Liver

Question 1

Causes of liver cirrhosis

Answer 1

Alcohol (60-70%), infection (10%) biliary pathology (5%), metabolic, vascular, other (sarcoidosis, intestinal bypass)

Question 2

Metabolic causes of cirrhosis

Answer 2

Haemachromatosis, Wilson’s disease, Galactosaemia, Alpha-1 antitrypsin deficiency

Question 3

What is haemachromatosis?

Answer 3

Increased intestinal absorption of iron which accumulates as haemosiderin in cells of various organs including liver and pancreas. In the liver, excessive iron causes lipid per oxidation, interaction with DNA and stimulation of collagen formation.

Question 4

What is Wilson’s disease?

Answer 4

Toxic levels of copper accumulate in the liver, kidney, brain (basal ganglia)and cornea of the eye. In the liver, enzymes are poisoned, copper binds to the SH groups of proteins and increased free radical formation occurs.

Question 5

What is alpha-1 antitrypsin deficiency?

Answer 5

a protease inhibitor, especially of neutrophil elastase.

Question 6

Why does cirrhosis cause chronic hepatic failure?

Answer 6

There is progressive loss of hepatocytes followed by nodular regeneration and fibrosis

Question 7

What causes chronic hepatic failure?

Answer 7

1. Relentless progression of a chronic disorder

2. Repeated bouts of damage to hepatocytes

Question 8

What does worsening fibrosis in cirrhosis lead to?

Answer 8

types I and III collagen are deposited in the lobules, resulting in disturbances in hepatic blood flow and also diffusion of solutes between blood and hepatocytes

Question 9

What is the source of collagen in cirrhosis?

Answer 9

The source of the collagen in cirrhosis is the Ito cell, which is found in the extra sinusoidal space of Disse and which normally stores fat and vitamin A. In cirrhosis the cell becomes activated, transformed into a fibroblast like cell and develops contractile properties.

Question 10

Features of haemochromatosis

Answer 10

Diabetes mellitus, skin pigmentation

Question 11

Non-specific symptoms and signs of chronic hepatic failure

Answer 11

poor health, anorexia, weight loss, weakness, dyspepsia, nausea and abdominal swelling (due to enlargement of liver and spleen and also ascites).

Question 12

Symptoms and signs of progressive hepato-cellular failure

Answer 12

Jaundice, disturbances of blood coagulation, decreased protein synthesis, endocrine problems (impaired oestrogen metabolism leading to increased levels of oestrogen in the blood.

Question 13

Why do you get coagulation problems in hepatic failure?

Answer 13

1. decreased production of clotting factors
2. decreased absorption of vitamin K leading to even lower production of factors II, VII, IX and X This leads to a bleeding tendency and spontaneous bruising

Question 14

What do you see with decreased protein synthesis in liver failure?

Answer 14

Decreased albumin leads to reduced colloid pressure and oedema (ankle swelling)
Decreased transport proteins for hormones, vitamins, fats and bilirubin

Question 15

In males, decreased oestrogen levels lead to:

Answer 15

Gynaecomastia
Testicular atrophy
Loss of body hair

Question 16

Decreased oestrogen in liver failure may also be responsible for:

Answer 16

Palmar erythema, spider naevi in the area drained by the SVC, finger clubbing, Dupuytren’s contracture

Question 17

Signs of portal hypertension

Answer 17

Ascites, splenomegaly, malabsorption, porto systemic venous shunting

Question 18

What are some of the sequelae of porto systemic venous shunting?

Answer 18

Hepatic encephalopathy, oesophageal varices (bleed), rectum- haemorrhodal vessels, haemorrhoidal bleed.

Question 19

ALT is a good marker of what?

Answer 19

It is found in high concentrations in liver cells, therefore it is raised in incidences of hepatocellular injury

Question 20

ALP is a good marker of what?

Answer 20

ALP is particularly concentrated in the liver, bile duct and bone tissues. ALP is often raised in liver pathology due to increased synthesis in response to cholestasis. As a result, ALP is a useful indirect marker of cholestasis.

Question 21

What are the antibodies associated with Type 1 autoimmune hepatitis?

Answer 21

Type I autoimmune hepatitis is characterized by the presence of anti-nuclear and anti-smooth muscle antibodies

Question 22

What are the antibodies associated with Type 2 autoimmune hepatitis?

Answer 22

Anti–liver kidney microsome-1 and anti–liver cytosol-1 antibodies are typical of type II autoimmune hepatitis

Question 23

What is the pathology of fatty liver disease?

Answer 23

Absolute accumulation in total cell triglyceride due a. excess uptake of FFA

b. excess FA synthesis
c. reduced fatty acid oxidation
d. increased FA to TG (alcohol)
e. decreased apoprotein synthesis (CCl4, malnutrition)
f. reduced hepatocyte lipoprotein secretion

Question 24

What other organs can fatty change occur in and why?

Answer 24

It can occur in many other organs e.g. heart due to hypoxia or toxins

Question 25

Which hepatitis virus most often leads to chronic liver disease?

Answer 25

Hep C