case 5 - pathological overview of the liver

Question 1

what does bacteriology of the liver look for

Answer 1

sepsis in liver failure

Question 2

what is in the portal tracts in damaged liver

Answer 2

inflammatory cells
Damaged bile ductules
Fibrosis

Question 3

what is in the hepatocellular lobules in liver damage

Answer 3

near normal (but functionally less normal)
Inflammatory cells
Hepatocytes full of fat (steatosis)
Masses

Question 4

what happens to the portal tracts in hepatitis C

Answer 4

filled with lymphocytes and plasma cells
Making antibodies against the virus

Question 5

what does inflammation at the interface with the lobules cause

Answer 5

loss of hepatocytes

Question 6

what does bile ductule damage from hep c imitate

Answer 6

autoimmune liver disease

Question 7

what are features of hepatocellular parenchyma

Answer 7

inflammatory cells
Lymphocytes damaging hepatocytes
hepatocytes full of fat (steatosis)
Not sure why this happens
But the combination of alcohol and hepatitis C is really bad

Question 8

features of hep a

Answer 8

infectious
Epidemic
Oral-faecal transmission
2-6 weeks incubation period

Question 9

features of hep b

Answer 9

serum
Sporadic
Blood borne
Sexual transmission
6 weeks to 6 months incubation period

Question 10

features of hep c

Answer 10

transfusion related
Blood-borne transmission
2 weeks to 6 months incubation period

Question 11

features of hep d

Answer 11

Needs hepatitis B for disease

Question 12

features of hep e

Answer 12

very similar to HAV

Question 13

what is EBV

Answer 13

Epstein-Barr virus - glandular fever
infectious mononucleosis

Question 14

when is hepatitis chronic

Answer 14

after 6 months

Question 15

how is ethanol absorbed

Answer 15

Absorbed from upper small intestine, then via portal vein to liver
Rate of metabolism variable
Related to weight, gender and body fat
Enzymes can be induced, so tolerance increases

Question 16

what is the average elimination rate of ethanol

Answer 16

average elimination rate is 0.015g/dL/hr
From legal intoxication to undetectable takes about 5 hours
Alcoholic misusers may eliminate up to 0.05g/dL/hr
Post mortem production of alcohol up to 0.05g/dL/hr

Question 17

what does alcoholic liver disease lead to

Answer 17

fatty change - reversible
Alcoholic hepatitis - reversible
Pericellular fibrosis - reversible up to a point
Cirrhosis - irreversible

Question 18

what is Mallory’s hyaline

Answer 18

Mallory’s Hyaline - characteristic of alcoholic liver disease - cytoskeletal particles which have aggregated in the severely damaged hepatocytes

Question 19

what does non-alcoholic fatty liver disease lead to

Answer 19

fatty change
Non-alcoholic steatohepatitis (NASH)
Fibrosis
Cirrhosis

Question 20

what is cirrhosis

Answer 20

Disease of all of the liver with parenchymal nodules and surrounding fibrosis

Question 21

what is micronodular cirrhosis

Answer 21

Less than or equal to 0.3cm
Typically alcohol

Question 22

what is macronodular cirrhosis

Answer 22

Typically greater than or equal to 0.3cm
Typically viral

Question 23

what are the causes of cirrhosis

Answer 23

alcohol
Viruses
Especially HBV and HCV
The stain for HBsAg is orecin and IHC
Metabolic diseases
Iron, copper, glycogen storage disease, lipid disorders, alpha-one antitrypsin deficiency, haemachromatosis
Autoimmune
‘Lupoid’, young woman: anti-nuclear and anti-smooth muscle antibodies
Primary biliary cirrhosis: middle aged women, anti-mitochondrial antibodies

Question 24

what happens during liver failure

Answer 24

protein synthesis: low albumin
Coagulation factors: bleeding
Jaundice
Encephalopathy: confusion

Question 25

what are there raised levels of in hepatocellular carcinoma

Answer 25

There are raised serum alpha-fetoprotein levels in hepatocellular carcinoma