Histopath - liver disease CPC Flashcards
List as many causes of high bilirubin as you can
Gilbert's syndrome Haemolysis Bile duct obstruction Viral hepatitis Alcohol
van den Bergh reaction - 2 types. what are they?
DIRECT reaction: measures conjugated Br
INDIRECT reaction: unconjug Br
Which Br commonly raised in neonates and doesn’t cause any huge problems. Why does it rise?
Unconjugated Br.
Because the liver immaturity coupled with a fall in Hb early in life
Weird Tx for neonates with jaundice? How does it work?
Phototherapy converts Br into LUMIRUBIN + PHOTOBILIRUBIN
–> these don’t need conjugation for excretion
How is Gilbert’s inherited?
What % of us carry the gene?
Autosomal recessive
50%
What is GIlebrts syndrome
UDP glucoronyl transferase activity is reduced by 30%
What happens to the urine in Gilbert’s?
Unconjugated Br is tightly bound to albumin and therefore does NOT enter the urine
Most representative blood test of liver function?
Prothrombin time
35 yo Chronic EtOH intake, often appearing drunk in A&E Nausea Abdo pain Jaundice
Ddx?
Alcoholic hepatitis Viral hepatitis Cirrhosis Pancreatitis Gall stones
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?
Hepatic - ALP rise is marginal so hepatic is more likely
HBV has 3 antigens which we commonly test for. What are they?
e, s and c
Which HBV antigen is used for HBV immunisation?
s
Which antibody is ONLY seen in someone that has had a primary infection (and not in those who’ve just been immunised?)
anti-HBe
What do you suspect in someone with high levels of Anti-HBs and no Anti-HBe
healthy individual who has been immunised against HBV
An individual who appears healthy but has high levels of HBs antigen?
an HBV carrier - they are infectious
Mallory Denk bodies
Alcoholic hepatitis
Defining histological features of alcoholic hepatitis
Fibrosis
Inflammation
Ballooning
Mallory Denk bodies
Treatment for alcoholic hepatitis
Supportive
Stop EtOH
Nutrition + vitamins
Occasionally steroids
What can B1 deficiency lead to?
Beri Beri
What can niacin deficiency lead to?
Pellagra
Spider nave
Dupuytren’s contracture
Palmar erythema
Gynaecomastia
What does this suggest?
Chronic stable liver disease
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
B: splenomegaly
EtOH –> nodules form –> cirrhosis. this cause portal Hypertension.
This blood backs up into the splenic vein –> splenomegaly
Patient with chronic stable liver disease recently noticed visible veins, splenomegaly AND ascites. what does this suggest?
Portal hypertension
Hepatic flap is seen in a patient with previously chronic stable liver disease. What does this indicate?
Liver failure
4 possible portosystemic anastomoses?
- Oesophageal varices
- Rectal varices
- Umbilical vein reanalysing
- Spleno-renal shunt
What causes bile salts/acids to rise?
Obstruction of bile ducts
Courvoisier’s law
Palpable gall bladder + jaundice = ?
Pancreatic cancer
Life cycle of the hepatocyte - how does it move over time?
Hepatocytes are ‘born’ in zone 1, closest to the portal triad,
The move towards zone 3 as they mature
4 defining features of liver cirrhosis
- Whole liver involvement
- Fibrosis
- Regenerating nodules
- Disrupted vascular architecture
how to define chronic hepatitis from acute hepatitis
Chronic = abnormal LFTs for >6 months
wtf is ‘piecemeal necrosis’
Interface hepatitis i.e. inflammation is at the area between lobules +portal triad
3 types of alcoholic liver disease
- Fatty liver
- Alcoholic hepatitis
- Cirrhosis
2 histological features of alcoholic hepatitis
- Ballooning of hepatocytes
2. Mallory bodies (chunks of pink cytoplasm)
anti-mitochondrial antibodies are seen in…?
Primary biliary cirrhosis = AMA +ve
which liver disease is associated with UC?
Primary sclerosing cholangitis
Which chromosome is mutated in haemochromatosis
6
Name the disease in which iron accumulates in macrophages? what is the cause?
haemosiderosis
- caused by blood transfusions
Wilson’s disease - what is the pathophysiology?
Mutation of copper ATPase gene (Chr13)
what is the responsible antibody in autoimmune hepatitis?
Anti-smooth muscle
the effect of a1-antitrypsin deficiency on the liver?
the enzyme is synthesised but cant be secreted
- TONS of enzymes in hepatocytes
- Intracytoplasmic inclusions –> fibrosis + cirrhosis
Useful lab investigation of suspected hepatocellular carcinoma
alpha-fetoprotein
Anti-mitochondrial antibodies
PBC - primary biliary cirrhosis
Anti-smooth muscle antibodies
autoimmune hepatitis
Perl’s prussian blue stain
Stains for iron in the liver
haemochromatosis vs haemosiderosis
Haemochromatosis is genetic
Haemosiderosis is due to acquired cause (transfusions, EtOH)
