Histopath - liver disease CPC

Question 1

List as many causes of high bilirubin as you can

Answer 1

Gilbert's syndrome
Haemolysis
Bile duct obstruction
Viral hepatitis
Alcohol

Question 2

van den Bergh reaction - 2 types. what are they?

Answer 2

DIRECT reaction: measures conjugated Br

INDIRECT reaction: unconjug Br

Question 3

Which Br commonly raised in neonates and doesn’t cause any huge problems. Why does it rise?

Answer 3

Unconjugated Br.

Because the liver immaturity coupled with a fall in Hb early in life

Question 4

Weird Tx for neonates with jaundice? How does it work?

Answer 4

Phototherapy converts Br into LUMIRUBIN + PHOTOBILIRUBIN

–> these don’t need conjugation for excretion

Question 5

How is Gilbert’s inherited?

What % of us carry the gene?

Answer 5

Autosomal recessive

50%

Question 6

What is GIlebrts syndrome

Answer 6

UDP glucoronyl transferase activity is reduced by 30%

Question 7

What happens to the urine in Gilbert’s?

Answer 7

Unconjugated Br is tightly bound to albumin and therefore does NOT enter the urine

Question 8

Most representative blood test of liver function?

Answer 8

Prothrombin time

Question 9

35 yo 
Chronic EtOH intake, often appearing drunk in A&E
Nausea
Abdo pain
Jaundice

Ddx?

Answer 9

Alcoholic hepatitis
Viral hepatitis
Cirrhosis
Pancreatitis
Gall stones

Question 10

35 yo 
Chronic EtOH intake, often appearing drunk in A&E
Nausea
Abdo pain
Jaundice

ALP 200 (NR<130), AST 1500, ALT 750

Is it pre hepatic, hepatic or post hepatic?

Answer 10

Hepatic - ALP rise is marginal so hepatic is more likely

Question 11

HBV has 3 antigens which we commonly test for. What are they?

Answer 11

e, s and c

Question 12

Which HBV antigen is used for HBV immunisation?

Answer 12

s

Question 13

Which antibody is ONLY seen in someone that has had a primary infection (and not in those who’ve just been immunised?)

Answer 13

anti-HBe

Question 14

What do you suspect in someone with high levels of Anti-HBs and no Anti-HBe

Answer 14

healthy individual who has been immunised against HBV

Question 15

An individual who appears healthy but has high levels of HBs antigen?

Answer 15

an HBV carrier - they are infectious

Question 16

Mallory Denk bodies

Answer 16

Alcoholic hepatitis

Question 17

Defining histological features of alcoholic hepatitis

Answer 17

Fibrosis
Inflammation
Ballooning
Mallory Denk bodies

Question 18

Treatment for alcoholic hepatitis

Answer 18

Supportive
Stop EtOH
Nutrition + vitamins
Occasionally steroids

Question 19

What can B1 deficiency lead to?

Answer 19

Beri Beri

Question 20

What can niacin deficiency lead to?

Answer 20

Pellagra

Question 21

Spider nave
Dupuytren’s contracture
Palmar erythema
Gynaecomastia

What does this suggest?

Answer 21

Chronic stable liver disease

Question 22

If you see an alcoholic with a visible vein on the abdominal wall, which other finding are you most likely to see:

A: hepatomegaly, B: splenomegaly, C: bilateral palpable kidneys, D: palpable bladder, E: enlarged prostate on PR

Answer 22

B: splenomegaly

EtOH –> nodules form –> cirrhosis. this cause portal Hypertension.

This blood backs up into the splenic vein –> splenomegaly

Question 23

Patient with chronic stable liver disease recently noticed visible veins, splenomegaly AND ascites. what does this suggest?

Answer 23

Portal hypertension

Question 24

Hepatic flap is seen in a patient with previously chronic stable liver disease. What does this indicate?

Answer 24

Liver failure

Question 25

4 possible portosystemic anastomoses?

Answer 25

1. Oesophageal varices
2. Rectal varices
3. Umbilical vein reanalysing
4. Spleno-renal shunt

Question 26

What causes bile salts/acids to rise?

Answer 26

Obstruction of bile ducts

Question 27

Courvoisier’s law

Palpable gall bladder + jaundice = ?

Answer 27

Pancreatic cancer

Question 28

Life cycle of the hepatocyte - how does it move over time?

Answer 28

Hepatocytes are ‘born’ in zone 1, closest to the portal triad,

The move towards zone 3 as they mature

Question 29

4 defining features of liver cirrhosis

Answer 29

1. Whole liver involvement
2. Fibrosis
3. Regenerating nodules
4. Disrupted vascular architecture

Question 30

how to define chronic hepatitis from acute hepatitis

Answer 30

Chronic = abnormal LFTs for >6 months

Question 31

wtf is ‘piecemeal necrosis’

Answer 31

Interface hepatitis i.e. inflammation is at the area between lobules +portal triad

Question 32

3 types of alcoholic liver disease

Answer 32

1. Fatty liver
2. Alcoholic hepatitis
3. Cirrhosis

Question 33

2 histological features of alcoholic hepatitis

Answer 33

1. Ballooning of hepatocytes

2. Mallory bodies (chunks of pink cytoplasm)

Question 34

anti-mitochondrial antibodies are seen in…?

Answer 34

Primary biliary cirrhosis = AMA +ve

Question 35

which liver disease is associated with UC?

Answer 35

Primary sclerosing cholangitis

Question 36

Which chromosome is mutated in haemochromatosis

Answer 36

6

Question 37

Name the disease in which iron accumulates in macrophages? what is the cause?

Answer 37

haemosiderosis

- caused by blood transfusions

Question 38

Wilson’s disease - what is the pathophysiology?

Answer 38

Mutation of copper ATPase gene (Chr13)

Question 39

what is the responsible antibody in autoimmune hepatitis?

Answer 39

Anti-smooth muscle

Question 40

the effect of a1-antitrypsin deficiency on the liver?

Answer 40

the enzyme is synthesised but cant be secreted

• TONS of enzymes in hepatocytes
• Intracytoplasmic inclusions –> fibrosis + cirrhosis

Question 41

Useful lab investigation of suspected hepatocellular carcinoma

Answer 41

alpha-fetoprotein

Question 42

Anti-mitochondrial antibodies

Answer 42

PBC - primary biliary cirrhosis

Question 43

Anti-smooth muscle antibodies

Answer 43

autoimmune hepatitis

Question 44

Perl’s prussian blue stain

Answer 44

Stains for iron in the liver

Question 45

haemochromatosis vs haemosiderosis

Answer 45

Haemochromatosis is genetic

Haemosiderosis is due to acquired cause (transfusions, EtOH)