Liver Flashcards
How much is taken in a liver biopsy?
1/50000th of the total liver volume
Why would you biopsy the liver?
Confirm presence/nature of neoplasm
Exclude underlying liver disease
Exclude secondary process
Staging
Name 5 diseases of the liver
Steatohepatits Chronic hepatitis (viral/autoimmune/drugs) Biliary disease Iron overload (haematochromatosis) Metabolic disease
What cells activate fibrosis?
Stellate cells (they contain vitamin A)
What does chronic hepatitis involve architecturally?
Portal tract inflammation Interface hepatits Lobular inflammation Acidophil bodies Fibrosis and cirrhosis
What does biliary disease involve architecturally?
Portal tract inflammation and expansion
Bile duct damage and loss
Granulomas
How do you treat genetic haemoatochromatosis?
Venesection
What does paracetamol do to the liver?
Causes necrosis
What do steroids, flucloxicillin and erythromycin do to the liver?
Cause cholestasis (bland w/steroids) Cause cholangiolytic cholestasis (w/fluclox and eryth)
What do contraceptive steroids do to the liver?
Hepatic vein thrombosis
Nitrofurantoin and etretinate do to the liver?
Cause chronic hepatits
What does allopurinol do to the liver?
Cause granulomas
What do antineoplastic agents do to the liver?
Veno-occlusive disease
What would decompensation in liver disease look like?
Bleeding Jaundice Ascites Encephlopathy (due to sepsis, GI bleed, volume depletion)
What causes ascites in liver disease?
Portal hypertension -> hyperspelnism and varices -> less blood in circulation -> RAAS Fluid imbalance = ascites Also, hypoalbuminaemia due to liver failure= ascites
Why is jaundice seen in liver disease?
Lack of functioning hepatocytes Conjugated and unconjugated bilirubin increases Decreased urobilinogen Dark urin ALT and AST and ALP raised
What clotting factors aren’t able to be made in liver failure?
1, 2, 5, 7, 9, 10, 12, 13
Why do people with liver failure get more infections?
Unable to produce acute phase proteins
Why do people with liver failure experience hypoglycaemia?
Liver unable to store glycogen and fat
Pathogenesis of encephalopathy
Liver fails to detoxify and excrete Ammonia increases Brain converts ammonia to glutamine Osmotic imbalance and cerebral oedema = dorwsiness, confusion, coma
What is involved a liver screen?
Viral hepatitis serology
Autoantibodies
Immunoglobulins
Cholesterol, TGs, ferritin, Alpha-1 antitripsin
Management of ascites?
Na and water restriction
Diuretics
Treat precipitants
Encephalopathy treatment?
Modify microbiota (lactulose, rifaxamin, probiotics)
Laxatives
Nutrition
What marker is raised in fatty liver disease?
ALT
What is seen in the architecture of steatohepatitis?
Ballooning degeneration
Mallory’s hyaline
Pericellular and perisinusoidal fibrosis
Neutrophil infiltration
What causes oxidative stress in alcoholic hepatitis?
CCl4-> free radicals
Ethanol-> Cytp450 and diet -> oxidant stress
What are the major cytokines involved in alcoholic hepatitis?
IL-8 (attracts neutrophils)
TNF-alpha
NFKB (attracts IL-8)
What causes fatty liver to turn into alcoholic hepatitis?
A Babson event-> activated macrophage-> TNF
What could a Babson event be?
Massive boozing spree
Intercurrent infection
Endotoxin
Alcohol withdrawl
Treatment of alcoholic hepatitis?
Alcohol abstinence
Prednisolone
Pentoxyfyllene
When do you do a fibroscan?
ALT, AST, GGT high
Increased ALP
Metabolic syndrome
Hazardous/harmful alcohol risk
What does a fibroscan do?
Ferritin and liver elastography
What cells are antigen presenting in the liver?
Dendritic cells
What cells are found in hepatic sinusoids?
Kupffer cells, dendritic cells, T cells
What antibodies are found in autoimmune chronic hepatitis?
Type 1: Anti smooth muscle Ab
Anti nuclear Ab
Type 2: Anti-LKM antibodies
Treatment of autoimmune chronic hepatitis
Prednisolone
What antibodies are found in primary biliary cirrhosis?
Anti mitochondrial antibodies
Some antinuclear antibodies
How is primary biliary cirrhosis linked to environment?
Industry/mining
Toxic waste
N. aromaticovorans can induce AM Abs
How do you diagnose primary sclerosing cholangitis?
Radiology, autoantibody detection
Linked with IBD
MRCP/ERCP + biopsy
Treatment of primary sclerosing cholangitis?
Ursodeoxycholic acid
