Inflammatory Liver Disease

Question 1

What is the cellular response to nonlethal cell injury?

Answer 1

1. abnormal storage 2. hypertrophy 3. hyperplasia 4. dysplasia 5. neoplasia

Question 2

What is the tissue response to nonlethal cell injury?

Answer 2

1. acute inflammation 2. thrombosis 3. chronic inflammation 4. fibrosis

Question 3

What is the response to lethal cell injury?

Answer 3

1. necrosis 2. apoptosis

Question 4

What are the patterns of liver injury?

Answer 4

1. intracellular accumulations/abnormal storage
2. necrosis and apoptosis
3. inflammation
4. regeneration
5. fibrosis with subsequent cirrhosis

Question 5

Describe the intracellular accumulations/abnormal storage?

Answer 5

1. steatosis - triglyceride fat droplets 2. accumulation of copper, iron, bile and water

Question 6

Inflammatory liver disease is morphologically characterised by?

Answer 6

recruitment of inflammatory cells in addition to various cellular responses

Question 7

Inflammatory liver disease is characterised into?

Answer 7

1. acute and chronic - mostly chronic 2. infectious and non infectious - mostly infectious

Question 8

How to diagnose inflammtory liver disease?

Answer 8

1. patients clinical history 2. habits and lifestyle 3. physical examination findings 4. laboratory investigations 5. drug history 6. imaging/radiology 7. biopsy and tissue diagnosis

Question 9

What viruses cause infectious liver disease?

Answer 9

1. hepatitis A, B, C, D, E 2. cytomegalovirus - in immunocompromised hosts

Question 10

What bacteria cause infectious liver disease?

Answer 10

tuberculosis - as part of a septicaemia

Question 11

What fungi cause infectious liver disease?

Answer 11

1. candida 2. aspergillus 3. mucormycosis

Question 12

What parasites cause infectious liver disease?

Answer 12

1. amoeba 2. E.granulosus (hydatid)

Question 13

Name types of non-infectious liver diseases?

Answer 13

1. drug + toxin induced liver disease
2. metabolic liver disease
3. autoimmune hepatitis
4. neonatal hepatitis

Question 14

Name types of metabolic liver diseases?

Answer 14

1. non alcoholic fatty liver disease
2. Wilsons disease - copper accumulation
3. haemochromatosis - iron haemochromatosis
4. alpha 1 anti-trypsin deficiency

Question 15

Describe the pattern of the inflammatory changes?

Answer 15

can primarily affect 1. portal tracts and its constituents 2. hepatic lobular parenchyma - zonal: zone 1, 2, 3 3. both portal tracts and lobular parenchyma

Question 16

What is alcoholic liver disease?

Answer 16

common cause of acute and chronic liver disease due to excessive alcohol consumption

Question 17

What are the 3 forms of liver disease?

Answer 17

1. steatosis (micro and macrovesicular)
2. alcoholic hepatitis
3. cirrhosis

Question 18

What are the stages of alcoholic liver disease?

Answer 18

1. steatosis 2. fibrosis 3. cirrhosis 4. HCC

Question 19

What are the risk factors of alcoholic liver disease?

Answer 19

1. female 2. obesity 3. dietary factors 4. polymorphisms 5. drinking pattern 5. smoking

Question 20

What is the pathogenesis of alcoholic liver disease?

Answer 20

1. Diversion of cellular energy from essential metabolic pathways (fat metabolism) to alcohol metabolism leading to fat accumulation
2. Acetaldehyde directly injures hepatocyte leading to an inflammatory reaction
3. Alcohol stimulates collagen synthesis leading to fibrosis and cirrhosis

Question 21

What is steatosis?

Answer 21

build up of fat in the liver

Question 22

Describe steatosis?

Answer 22

• micro and macrovesicular
• Predominantly centrilobular/acinar
• hepatomegaly
• completely reversible if one stops taking alcohol

Question 23

What is alcoholic hepatitis?

Answer 23

hepatocyte swelling and necrosis caused by drinking too much alcohol

Question 24

Describe the micro morphology of alcoholic hepatitis?

Answer 24

1. mallory bodies - cytokeratin intermediate filaments and proteins in the cytoplasm
2. neutrophilic reaction
3. fibrosis

Question 25

What is cirrhosis?

Answer 25

end stage of disease causes by excessive alcohol consuption and hepatitis casudimg scarring and liver failure

Question 26

Describe the micro morphology of cirrhosis?

Answer 26

1. Bridging fibrous septae 2. Regenerative parenchymal nodules with proliferating hepatocytes encircled by fibrosis 3. Disruption of the entire liver architecture

Question 27

What reasons do liver tumours com to the attention of patients and doctors?

Answer 27

1. epigastric fullnes or discomfort 2. palpable abdominal mass 3. incidental findings

Question 28

What are the types of liver tumours?

Answer 28

1. benign 2. malignant

Question 29

What are the types of malignant tumours?

Answer 29

1. primary 2. metastatic: spread from other organs

Question 30

Describe 2 types of benign liver tumours?

Answer 30

1. haemongioma - blood vessel tumour | 2. liver cell adenomas - commonly seen in young women on oral contraceptives

Question 31

What are primary malignant tumours?

Answer 31

most arise from hepatocytes: Hepatocellular carcinoma(HCC).

Question 32

Describe types of malignant tumours?

Answer 32

1. cholangiocarcinoma - bile duct origin 2. hepatoblastomas - Liver tumour of childhood (<2yrs of age) 3. angiosarcoma - blood vessel tumours

Question 33

What is the epidemiology of hepatocellular carcinoma?

Answer 33

1. Documented prevalence for Malawi: 0. 8/100,000 in males, 0.4/100,000 in females 2. Globally 5.4% of all cancers 3. common in Asia followed by Africa 4. >85% in countries with high rates of chronic Hepatits B virus infection (HBV)

Question 34

What are the 3 major aetiological associations of neoplastic liver disease?

Answer 34

1. Viral infection: HBV, HCV 2. Chronic alcoholism 3. Food contaminants (Aflatoxins)

Question 35

What are the minor conditions associated with neoplastic liver disease?

Answer 35

1. tyrosinaemia 2. hereditary haemochromatosis

Question 36

Describe viral carcinogenesis?

Answer 36

1. Chronic liver injury with regeneration: increase in pool of cycling cells at risk of genetic changes - Mutations arise spontaneously or by environmental agents eg aflatoxins 2. HBV encodes HBx protein: regulatory protein that disrupts normal growth control of infected liver cells

Question 37

Describe the macroscopic morphology?

Answer 37

1. unifocal - one large mass 2. multifocal - several separate nodules 3. diffusely infiltrative - involving whole live

Question 38

Describe the microscopic morphology?

Answer 38

1. HCC - Poorly differentiated to well differentiated 2. fibrolamellar - distinctive variant that occurs in young males and has no association with HBC but has thick fibrous bands

Question 39

Describe the course of the disease?

Answer 39

progressive enlargement of primary mass - 1. mestastases 2. derangement of liver function

Question 40

Death occurs from?

Answer 40

1. cachexia 2. eosophageal variceal bleed 3. liver failure with hepatic coma 4. rupture of tumour with fatal haemorrhage