Hepatic, biliary and pancreatic pathology

Question 1

Characteristics of cirrhosis

Answer 1

• fibrotic tissue replace healthy liver tissue due to long term liver damage => liver cannot function properly
  1. diffuse process
  2. regenerative nodules separated by fibrous septa
  3. dynamic and bidirectional
  4. a spectrum of advanced liver disease (ascites, bleeding varices, encephalopathy)

Question 2

How to assess cirrhosis severity

Answer 2

Child-Pugh score (A, B, C) - higher points = higher severity
- parameters (ABCDE)
-> Albumin
-> Bilirubin
-> Clotting profile
-> Distended abdomen
-> Encephalopathy

Question 3

Cirrhosis classification based on appearance

Answer 3

• macronodular (>3mm) : viral hepatitis
• micronodular (<3mm) : alcohol fatty liver disease, hereditary hemochromatosis

Question 4

Name causes of cirrhosis

Answer 4

1. Infective: virus - HBV, HCV, HBV + HDV
2. metabolic
   - alcohol liver disease
   - non alcoholic fatty liver disease/ steatohepatitis (NAFLD/ NASH)
   - hereditary hemochromatosis/ Wilson’s disease/ AIAT deficiency
   - drug/ toxin related
3. immune related (all autoimmune)
   - AIH
   - primary biliary cholangitis (only affect intrahepatic bile ducts)
   - primary sclerosing cholangitis (affect both intra and extrahepatic bile ducts)
4. chronic biliary obstruction (secondary biliary cirrhosis)
5. Idiopathic (cryptogenic cirrhosis)c

Question 5

Name metabolic causes of cirrhosis

Answer 5

• alcohol liver disease
• non alcoholic fatty liver disease/ steatohepatitis (NAFLD/ NASH)
• hereditary hemochromatosis/ Wilson’s disease/ AIAT deficiency
• drug/ toxin related