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Block 15 Ellen > L6: Hepatic pathology > Flashcards

L6: Hepatic pathology Flashcards

1
Q

describe how liver disease often develops

A

silently

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2
Q

name 3 major risk factors for liver disease

A

alcohol
obesity
HepC virus

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3
Q

what percentage of first liver admissions have liver disease

A

90%

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4
Q

where does the liver sit

A

RUQ

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5
Q

liver is made up of

A

> 90% hepatocytes

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6
Q

portal triad made up of

A

hepatic artery proper
portal vein
biliary duct

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7
Q

what drains the liver

A

central vein

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8
Q

where does blood travel in the liver

A

in the sinusoids from portal triad to central vein

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9
Q

basic unit of the liver=

A

acinus

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10
Q

special feature of hepatocytes

A

regenerative capacity

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11
Q

why do hepatocytes have multiple glycogen stores

A

high metabolic rate

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12
Q

what does the endoplasmic reticulum do in the hepatocyte

A

excretory functions such as bile

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13
Q

what does the hepatocyte need to be in close contact with

A

sinusoid (blood)

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14
Q

kupffer cell=

A

specialised macrophages

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15
Q

functions of the liver (7)

A
  • 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
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16
Q

hepatitis=

A

inflammation of the liver

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17
Q

5 common causes of hepatitis

A 
alcohol 
viral 
NASH/ NAFLD 
drugs 
autoimmune hepatitis
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18
Q

viral hepatitis causes acute symptomatic disease (4)

A

Hep A
Hep B
Hep B + D
Hep E

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19
Q

which viral hepatitis causes most chronic disease

A

Hep C

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20
Q

which hepatitis never cause chronic disease

A

Hep E

Hep A

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21
Q

5 other non Hepatitis viruses causes hepatitis

A 
CMV
EBV
Herpes 
Varicella
Reo virus
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22
Q

transmission route of Hep A

A

Faeco-oral route (mainly through food)

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23
Q

what can happen in Hep A before the symptomatic phase

A

faecal load of HAV is high

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24
Q

what is the consequence of Hep A

A

self limiting majority recover

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25
Q

what is protracted hepatitis

A

lingering

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26
Q

what is cholestatic hepatitis

A

bilirubin build up and jaundice

27
Q

what is fluminant hepatitis

A

very rare either recover or die

28
Q

Hep B mode of transmission (7)

A 
blood 
sexual 
unsterile needles 
mother--> baby 
razors 
toothbrushes 
tattooing
29
Q

biggest Hep B risk factor

A

heterosexual activity

30
Q

when are you at an increased risk of carrier state after an acute infection

A

the younger you are the higher the risk

31
Q

where does Hep B live

A

within genome of the cell

32
Q

drugs to suppress Hep B

A

Tinofovir

entecavir

33
Q

outer surface of Hep B virus

A

HBSaAg coat

34
Q

inner surface of Hep B coat

A

HBcAg coat

35
Q

Hep B treatment/ prevention sequence

A

vaccination
antivirals
transplant

36
Q

treatment of Hep C

A

ribavirin

37
Q

mode of Hep C transmission (3)

A

blood
vertical
sex/ household contact

38
Q

when can cirrhosis occur after HepC infection

A

10-30 years

39
Q

how to test HepC

A

HCV antibody and PCR

40
Q

commonest cause of acute viral hepatitis

A

HepE

41
Q

primary host of HepE

A

pig

42
Q

symptoms of most HepE cases

A

asymptomatic / unrecognised

43
Q

NAFLD=

A

non-alcoholic fatty liver disease

44
Q

process of NAFLD

A

build- up of fat in the liver

45
Q

range of severity of NAFLD

A

from fatty liver (steatosis) to cirrhosis

46
Q

in some cases what can cirrhosis from NAFLD lead to

A

hepatocellular carcinoma

47
Q

NASH=

A

non-alcoholic steatohepatitis

48
Q

pathology of hepatic cirrhosis

A

fibrosis –> nodules
–> loss of hepatocyte microvilli –> activated stellate cells –> scar matrix –> loss of fenestrae –> kupffer cell activation

49
Q

causes of liver cirrhosis

A
  • alcohol
  • viral hepatitis
  • NASH
  • drugs
  • autoimmune liver disease
  • cholestatic liver disease
  • metabolic liver disease
  • hepatic venous congestion
  • cryptogenic
50
Q

4 complications of cirrhosis

A
  • portal hypertension
  • hepatorenal syndrome
  • ascites
  • hepatic encephalopathy
51
Q

what causes portal hypertension

A

back up of blood down portal venous system

52
Q

variceal bleeds=

A

patient vomits large volumes of blood

53
Q

what causes variceal bleeds

A

varicose veins in the gullet due to increased pressure of blood entering liver

54
Q

hepatorenal syndrome=

A

rapid deterioration in kidney function with liver cirrhosis/ liver failure

55
Q

what causes ascites

A

fluid produced by the liver not being recycled by the unhealthy liver

56
Q

hepatic encephalopathy symptoms=

A

confusion
altered level of consciousness
coma

57
Q

cause of hepatic encephalopathy

A

ammonia accumulation

58
Q

3 branches leading into the portal vein

A

-superior mesenteric vein
-inferior mesenteric vein
splenic vein

59
Q

does hepatocellular cancer usually cause pain

A

no

60
Q

loss of function due to hepatic failure

A
  • unable to filter toxins and drugs
  • metabolism reduced
  • reduced immunity
  • reduction in clotting factors
  • unable to store nutrients so body may experience shortage
61
Q

loss of function due to hepatic failure

A
  • 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
62
Q

reduced bile production leads to

A

reduced absorption of ADEK - fat soluble vitamins

63
Q

clinical consequences of hepatic failure

A
  • cerebral oedema
  • Bleeding
  • infections
  • kidney failure
  • jaundice
  • ascities
  • melena
  • hypotension/ tachycardia

Block 15 Ellen (11 decks)

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