Conditions of the Liver

Question 1

Time frame of acute vs chronic hepatitis?

Answer 1

Acute - <6mo
Chronic - >6mo

Question 2

Causes of acute hepatitis?

Answer 2

• Viral
• Alcohol/Drugs
• Ischaemia
• Pregnancy
• Autoimmune

Question 3

Which viral diseases can present with hepatitis?

Which are also found in chronic hepatitis?

Answer 3

Hep A, E, B, C and D (E is most common)

Also, CMV, EBV and HSV

Chronic hepatitis = Hep B and C

Question 4

What is Wilson’s disease?

Answer 4

Inhibited copper elimination, leading to build up in liver and can cause hepatitis.

Question 5

Causes of chronic hepatitis that aren’t seen in acute hepatitis

Answer 5

• Viral (Hep B and C)
• Drugs - methotrexate
• Primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC)
• Non-alcoholic fatty liver disease (NAFLD, major)

Question 6

Pathogenesis of hepatitis?

Answer 6

Inflammation causes hepatocyte (portal tract and lobular inflammation) damage and subsequent repair, leaving to fibrosis which may progress to cirrhosis.

Question 7

What are the two types of steatosis?

Answer 7

Steatosis = fatty liver

Macrovesicular steatosis - ONE vacuole filling cytoplasm of hepatocyte

Microvesicular steatosis - MULTIPLE small vacuoles filling cytoplasm of hepatocyte

Question 8

Which type of steatosis is more common?

Answer 8

MAcrovesicular > microvesicular

Question 9

Causes of macrovesicular vs microvesicular steatosis?

Answer 9

Macrovesicular:

• Alcohol
• Non-alcoholic steatohepatitis
• Hep C

Microvesicular:

• Pregnancy
• Congenital disorders

Question 10

Three types of cholestasis and the underlying causes behind the types?

Answer 10

Pre-hepatic

• Excess bilirubin

Intra-hepatic

• PBC
• PSC

Post-hepatic

• Extra-hepatic biliary obstruction, e.g. gall stones, tumours

Question 11

Histological features of cholestasis?

Answer 11

• Bile plugs
• Bile duct proliferation - liver tries to make bile ducts to clear it
• Fibrosis that leads to cirrhosis
• Cell death
• Inflammation

Question 12

What is cirrhosis of the liver?

Answer 12

Diffuse change in normal architecture by fibrous septa separating nodules of regenerating hepatocytes.

Cirrhosis is the end point of many cycles of inflammation followed by repair/fibrosis.

Question 13

Aetiologies of cirrhosis: (many)

Answer 13

• Alcohol/drugs
• Viral hepatitis
• Auto-immune hepatitis
• Wilson’s disease
• PBC, PSC

Question 14

Symptoms of cirrhosis?

Answer 14

• Abnormal LFTs
• Non-specific symptoms - abdominal pain, hepatomegaly, malaise
• Signs of liver failure

Question 15

Treatment of cirrhosis

Answer 15

REmove aetiological factor and supportive care while awaiting liver regeneration.

In bad cases - transplant.