L6: Hepatic pathology Flashcards
describe how liver disease often develops
silently
name 3 major risk factors for liver disease
alcohol
obesity
HepC virus
what percentage of first liver admissions have liver disease
90%
where does the liver sit
RUQ
liver is made up of
> 90% hepatocytes
portal triad made up of
hepatic artery proper
portal vein
biliary duct
what drains the liver
central vein
where does blood travel in the liver
in the sinusoids from portal triad to central vein
basic unit of the liver=
acinus
special feature of hepatocytes
regenerative capacity
why do hepatocytes have multiple glycogen stores
high metabolic rate
what does the endoplasmic reticulum do in the hepatocyte
excretory functions such as bile
what does the hepatocyte need to be in close contact with
sinusoid (blood)
kupffer cell=
specialised macrophages
functions of the liver (7)
- glucogen storage and glucose release
- protein synthesis (albumin/ coagulation factors)
- catabolism of AA and urea production
- drug and steroid metabolism
- lipoprotein synthesis
- production and excretion of bile salts
- immune response
hepatitis=
inflammation of the liver
5 common causes of hepatitis
alcohol viral NASH/ NAFLD drugs autoimmune hepatitis
viral hepatitis causes acute symptomatic disease (4)
Hep A
Hep B
Hep B + D
Hep E
which viral hepatitis causes most chronic disease
Hep C
which hepatitis never cause chronic disease
Hep E
Hep A
5 other non Hepatitis viruses causes hepatitis
CMV EBV Herpes Varicella Reo virus
transmission route of Hep A
Faeco-oral route (mainly through food)
what can happen in Hep A before the symptomatic phase
faecal load of HAV is high
what is the consequence of Hep A
self limiting majority recover
what is protracted hepatitis
lingering
what is cholestatic hepatitis
bilirubin build up and jaundice
what is fluminant hepatitis
very rare either recover or die
Hep B mode of transmission (7)
blood sexual unsterile needles mother--> baby razors toothbrushes tattooing
biggest Hep B risk factor
heterosexual activity
when are you at an increased risk of carrier state after an acute infection
the younger you are the higher the risk
where does Hep B live
within genome of the cell
drugs to suppress Hep B
Tinofovir
entecavir
outer surface of Hep B virus
HBSaAg coat
inner surface of Hep B coat
HBcAg coat
Hep B treatment/ prevention sequence
vaccination
antivirals
transplant
treatment of Hep C
ribavirin
mode of Hep C transmission (3)
blood
vertical
sex/ household contact
when can cirrhosis occur after HepC infection
10-30 years
how to test HepC
HCV antibody and PCR
commonest cause of acute viral hepatitis
HepE
primary host of HepE
pig
symptoms of most HepE cases
asymptomatic / unrecognised
NAFLD=
non-alcoholic fatty liver disease
process of NAFLD
build- up of fat in the liver
range of severity of NAFLD
from fatty liver (steatosis) to cirrhosis
in some cases what can cirrhosis from NAFLD lead to
hepatocellular carcinoma
NASH=
non-alcoholic steatohepatitis
pathology of hepatic cirrhosis
fibrosis –> nodules
–> loss of hepatocyte microvilli –> activated stellate cells –> scar matrix –> loss of fenestrae –> kupffer cell activation
causes of liver cirrhosis
- alcohol
- viral hepatitis
- NASH
- drugs
- autoimmune liver disease
- cholestatic liver disease
- metabolic liver disease
- hepatic venous congestion
- cryptogenic
4 complications of cirrhosis
- portal hypertension
- hepatorenal syndrome
- ascites
- hepatic encephalopathy
what causes portal hypertension
back up of blood down portal venous system
variceal bleeds=
patient vomits large volumes of blood
what causes variceal bleeds
varicose veins in the gullet due to increased pressure of blood entering liver
hepatorenal syndrome=
rapid deterioration in kidney function with liver cirrhosis/ liver failure
what causes ascites
fluid produced by the liver not being recycled by the unhealthy liver
hepatic encephalopathy symptoms=
confusion
altered level of consciousness
coma
cause of hepatic encephalopathy
ammonia accumulation
3 branches leading into the portal vein
-superior mesenteric vein
-inferior mesenteric vein
splenic vein
does hepatocellular cancer usually cause pain
no
loss of function due to hepatic failure
- unable to filter toxins and drugs
- metabolism reduced
- reduced immunity
- reduction in clotting factors
- unable to store nutrients so body may experience shortage
loss of function due to hepatic failure
- unable to filter toxins and drugs
- metabolism reduced
- reduced immunity
- reduction in clotting factors
- unable to store nutrients so body may experience shortage
- reduced protein production
- reduced bile production
reduced bile production leads to
reduced absorption of ADEK - fat soluble vitamins
clinical consequences of hepatic failure
- cerebral oedema
- Bleeding
- infections
- kidney failure
- jaundice
- ascities
- melena
- hypotension/ tachycardia
