Liver and Biliary Disease Flashcards
How much does the liver weight?
1500g
What is the blood supply to the liver?
Portal vein.
Hepatic artery.
What are the cells of the liver? (6)
Hepatocytes. Bile ducts. Blood vessels. Endothelial cells. Kupffer cells. Stellate cells.
What is the normal structure of the liver based on?
Based on the blood supply to the liver.
What leads to stellate cell activation?
Liver injury - i.e. loss of hepatocyte microvilli.
What do stellate cells do once activated? (3)
Deposition of scar matrix.
Loss of fenstrae.
Activate Kupffer cells.
What is the definition of cirrhosis? (4)
Whole liver involved.
Fibrosis.
Nodules of regenerating hepatocytes.
Distortion of liver vascular architechture: intra and extra hepatic (e..g gastro-oesophageal) shunting of blood.
What are the two ways in which cirrhosis is classified?
According to nodule size (micronodular or macronodular)
According to aetiology (alcohol/insulin resistance, viral hepatitis)
What are the complications of cirrhosis? (3)
Portal hypertension.
Hepatic encephalopathy.
Liver cell cancer.
Is cirrhosis reversible?
It can be.
What are the two primary causes of acute hepatitis?
Viruses.
Drugs.
What is the histological finding in acute hepatitis
Spotty necrosis.
What are the three primary causes of chronic hepatitis?
Viral hepatitis.
Drugs.
Auto-immune.
How is grade defined in chronic hepatitis?
Severity of inflammation.
How is stage defined in chronic hepatitis?
Severity of fibrosis.
What is the histological finding in interface hepatitis?
Piecemeal necrosis.
What percentage of people clear hepatitis C infection?
15-30% of people
What are the symptoms of chronic hepatitis C infection? (6)
Fatigue.
Upper right quadrant discomfort.
Transient loss of appetite.
Itching.
Depression.
Impaired memory.
What are some extrahepatic complications of chronic hepatitis C infection? (3)
Cryoglobuinaemia.
Glomerulonephritis.
Keratoconjunctivitis sicca.
What are some symptoms of hepatic insufficiency due to hepatitis C infection? (3)
Ascites.
Oesophageal varices.
Hepatic encephalopathy.
What is the average time to development of HCC due to chronic hepatitis C infection?
10-50 years.
What are the options for early stage HCC treatment? (3)
OLT
Surgery
Percutaneous ablation.
What should be considered to treat intermediate HCC?
TACE
What is done in terminal HCC?
Institute a supportive program.
What are the three types of alcoholic liver disease?
Fatty liver.
Alcoholic hepatitis.
Cirrhosis.
What is NAFLD/NASH?
Non-alcholic fatty liver disease.
Non-alcoholic steatohepatitis.
What is NAFLD/NASH due to?
Due to insulin resistance associated with raised BMI and diabetes.
How do you tell apart ALD and NAFLD?
Cannot do so histologically - reliant on the history.
What is primary biliary cirrhosis.
Bile duct loss associated with chronic inflammation (with granulomas)
What can be found in primary biliary cirrhosis.
Anti-mitochondrial antibodies.
What is primary sclerosing cholangitis
Periductal bile duct fibrosis leading to loss of architechture.
What is primary sclerosing cholangitis associated with?
Ulcerative colitis
What risk is associated with primary sclerosing cholangitis
Increased risk of cholangiocarcinoma
What is the investigation of choice for primary sclerosing cholangitis
ERCP
What is haemochromatosis
Genetically determined increased gut iron absorption
What gene is responsible for haemochromatosis
Chromosome 6
What is the pathological process in haemochoromatosis
Parenchymal damage to organs secondary to iron deposition (bronzed diabetes)
What is haemosiderosis
Accumulation of iron in macrophages
What is the treatment for haemosiderosis
Blood transfusion
What is Wilson’s disease
Accumulation of copper due to failure of excretion by hepatocytes
What gene is responsible for Wilson’s disease
Chromosome 13
Where does copper primarily accumulate in Wilson’s disease (2)
Liver and CNS (hepato-lenticular degeneration)
What stain is used to detect Wilson’s
Rhodanine stain
What condition are Kayser-Fleischer rings seen in?
Wilson’s disease.
They are golden-brown pigment deposits in descemet’s membrane in the peripheral of the iris.
What are the ophthalmoligic manifestations of Wilson’s disease? (2)
Kayser-Fleischer rings.
Sunflower cataracts.
What is autoimmune hepatitis
Interface hepatitis with plasma cells
What are the biochemical markers of autoimmune hepatitis?
Anti-smooth muscle actin antibodies
What is the primary treatment for autoimmune hepatitis?
Steroids.
What is alpha-1-antitrypsin deficiency
Failure to secrete alpha-1-antitrypsin leading to intra-cytoplasmic inclusions and hepatitis/cirrhosis.
What is drug-related injury of the liver
Any kind of liver disease can be caused by a drug
What drug can cause hepatic toxicity
Paracetamol (acataminiphen)
What are some causes of hepatic granulomas? (4)
Primary biliary cirrhosis.
Drugs.
TB.
Sarcoid.
What are some benign liver tumours (3)
Liver cell adenoma
Bile duct adenoma
Haemangioma
What are some causes of malignant liver tumours (2)
Secondary tumours.
Primary tumours.
What is a common cancer than metastases to the liver.
Pancreatic cancer.
What are some primary malignant liver tumours (4)
Hepatocellular carcinoma
Hepatoblastima
Cholangiocarcinoma
Haemangiosarcoma
What is HCC associated with
Cirrhosis (especially in the West)
What is cholangiocarcinoma associated with (3)
Primary biliary cirrhosis.
Worm infections.
Cirrhosis.
Where can cholangiocarcinoma arise from (2)
Intrahepatic ducts. Extrahepatic ducts (including gallbladder).
