Chempath 4: LIVER disease CPC Flashcards

1
Q

how are hepatocytes arranged

A

a trabeculae with sinusoids between them

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2
Q

what 3 vessels make up the portal triad

A

hepatic artery
bile duct
portal vein

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3
Q

describe the arrangement of endothelial cells in the liver

A

discontinuous
spaces between the hepatocytes and the endothelium of the sinusoids
so all blood comes into contact with all the liver enzymes
space = space of disse

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4
Q

describe the zones in between the portal tract and central vein

A

zone 1 - closest to the portal tract - highest oxygen concentration
zone 3 - most susceptible to hypogea, most metabolically active cells

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5
Q

how can fractions of bilirubin be measured

A

van den Bergh reaction (amount of conjugated bilirubin in blood)
add methanol - total bilirubin
difference = unconjugated bilirubin

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6
Q

how does phototherapy work

A

converts bilirubin into lumirubin and photobilirubin

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7
Q

what is Gilberts syndrome

A

AR
worsened by fasting
phenobarbital can reduce bilirubin levels
UDP glucuronyl transferase activity reduced to 30%
no bilirubinuria (bound tight to albumin)

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8
Q

what is a negative uribilinogen suggestive of

A

biliary obstruction

should always be in the urine of normal people

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9
Q

what is the best marker of liver function

A

PT
normal 12-14 s
extrinsic pw - I,II,V,VII,X

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10
Q

what is a marker of the livers synthetic function

A

albumin

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11
Q

when are ALP levels highest

A

biliary obstruction

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12
Q

describe key histological features in hepatitis

A

lots of cells containing fat
cells containing mallory hyaline (inclusion in cytoplasm of liver cells)
neutrophil polymorphs
alcoholic hepatitis –> balloon cells containing mallory hyaline
bile accumulation in the liver - blocked flow

  • liver cell damage, inflammation, fibrosis, fatty change, mega mitochondria
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13
Q

what might a collages stain show in hepatitis

A

pattern of collagen around liver cells

cirrhosis

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14
Q

DD in fatty liver disease

A

NASH
alcoholic hepatitis
malnourishment (kwashiorkor)

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15
Q

how does the liver regenerate after alcohol

A

produces lots of nodules

disorganised regeneration - rise in portal pressure

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16
Q

list features of chronic alcoholic liver disease

A

palmar erythema
spider nave
gynaecomastia (liver fails to break down estradiol)
dupuytrens contractures

17
Q

features of portal hypertension

A
caput medusae
splenomegaly 
scrotal oedema 
shifting dullness 
visible veins, ascites, splenomegaly 

later - flapping tremor (asterisks) = hepatic encephalopathy

18
Q

how is liver failure defined

A

failed synthetic function
failed clotting factor and albumin production
failed clearance of bilirubin
failed clearance of ammonia ( –> encephalopathy)

19
Q

list sites of porto-systemic anastamoses

A

oesophageal varices
rectal varices
umbilical vein reanalysing
spleen-renal shunt

20
Q

what are scratch marks a sign of

A

obstructive jaundice
only post-hepatic causes of jaundice make you itchy (gallstones, pancreatic cancer)
because of bile salts and bile acids

21
Q

what is courvoisiers law

A

if the gallbladder is palpable in a jaundiced patient, the cause is unlikely to be gallstones
(gallstones are painful)