubin metabolised?

Answer 9

Unconjuguated bilirubin arises from heme breakdown in RBC
Then transported bound to albumin to liver -> conjugation by UDP glucuronyl transferase to bilirubin glucuronide.
Excreted via bile ducts to bowel -> converted to bacteria to be excreted in faeces as stercobilin or reabsorbed back into bood and excreted in urine as urobilin

Question 10

What are the main causes of jaundice?

Answer 10

Prehepatic (raised unconjuguated bilirubin) -> Haemolysis or Gilberts syndrome
Intrahepatic
Post hepatic

Question 11

How can chronic liver disease cause low platelets?

Answer 11

Chronic liver disease causes portal hypertension
This pushes more blood into spleen
Spleen traps and reduces number of platelets

Question 12

What are some signs that suggest chronic liver disease?

Answer 12

Spider naevi
Gynaecomastia
Ascities

Question 13

What is ascites?

Answer 13

Leakage of fluid out of portal blood vessels into peritoneal cavity

Question 14

What is portal hypertension?

Answer 14

Liver becomes inflamed, damaged or cirrhotic

Blood cannot enter and backs up into portal mesenteric system causing increased pressure

Question 15

What is intrahepatic jaundice?

Answer 15

The liver cannot clear bile

Question 16

What is hepatocellular jaundice and what liver markers are raised?

Answer 16

Inflammation of hepatocytes

Raised ALT/AST

Question 17

What are some causes of hepatocellular jaundice?

Answer 17

Viruses
Fat
Alcohol 
Drugs
Ischaemia
Inherited conditions

Question 18

What is cholestatic jaundice and what liver markers are raised?

Answer 18

Inflammation of cholangiocytes

Raised ALP/GGT

Question 19

What are some causes of cholestatic jaundice?

Answer 19

Primary biliary cirrhosis
Primary sclerosing cholangitis
Drugs
Sarcoidosis

Question 20

What cells line bile ducts?

Answer 20

Cholangiocytes

Question 21

What are the causes of post hepatic jaundice?

Answer 21

Stones
Strictures (Primary Sclerosing Cholangitis)
Worms
Pancreatic Ca
Gall bladder Ca
Cholangiocarcinoma

Question 22

What is primary sclerosing cholangitis strongly associated with (80%)?

Answer 22

Ulcerative colitis

Question 23

High ALT and AST could be caused by abnormal what?

Answer 23

Hepatocytes

Question 24

High ALP and GGT could be caused by abnormal what?

Answer 24

Cholangiocytes

Question 25

What would a high ALT suggest?

Answer 25

Viral, drug or ischaemic cause

Question 26

What should you consider with an isolated raised ALP (with normal GGT and transaminases)?

Answer 26

Bone cause | Check ALP isoenzymes, bone profile, vit D, pregnancy

Question 27

What could an isolated raised bilirubin suggest?

Answer 27

Gilbert's syndrome

Question 28

What would a full liver screen include?

Answer 28

Virus screen - Hep A,B,C,E AI Inherited causes - Wilsons, A1AT deficiency, Haemochromatosis USS liver

Question 29

What is Wilson's disease?

Answer 29

Failure to excrete copper - builds up in liver causing inflammation and cirrhosis Inherited condition

Question 30

Portal hypertension can cause hepatorenal failure. What is this?

Answer 30

Kidney failure secondary to liver failure | due to reduced blood flow to kidneys

Question 31

The causes of jaundice can be categorised into which three areas?

Answer 31

Pre-hepatic Intra-hepatic Post-hepatic

Question 32

What are the two causes of pre-hepatic jaundice?

Answer 32

Haemolysis - excessive RBC breakdown | Gilbert's - UDP glucuronyl transferase deficiency

Question 33

What does intrahepatic jaundice mean?

Answer 33

Inside liver | Hepatocytes cannot conjugate bilirubin so cannot be removed

Question 34

What does post hepatic jaundice mean?

Answer 34

Bilirubin has been conjugated but cannot be removed

Question 35

What clotting factors does the liver produce?

Answer 35

10 9 7 2

Question 36

What is primary sclerosing cholangitis?

Answer 36

Progressive course of cholestasis with inflammation and fibrosis of intrahepatic and extra hepatic bile ducts Causes duct narrowing

Question 37

What two cancers are patients with PSC at an increased risk of?

Answer 37

Bowel Ca due to UC | Cholangiocarcinoma

Question 38

What two enzymes do hepatocytes produce?

Answer 38

ALT | AST

Question 39

Alcohol causes AST to be more raised that what?

Answer 39

ALT

Question 40

What non-invasive investigation can be done to assess for fibrosis?

Answer 40

Fibroscan

Question 41

What is the greatest cause of needing a liver transplant in the UK?

Answer 41

Paracetamol overdose