Hepatic

Question 1

6 Functions of the Liver

Answer 1

1) Metabolism including drug metabolism
2) Protein Synthesis
3) Storage
4) Hormone metabolism
5) Bile Synthesis
6) Immune function

Question 2

Clinical Features of Hepatic adenoma

Answer 2

Benign
Associated with OCP
Abdo pain, intraperitoneal bleeding

Question 3

Clinical features of Haemangioma

Answer 3

Benign
Most common benign lesion
No treatment

Question 4

Causes of Hepatocellular Carcinoma

Answer 4

Hepatitis B + C, Alcoholic cirrhosis

Question 5

Clinical Features of Cholangiocarcinoma

Answer 5

Adenocarcinomas arising from bile ducts
Can be intra or extrahepatic
poor prognosis

Question 6

7 Major causes of cirrhosis

Answer 6

1) Alcoholic liver disease
2) Non-alcoholic fatty liver disease
3) Chronic viral hepatitis (Hep B +/- D and C)
4) Autoimmune hepatitis
5) Biliary causes: Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis
6) Genetic causes : Wilson’s disease, Glycogen storage diease
7) Drugs: Methotrexate

Question 7

Classification of Cirrhosis and causes

Answer 7

Micronodular (less than 3mm) - alcoholic hepatits, biliary tract disease
Macronodular (greater than 3mm) - Viral hepatitis, Wilsons

Question 8

Pathology of Cirrhosis

Answer 8

Chronic inflammation causes activation of stellate cells that are usually quiescent.
This initiates fibrosis via deposition of collagen in the spaces of Disse
Constricting sinusoids cause increasing vascular resistance

Question 9

Portal Hypertension - Causes

Answer 9

Prehepatic - Portal vein thrombosis
Hepatic - Primary biliary cirrhosis, sarcoid, cirrhosis, veno-occlusive diease
Posthepatic - Budd Chiari syndrome = occlusion of hepatic vein

Question 10

3 types of Alcoholic Liver Disease and the characteristiscs

Answer 10

1) Hepatic Steatosis (fatty liver) - Large, pale, yellow and greasy liver —Reversible
2) Alcoholic Hepatitis - Large, fibrotic liver —Mallory Bodies
3) Alcoholic Cirrhosis - Yellow-Tan, fatty, enlarged. Transforms into shrunken, non-fatty, brown organ.

Question 11

Autoimmune Hepatitis - who gets it? Types?

Answer 11

Common with other autoimmune diseases
78% female - young and postmenopausal
Associated with HLA-DR3
Type 1 - ANA 
Type 2 - Anti-LKM Ig

Question 12

Biliary causes of cirrhosis

Primary Biliary Cirrhosis (PBC) - what is it? who gets it? buzz words?

Answer 12

Autoimmune inflammatory destruction of medium sized intrahepatic bile ducts, Slow devo
10 times more common in women
increased serum ALP and cholesterold
Anti-mitochondrial antibodies seen in over 90per cent of women
USS shows no bile duct dilation

Question 13

Biliary causes of cirrhosis

Primary Sclerosing Cholangitis (PSC) - what is it? who gets it? buzz words?

Answer 13

Inflammation and obliterative fibrosis of extrahepatic and intrahepatic bile ducts.
more common in men, 40-50 years old
Associated with IBD especially UC
USS - bile duct dilation
ERCP shows beading of bile ducts

Question 14

Genetic causes of Cirrhosis

Haemochromatosis - age? inheritance? Histology? Signs/symptoms?

Answer 14

40-50 years old
Autosomal recessive
Fe deposits in liver (Prussian blue stain)
Skin bronzing, Diabetes, Hepatomegaly

Question 15

Genetic causes of Cirrhosis

Wilson’s Disease - age? inheritance? Histology? Signs/symptoms?

Answer 15

11-14 years old
Autosomal recessive
Cu deposits, stains with Rhodanine stain
Liver disease, Neuro disease, Kayser Fleischer rings