L1: Liver Structure, Function and Dysfunction

Question 1

What is the normal weight of the liver?

Answer 1

1.5kg

Question 2

What cell type makes up the majority of the liver?

Answer 2

Stable Cells - capable of regeneration

Question 3

The liver has a dual blood supply. Which 2 vessels supply the liver and which one is the predominant/major source of blood?

Answer 3

[1] Portal Vein - 75%

[2] Hepatic Artery

Question 4

What drains into the portal vein?

Answer 4

GIT, spleen, pancreas, gall bladder, stomach

Question 5

What stain is used to stain the connective tissue in the liver?

Answer 5

Trichrome Stain

Question 6

What is the main function of the gall bladder?

Answer 6

Bile Storage

Question 7

How is the common bile duct made?

Answer 7

left + right hepatic duct = common hepatic duct

CHD + cystic duct = CBD

CBD + pancreatic duct = CBD

Question 8

What is an acinus of the liver?

Answer 8

areas of the liver supplied by 1 portal tract

Question 9

If there is chronic venous congestion of the liver, what will happen to the liver blood tests - ALT, AST?

Answer 9

mild elevation of AST + ALT

Question 10

What is Budd Chiari syndrome?

Answer 10

blood clots partially or completely block blood flow out of the liver

Question 11

Blood congestion in the liver is most obvious in which part of the liver?

Answer 11

around central hepatic vein - increase in blood in zone 3

Question 12

Why does nutmeg liver occur?

Answer 12

due to venous congestion in the liver - blood backup

Question 13

What are some of the functions of the liver?

Answer 13

• Synthesis
• Bile Formation
• Detoxification
• Intermediary Metabolism
• Immune
• Storage

Question 14

What is spotty necrosis?

Answer 14

small groups of cells die (in liver)

Question 15

What is bridging necrosis?

Answer 15

large confluent groups fo cells die (in liver)

Question 16

What is massive hepatic necrosis?

Answer 16

huge amount of tissue injury and death (in liver)

Question 17

What are the 2 factors that are used to assess liver damage?

Answer 17

1. Grade

2. Stage

Question 18

Grade is used in the assessment of liver damage. What does grade mean?

Answer 18

extent of inflammation ± necrosis

Question 19

Stage is used in the assessment of liver damage. What does stage mean?

Answer 19

extent of fibrosis

Question 20

What is piecemeal necrosis?

Answer 20

interface inflammation

Question 21

What is cirrhosis? (definition)

Answer 21

• diffuse distortion of liver architecture
• fibrous bands/septa surrounding regenerative nodules
• distorted vascular relationships (e.g obliteration of veins w/in liver, shunts form, hepatic venous pressure gradient (HVPG) rises)

Question 22

What may be the consequences of shunts in the liver where blood by-passes the liver?

Answer 22

• reduces liver function

- reduces perfusion of liver

Question 23

What are the key complications of decompensated cirrhosis? [7]

Answer 23

• ascites
• hepatic encephalopathy
• variceal haemorrhage
• hepatorenal syndrome (HRS)
• jaundice
• infection (esp. SBP)
• hepatocellular carcinoma

Question 24

What are Kupffer cells?

Answer 24

macrophages present in the liver

Question 25

What is Budd Chiari Syndrome?

Answer 25

• is caused by blood clots that completely or partially block blood flow from the liver
• the blockage may occur anywhere from the small and large veins that carry blood from the liver (hepatic veins) to the inferior vena cava

Question 26

Why may chronic (passive) venous congestion of the liver occur?

Answer 26

• right heart failure (e.g. cor pulmonale, mitral stenosis)

- rare tricuspid incompetence