Cirrhosis & Portal Hypertension

Question 1

what’s the main difference histologically between acute and chronic alcoholic hepatitis?

Answer 1

acute: hepatocytes are more damaged and have more Mallory bodies and neutrophils

Question 2

NASH looks acute or chronic?

Answer 2

looks more chronic, not crazy severe cellular injury

Question 3

what are the elements of stetohepatitis? 5 things

Answer 3

macrovesicular steatosis
hepatocellular balooning
Mallory bodies
inflamm
pericellular fibrosis

Question 4

a previously well 25 year old male returns from a medical elective in India with acute onset of jaundice and anorexia. On examination he has mild hepatic enlargement and right upper quadrant tenderness. LFTs show SBR 350, ALT 1300. U/S show no bile duct dilatation, liver biopsy most likely to show the following:
A. Coagulative Necrosis
B. evidence of parasitic infection
C. changes consistent with biliary obstruction
D. Lobular disarray and apoptotic bodies?

Answer 4

Lobular disarray and apoptotic bodies

Question 5

a 55 year old barrister is investigated with fatigue and loss of libido. He denies significant alcohol consumption but admits to a period of experimentation ith IVDU while at Uni. LFTs: ALT is 230. HCVAb is positive. Biopsy shows:
A. some degree of periportal fibrosis
B. Panlobular disarray with apoptosis
C. Mallory Bodies
d. Necrosis in acinar zone 1

Answer 5

A. some degree of periportal fibrosis

Question 6

Can you have heart Cirrhosis?

Answer 6

Nope. Only Liver dude.

Question 7

what is the abnormal anatomy of liver cirrhosis?

Answer 7

nodules of regenerating hepatocytes surrounded by bands of fibrous scar tissue

Question 8

features of liver cirrhosis: 2:

Answer 8

diffuse

irreversible

Question 9

only cure for cirrhosis?

Answer 9

liver transplant

Question 10

What kind of fibrosis with chronic Hep cirrhosis?

Answer 10

peri-portal stage 4

Question 11

Adult causes of cirrhosis

7 biggies

Answer 11

Alcohol
Non-alcoholic steatohepatitis
Viral
Autoimmune
Chronic biliary
Metabolic: Wilson's
Drugs

Question 12

Cirrhosis is specific or non-specific?

Answer 12

Non-specific

Question 13

What do Quiescent stellate cells normally do? in cirrhosis?

Answer 13

Normally store vitamins

Cirrhosis: turn ‘myofibroblast’ due to cytokine activation

Question 14

Pathogenesis of cirrhosis? 3 things:

Answer 14

persistent hepatocyte apoptosis
fibrosis
remodelling

Question 15

why do you get coagulopathy with cirrhosis?

Answer 15

decrease liver production or proteins and splenomegaly leads to thrombocytopenia

Question 16

Does liver carcinoma usually metastasize?

Answer 16

exceptionally rare, can have multiple lesions

Question 17

3 greatest risks for hepatocellular carcinoma?

Answer 17

alcohol
Chronic viral Hep, B,C
Haemochromatosis

Question 18

Portal Vein accounts for how much of hepatic blood flow?

Answer 18

2/3rds

Question 19

how much pressure increase to get portal hypertension? Absolute vs. gradient?

Answer 19

Absolute: 8mm Hg

gradient of >5mm Hg between portal/hepatic veins

Question 20

3 places in liver that can cause portal hypertension?

Answer 20

presinusoidal (thrombosis)
sinusoidal (cirrhosis)
postsinusoidal (thrombosis, back pressure)

Question 21

Pathogenesis of portal hypertension: 4 things

Answer 21

hyperdynamic splanchnic flow
hepatic vein compression from regen nodules
portal veins distorted by scar tissue
shunts due to fibrous septa

Question 22

portal hypertension clinical consequences: 3 things:

Answer 22

splenic enlargement
ascites
varices (oesophagus, rectum(haemorrhoids), umbilicus, caput medusae)