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A-Level Flashcards on various topics > Histopath - liver disease CPC > Flashcards

Histopath - liver disease CPC Flashcards

1
Q

List as many causes of high bilirubin as you can

A 
Gilbert's syndrome
Haemolysis
Bile duct obstruction
Viral hepatitis
Alcohol
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2
Q

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

A

DIRECT reaction: measures conjugated Br

INDIRECT reaction: unconjug Br

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3
Q

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

A

Unconjugated Br.

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

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4
Q

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

A

Phototherapy converts Br into LUMIRUBIN + PHOTOBILIRUBIN

–> these don’t need conjugation for excretion

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5
Q

How is Gilbert’s inherited?

What % of us carry the gene?

A

Autosomal recessive

50%

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6
Q

What is GIlebrts syndrome

A

UDP glucoronyl transferase activity is reduced by 30%

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7
Q

What happens to the urine in Gilbert’s?

A

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

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8
Q

Most representative blood test of liver function?

A

Prothrombin time

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9
Q 
35 yo 
Chronic EtOH intake, often appearing drunk in A&E
Nausea
Abdo pain
Jaundice

Ddx?

A 
Alcoholic hepatitis
Viral hepatitis
Cirrhosis
Pancreatitis
Gall stones
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10
Q 
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?

A

Hepatic - ALP rise is marginal so hepatic is more likely

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11
Q

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

A

e, s and c

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12
Q

Which HBV antigen is used for HBV immunisation?

A

s

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13
Q

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

A

anti-HBe

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14
Q

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

A

healthy individual who has been immunised against HBV

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15
Q

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

A

an HBV carrier - they are infectious

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16
Q

Mallory Denk bodies

A

Alcoholic hepatitis

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17
Q

Defining histological features of alcoholic hepatitis

A

Fibrosis
Inflammation
Ballooning
Mallory Denk bodies

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18
Q

Treatment for alcoholic hepatitis

A

Supportive
Stop EtOH
Nutrition + vitamins
Occasionally steroids

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19
Q

What can B1 deficiency lead to?

A

Beri Beri

20
Q

What can niacin deficiency lead to?

A

Pellagra

21
Q

Spider nave
Dupuytren’s contracture
Palmar erythema
Gynaecomastia

What does this suggest?

A

Chronic stable liver disease

22
Q

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

A

B: splenomegaly

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

This blood backs up into the splenic vein –> splenomegaly

23
Q

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

A

Portal hypertension

24
Q

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

A

Liver failure

25
Q

4 possible portosystemic anastomoses?

A
  1. Oesophageal varices
  2. Rectal varices
  3. Umbilical vein reanalysing
  4. Spleno-renal shunt
26
Q

What causes bile salts/acids to rise?

A

Obstruction of bile ducts

27
Q

Courvoisier’s law

Palpable gall bladder + jaundice = ?

A

Pancreatic cancer

28
Q

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

A

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

The move towards zone 3 as they mature

29
Q

4 defining features of liver cirrhosis

A
  1. Whole liver involvement
  2. Fibrosis
  3. Regenerating nodules
  4. Disrupted vascular architecture
30
Q

how to define chronic hepatitis from acute hepatitis

A

Chronic = abnormal LFTs for >6 months

31
Q

wtf is ‘piecemeal necrosis’

A

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

32
Q

3 types of alcoholic liver disease

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
33
Q

2 histological features of alcoholic hepatitis

A
  1. Ballooning of hepatocytes

2. Mallory bodies (chunks of pink cytoplasm)

34
Q

anti-mitochondrial antibodies are seen in…?

A

Primary biliary cirrhosis = AMA +ve

35
Q

which liver disease is associated with UC?

A

Primary sclerosing cholangitis

36
Q

Which chromosome is mutated in haemochromatosis

A

6

37
Q

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

A

haemosiderosis

- caused by blood transfusions

38
Q

Wilson’s disease - what is the pathophysiology?

A

Mutation of copper ATPase gene (Chr13)

39
Q

what is the responsible antibody in autoimmune hepatitis?

A

Anti-smooth muscle

40
Q

the effect of a1-antitrypsin deficiency on the liver?

A

the enzyme is synthesised but cant be secreted

  • TONS of enzymes in hepatocytes
  • Intracytoplasmic inclusions –> fibrosis + cirrhosis
41
Q

Useful lab investigation of suspected hepatocellular carcinoma

A

alpha-fetoprotein

42
Q

Anti-mitochondrial antibodies

A

PBC - primary biliary cirrhosis

43
Q

Anti-smooth muscle antibodies

A

autoimmune hepatitis

44
Q

Perl’s prussian blue stain

A

Stains for iron in the liver

45
Q

haemochromatosis vs haemosiderosis

A

Haemochromatosis is genetic

Haemosiderosis is due to acquired cause (transfusions, EtOH)

A-Level Flashcards on various topics (69 decks)

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