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GI Histology & Pathology > Cirrhosis and Portal Hypertension > Flashcards

Cirrhosis and Portal Hypertension Flashcards

1
Q

Chronic hepatitis refers to

A

Chronic viral hepatitis (B and C) and autoimmune hepatitis

not synonymous with chronic liver disease

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2
Q

Chronic liver disease refers to

A
  • chronic hepatitis (B, C, AIH)
  • NASH
  • alcoholic liver disease (SH, pericellular fibrosis)
  • metabolic diseases (Wilson’s/copper, haemachromatosis/iron)
  • chronic inflammatory diseases of bile ducts
    • primary sclerosing cholangitis
    • primary biliary cirrhosis
  • drugs
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3
Q

What are the common features of diseases causing chronic liver disease?

A
  • chronic inflammation (pattern differs)
  • fibrosis that can lead to cirrhosis (progression varies eg AIH 5 years un-dx)
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4
Q

Steatohepatitis characterizes what conditions?

A
  • acute alcoholic hepatitis
  • chronic alcoholic liver disease
  • NASH
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5
Q

What are the elements of steatohepatitis?

A
  • macrovesicular steatosis
  • hepatocelluar ballooning
  • mallory bodies
  • inflammation
  • varying degrees of pericellular/chicken wire fibrosis
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6
Q

What is the difference between acute alcoholic hepatitis and chronic alcoholic liver disease?

A
  • in acute alcoholic hepatitis hepatocellular injury is more severe
    • more Mallory bodies, more neutrophils
    • pt presents with acute hepatitis
  • chronic alcoholic liver disease is a more dialed down process of the disease
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7
Q

Presentation of acute hepatitis is not related to what condition?

A

NASH does not produce acute hepatitis; severe of hepatocellular injury is uncommon in NASH

presentation of acute hepatitis + steatohepatitis on biopsy = ASH

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8
Q
A

D - lobular dissaray and apoptotic bodies

significant ALT elevation, less than 6mo duration and no previous hx = acute

likely caused by hep A

(coagulative necrosis is paracetamol/toxicity and there is no biliary obstruction on ultrasound)

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9
Q
A

A - some degree of periportal fibrosis

chronic hepatitis due to HCV

C could be an additional consideration with further history investigation

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10
Q

What is cirrhosis?

A
  • nodules of regenerating hepatocytes surrounded by bands of fibrous scar tissue
  • diffuse disease: involves the whole liver
  • irreversible; only cure is transplantation
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11
Q

What are the causes of cirrhosis in adults?

A
  • alcoholic liver disease
  • NASH
  • chronic viral hepatitis B and C (300, 000 Australians)
  • AIH
  • chronic biliary disease
  • metabolic diseases (wilson’s, haemochromatosis, a1-antitrypsin deficiency)
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12
Q

What is the pathogenesis of cirrhosis?

A
  • stellate cells (VitA storage) in space of Disse (btw sinusoid & hepatocyte) are
  • chronic/persistant apoptosis and inflammation causes release of cytokines rom Kupffer cells
  • cytokines activate stellate cells; have myofibroblast phenotype - contract & produce collagen
  • also get remodeling of the liver vascular supply (causes ischaemia important in progression of cirrhosis in later stages)
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13
Q

What complications in cirrhosis are due to parenchymal liver failure?

A
  • hepatic encephalopathy (+circulation of GABA-like inhibitory peptides that are normally removed by the liver)
  • coagulopathy - decreased clotting factors produced in liver
  • hypoalbuminaemia - decreased albumin production in liver
  • portal hypertension
  • jaundice
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14
Q

What complications of cirrhosis are due to secondary endocrine disturbances?

A
  • gynaecomastia
  • spider naevi
  • testicular atrophy
  • feminization of hair patterns
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15
Q

What complications of cirrhosis are due to portal hypertension?

A
  • 3 major clinical features:
    • ascites
    • splenomegaly (causing thrombocytopaenia)
    • formation of varices at portosystemic anastamoses
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16
Q

What are the clinical signs of chronic liver disease?

A
  • jaundice
  • hepatomegaly
  • splenomegaly (due to portal hypertension; causes thrombocytopaenia)
  • ascites (portal hypertension and low serum albumin)
  • caput medusae/abdominal wall collaterals
  • skin telangiectasia (spider naevi)
  • palmar erythema
  • gynaecomastia
  • testicular atrophy (mainly alcoholic cirrhosis and haemachromatosis)
  • digital clubbing
  • dupuytrens contractures
  • asterixis (metabolic flap)
17
Q

The greatest risk of hepatocellular carcinoma is seen in cirrhosis due to

A
  • alcohol
  • chronic viral hepatitis B and C
  • haemochromatosis
18
Q

How is hepatocellular carcinoma (hepatoma) related to cirrhosis?

A
  • majority of primary liver cell carcinomas occur in cirrhosis pt
    • risk related to cause of cirrhosis in addition to cirrhosis itself
  • secondary metastatic carcinoma of the liver is extremely rare in cirrhosis
19
Q

Multiple lesions in a cirrhotic liver is

A

multi-focal hepatocellular carcinoma

secondary metastases are exceptionally rare in cirrhotic livers

20
Q

What defines portal hypertension?

A
  • absolute increase in portal venous BP (>8mmHg), or
  • increase in pressure gradient between the portal ven and the hepatic vein of 5mmHg or more
21
Q

What are the causes of portal hypertension?

A
  • pre-sinusoidal: portal vein thrombosis
  • intra-hepatic/sinusoidal: cirrhosis
  • post-sinusoidal: thrombosis or occlusion of hepatic veins (Budd-Chiari syndrome); high risk in women post-partum or taking synthetic estrogens
22
Q

What are the 4 factors that contribute to portal hypertension in cirrhosis?

A
  1. increased blood flow through splanchnic vascular bed increases portal flow and stimulates contraction of vascular smooth muscle and stellate cells (even before fibrosis has advanced)
  2. hepatic vein is compressed by regenerating nodules, increasing resistance to flow through the liver
  3. small portal vein branches become trapped, distorted, and destroyed by scar tissue - obliterated small portal veins
  4. shunts opening up between branches of hepatic artery and portal vein (arteriovenous anastamoses) in fibrous septa
23
Q

What are the main sites of porto-systemic anastomoses in cirrhosis?

A
  • oesophagus
  • rectum
  • umbilicus
24
Q

What is the most important site of varices in portal hypertension?

A
  • oesophagus; extremely common (cirrhosis pt screened for them)
  • treated prophylactically bc prone to cataustrophic bleeding

GI Histology & Pathology (7 decks)

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