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Pathology > Chemical Pathology - Liver Disease CPC > Flashcards

Chemical Pathology - Liver Disease CPC Flashcards

1
Q

what does the portal triad consist of?

A

artery
vein
bile duct

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2
Q

what is the space of disse?

A

spaces between hepatocytes and endothelium of sinusoids

blood comes into contact with liver enzymes

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3
Q

what causes zone 1 damage (periportal)?

A

directly hepatoxic substances

damage to zone 1 makes ALP rise more due to close proximity to bile duct

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4
Q

what causes zone 3 damage (centrilobular)?

A 
hypoxic damage (blood lost quite a lot of O2 by time it passes through zones 1 and 2)
metabolised hepatotoxic substances (zone 3 = most metabolically active cells in liver)
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5
Q

where does bilirubin conjugate?

A

as passes through liver

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6
Q

what are the causes of a high bilirubin?

A
  • pre-hepatic (unconjugated) –> haemolysis
  • hepatic (look at LFTs)
  • post-hepatic (obstructive jaundice)
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7
Q

how do you measure the fractions of bilirubin?

A

Van den bergh reaction

  • DIRECT: conjugated bilirubin
  • INDIRECT: add methanol, reaction completed and allows you to measure total bilirubin
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8
Q

what causes paediatric jaundice?

A

NORMAL
caused by liver immaturity
unconjugated bilirubinaemia

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9
Q

how do you treat paediatric jaundice?

A

phototherapy

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10
Q

inheritance pattern of Gilbert’s

A

autosomal recessive

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11
Q

what can improve jaundice in Gilbert’s?

A

phenobarbital

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12
Q

what is the pathophysiology of Gilbert’s?

A

decreased UDP glucuronyl transferase activity

unconjugated bilirubin is tightly bound to albumin so does not enter urine

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13
Q

what does the presence of urobilinogen tell you?

A

enterohepatic circulation is intact
urobilinogen is always present in urine of normal people
bilirubin –> biliary tree –> into bowel –> bacteria convert it into stercobilinogen and urobilnogen
this is reabsorbed into circulation and you excrete it

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14
Q

what is the most representative function of liver function?

A

PT

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15
Q

what is the general rule about PT and paracetamol overdose?

A

if the PT is higher than the number of hours since the OD, pt should be transferred for transplant

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16
Q

what are the 3 ways that the function of the liver can be measured by?

A
  • albumin
  • clotting factors
  • bilirubin
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17
Q

what does high AST and ALT suggest? what if one is higher than the other?

A

AST and ALT high = hepatocyte damage
ALT > AST = other forms of hepatitis
AST > ALT = alcoholic hepatitis

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18
Q

what are the causes of abnormal LFTs?

A

Pre-hepatic: Gilbert’s, haemolysis
Hepatic: viral hepatitis, alcoholic hepatitis, cirrhosis
Post-hepatic: gallstones, pancreatic

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19
Q

causes of pre-hepatic jaundice

A

haemolysis

CHF

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20
Q

causes of hepatic jaundice

A 
liver failure
gilbert syndrome
crigler-naijar syndrome
viral hepatitis 
alcoholic hepatitis
PBC
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21
Q

causes of post-hepatic jaundice

A

obstruction of biliary tree

  • intraluminal: stones, strictures
  • luminal: mass, neoplasm, inflammation (PSC/PBC)
  • extra-luminal: pancreatic Ca, cholangiocarcinoma
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22
Q

what are the features of hepatitis?

A
  • fever
  • jaundice
  • raised ALT/AST
23
Q

how is Hep A transmitted?

A
  • faeco-oral (food, men-on-men sex)

- contaminated water, recent shellfish

24
Q

how does Hep A present? time period?

A

acute: asymptomatic OR nausea, D+V, fever, jaundice, RUQ pain
onset: 2-6 weeks, symptoms last 8 wees
infectious when asymptomatic

25
Q

how do the antibodies respond in Hep A?

A
  1. viral titres start to drop
  2. get a rise in IgM antibodies, become unwell with jaundice
  3. if you survive initial few weeks, produce IgG antibodies
  4. this point onwards, cured and immune
26
Q

how do you treat Hep A?

A

supportive
avoid alcohol
Vaccine (Havrix) - contaisn some Hep A antigens

27
Q

what are the routes of infection of Hep B?

A
  • sex
  • vertically (mother to child)
  • blood products
28
Q

how does Hep B infection normally present?

A

normally acute presetnation
chronic infection follows in 10%
hepatitis symptoms: fever, jaundice, N+V, RUQ pain

29
Q

what are the 2 main antigens measured in Hep B?

A

HBsAg
HBeAg (highly infectious)
after these antigens go down, you can detect antibodies against
end with 3 antibodies and no antigens

30
Q

what will be seen in the blood if you have been vaccinated against Hep B?

A

vaccine contains HBsAg

if vaccinated, you will have anti-HVs but no HBeAg or anti-HBe

31
Q

what will chronic carriers have?

A

chronic carriers never clear the HBsAg

but infectivity decreases with time

32
Q

what is the tx of Hep B?

A

acute - supportive

chronic - anti-viral therapy

33
Q

what can HBV and HCV be associated with?

A
  • hepatocellular carcinoma

- history of thalassaemia –> blood transfusions

34
Q

what are the features of HCV?

A
  • blood products spread

- normally asymptomatic leading to chronic infection

35
Q

what is important to remember about Hep D?

A

requires co-infection with Hep B to invade liver cells

36
Q

how is Hep E transmitted?

A
  • faecal oral (food, men on men sex)
  • shellfish
  • uncooked pork
37
Q

how does Hep E present?

A

asymptomatic OR nausea, D+V, fever, jaundice, RUQ pain
onset = 2-6 weeks
symptoms = 8 weeks

38
Q

who has an increased risk for Hep E?

A

expectant mothers

immunocompromised patients

39
Q

what is the histology of alcoholic hepatitis?

A
  • too much alcohol = fat deposit in liver = reversible
  • if alcohol abuse continues = alcoholic hepatitis (neutrophils will infiltrate liver)
  • when hepatocytes get damages, see balloon cells containing mallory hyaline
40
Q

defining histological features of alcoholic hepatitis

A
  • liver cell damage
  • inflammation
  • fibrosis
  • fatty change
  • megamitochondria
41
Q

what are the different differential diagnoses for fatty liver disease?

A
  • NASH (looks like alcoholic hepatitis)
  • alcoholic hepatitis
  • malnourishment (Kwashiorkor)
42
Q

what are the treatments for alcoholic hepatitis?

A
  • supportive
  • stop alcohol
  • occasionally steroids
  • nutrition
  • Vits (B1 and thiamine)
43
Q

what happens if alcohol is stopped?

A
  • liver can regenerate
  • will heal in disorganised fashion
  • difficult for blood to flow through
  • inc BP
    = PORTAL HTN
44
Q

what are the features of chronic STABLE alcoholic liver disease?

A
  • palmar erythema
  • gynaecomastia
  • spider naevi (>5)
  • dupuytren’s contracture
45
Q

what are the features of portal HTN?

A
  • visible veins
  • ascites
  • splenomegaly
46
Q

what is liver failure defined as?

A
  • failed synthetic function
  • failed clotting factor and albumin production
  • failed clearance of bilirubin
  • failed clearance of ammonia (encephalopathy)
47
Q

what do nodules represent in fatty liver?

A

regenerating hepatocytes

48
Q

what are the sites of portosystemic anastomoses?

A
  • oesophageal varices
  • rectal varices
  • umbilical vein recanalizing
  • spleno-renal shunt
49
Q

what are the examination findings in obstructive jaundice?

A
  • jaundice
  • cachectic
  • palpable gall bladder
  • scratch marks (bile salts and acids that appear in blood stream when bile duct is blocked)
50
Q

how will your gallbladder present with gall stones?

A

small
fibrotic
non palpable

51
Q

different causes of micronodular vs macronodular hepatitis

A

micronodular: alcoholic hepatitis, biliary tract disease
macronodular: viral hepatitis, Wilson’s disease, A1AT

52
Q

antibodies in AI hepatitis

A

Type 1: ANA, anti-SMA, anti-actin Ig, anti-soluble liver antigen Ig
Type 2: anti-LKM Ig

53
Q

what scoring system is used to calculate prognosis in liver cirrhosis?

A

modified Child Pugh Score

Pathology (21 decks)

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