Chronic liver disease

Question 1

What is chronic liver disease?

Answer 1

When it lasts for more than 6 months and can still present acutely.
End stage is almost always cirrhosis

Question 2

How is the progression of Chronic liver disease?

Answer 2

Recurrent Inflammation -> fibrosis -> repair and regeneration

Question 3

When does a patient with CLD present with symptoms of liver failure?

Answer 3

When the cirrhosis becomes decompensated

Question 4

How are stellate cells activated in hepatic fibrosis?

Answer 4

Stimulation neighboring cell types - sinusoidal endothelium, Kupffer cells, hepatocytes, platelets, and leukocytes
Kupffer cell - releases cytokines (TGF, RoS, MMP-9) which stimulate collagen synthesis

Question 5

What are the cytokines released by KUpffer cells which stimulate collagen synthesis in hepatic stellate cells?

Answer 5

TGF, MMP-9, RoS

Question 6

How is simple steatosis in NAFLD diagnosed and managed?

Answer 6

Diagnosis - Ultra sound
Management - Weight loss and exercise
Risks - increased cardio-vascular risks

Question 7

What is the pathogenesis of NAFLD?

Answer 7

1st hit - Excess fat accumulation
2nd hit - Intrahepatic oxidative stress
Lipid peroxidation
TNF-alpha, cytokine cascade (pro-inflammatory)

Question 8

What is the histopathology of NAFLD?

Answer 8

Maladaptive response to oxygen stress

Question 9

What are the risks, diagnosis and management of Non-alcoholic steato-hepatitis?

Answer 9

Risks - Progression to Cirrhosis
Diagnosis- On presentation with liver biopsy
Management - Weight loss and exercise, experimental treatments