Liver Flashcards
What compromises portal triad
Bile duct
Hepatic artery
Portal vein
Which zone is closest to portal triad
Zone 1
Which hepatocyte in the zone Q receives more oxygen
Periportal hepatocyte
Which zone is close to terminal hepatic vein
Zone 3
Which zone has the most liver enzymes
Zone 3
Which hepatocyte is the most mature and metabolically active in zone 3
Perivenular hepatocyte
What cell phagocytoses antigens in liver
Kupffer cells
How much bile does liver synthesis per day
600 to 1000 ml/ day
Acute hep histopathology
Spotty necrosis
Small foci of periportal inflammation and infiltrates)
Biopsy of chronic hepatitis
Piecemeal necrosis
Lymphocyte infiltrates
Ground glass hepatocytes
Which aspect of chronic hepatitis histopathology shows critical stage in the evolution of hepatitis to cirrhosis
Bridging from portal vein to central vein
Histopathology of cirrhosis liver
Hepatocyte necrosis
Fibrosis
Nodules of regenerating hepatocytes (which lack normal acinar structure)
Disturbance of vascular architecture
Gene affected in haemochromatosis
HFE gene
Chromosome 6
Autosomal recessive.
Gene affected in Wilson’s disease
ATP7B gene
Chromosome 13
Autosomal recessive
Causes of micronodular cirrhosis
Modules <3 mm
Alcoholic hepatitis
Biliary tract disease
Causes of macronodular cirrhosis
Modules >3mm
Viral hepatitis
Wilson’s disease
Alpha anti trypsin deficiency
What scoring system used to assess prognosis in liver cirrhosis
Modified Child’s Pugh Score
What does modified child Pugh score assess
Albumin Bilirubin Clotting (thrombin time) Distension (ascites) Encephalopathy
Microscopic characteristics of hepatic steatosis (fatty liver)
Accumulation of fat droplets in the hepatocytes (Steattosis)
Chronic exposure can cause fibrosis
Fully reversible if alcohol avoided
Microscopic characteristics of alcoholic hepatitis
Mallory Denk bodies
Hepatocyte ballooning and necrosis due to accumulation of fat, water and proteins
Fibrosis
Seen acutely after a heavy night of drinking
Microscopic characteristics of alcoholic cirrhosis
Micronodular cirrhosis (nodules <3mm) I.e small nodules and bands of fibrosis
Most common cause of liver disease in the West
Non alcoholic fatty liver disease
Which type of non alcoholic fatty liver disease can progress to cirrhosis
Non alcoholic steatohepatitis (NASH)
Which HLA CLASS ASSOCIATED WITH AUTOIMMUNE HEPATITIS
HLA DR 3
Antibodies associated with type 1 autoimmune hepatitis
Anti nuclear antibody
Anti smooth muscle antibody
Anti actin antibody
Anti soluble liver antigen antibody
Antibody associated with type 2 autoimmune hepatitis
Anti liver kidney microsomal antibody
Primary biliary cirrhosis
Who is affected more m or f?
Female
Autoimmune inflammatory destruction of medium sized INTRAHEPATIC BILE DUCTS and CHOLESTASIS with slow development of cirrhosis over many years
Primary biliary cirrhosis
Biochem profile of Primary biliary cirrhosis
High ALP
High cholesterol
High IgM
Hyperbilirubinaemia (late)
Antibody associated with Primary biliary cirrhosis
Antimitochondrial antibody
What does the ultrasound scan show in Primary biliary cirrhosis
NO bile duct dilation
Histology of Primary biliary cirrhosis
Bile duct loss with granulomas
What can you treat Primary biliary cirrhosis with
Ursodeoxycholic acid in early phase
Primary sclerosing cholangitis
Male or female affected more
Male
Inflammation and obliterating fibrosis of extrahelatic and intrahepatic bile ducts and multi focal stricture formation with dilation of preserved segments
Primary sclerosing cholangitis
Primary sclerosing cholangitis
Male or female affected more
Male
What condition is Primary sclerosing cholangitis associated with
IBD in particular UC
Biochem of Primary sclerosing cholangitis
High ALP
pANCA
USS of Primary sclerosing cholangitis
Bile duct dilation
ercp of Primary sclerosing cholangitis
Heading of bile ducts due to multifocal strictures
Histology of Primary sclerosing cholangitis
Onion skinning fibrosis - concentric fibrosis
What does Primary sclerosing cholangitis increase your risk of
Cholangiocarcinoma
What is hepatic adenoma associated with
Oral contraceptive pill
Most common benign lesion of liver
Haemangioma
Causes of hepatocellular cirrhosis
Hep B Hep C Alcoholic cirrhosis NAFLD Haemochromatosis Aflatoxin Androgenic steroids
Investigation for hepatocellular carcinoma
Alpha fetoprotein (raised) USS
Most common malignant liver lesion
Secondary tumour (metastasis) Usually from GI/breast/bronchus
CAuses of cholangiocarcinoma
Primary sclerosing cholangitis Lynch syndrome type 2 Parasitic liver disease Chronic liver disease Congenital liver abnormalities
Investigation results of haemochromatosis
Iron RAISED
Ferritin RAISED
transferrin saturation > 45%
TIBC DECREASED
Treatment for haemochromatosis
Venesection
Desferrioxamine
Signs and sx of haemochromatosis
Skin bronzing Hepatomegaly Diabetes Cardiomyopathy Hypogonadosm Pseudo gout
Haemochromatosis
AR OR AD
Autosomal recessive
Wilson’s disease Common affected age is
Common affected age 11-14 years
Wilson’s disease AR OR AD
Autosomal recessive
Wilson’s disease gene affected
Mutated gene ATP7B. (Chr13)
Mutated means decreases biliary copper excretion and deposition of copper in liver CNS and iris
Histology of Wilson’s diseas e
Copper stains with rhodanine stain
Mallory bodies
Fibrosis
Signs and sx of Wilson’s diseas e
Kayser Fleuscher rings - copper deposit in descemets membrane in cornea
Neuro - Parkinson’s, psychosis, dementia (basal ganglion involvement)
Liver disease - acute hepatitis, fulminant liver failure of cirrhosis
Alpha anti 1 antitrypsin deficiency
Autosomal dominant or recessive
Autosomal dominant
Alpha anti 1 antitrypsin deficiency
Histology
Intracytoplasmic inclusions of A1AT which stain with PERIODIC ACID SCHIFF
Symptoms of Alpha anti 1 antitrypsin deficiency in children and adults
Kids - neonatal jaundice
Adults - emphysema, chronic liver disease
Electrophoresis of Alpha anti 1 antitrypsin deficiency
Absent alpha globulin band
Fitz Hugh Curtis Syndrome
RUQ pain from peri hepatitis
Violin string peri-hepatic adhesions
3 theories of aetiology of endometriosis
Regurgitant/implantation from retrograde menstrual flow of endometrial cells
Metaplastic transformation of coelomic epithelial cells
