Liver and Biliary System Pathology Flashcards
Describe liver function. (9)
Stores: glycogen, vitamins, iron, copper
Makes: glucose, proteins, lipids, coagulation factors, albumin, cholesterol, bile.
Breaks: bilirubin, ammonia, drugs, alcohol.
Describe cirrhosis of the liver. (7)
Cirrhosis develops in response to any chronic injury to the liver.
Inflammation causes fibrosis associated with necrosis and structural changes (bumps of healthy tissue between bands of fibrosis).
It is not reversible.
End result is impaired liver function and vascular changes eg portal hypertension due to architectural changes.
Describe two drug related causes of cirrhosis. (9)
Alcoholic liver disease: fatty change > alcoholic hepatitis > cirrhosis. Build up of acetaldehyde. Initially can be reversed. Hepatomegaly, rapid onset jaundice, AST>ALT.
Iatrogenic cirrhosis: long term hepatotoxic drugs eg paracetamol.
Describe infectious causes of cirrhosis. (3)
Hepatitis B and C: chronic inflammation from infection leads to fibrosis and cirrhosis. Increased risk of hepatocellular carcinoma.
Describe deposition disorders as a cause of cirrhosis.
Fat (3)
Iron (6)
Copper (6)
Non-alcoholic fatty liver disease: similar to alcoholic but caused by obesity and metabolic disorders. Reduce risk and modify lifestyle.
Hereditary haemochromatosis: increased SI iron absorption leads to increased deposition. Raised serum iron. Autosomal recessive, treated by venesection. Risk of hepatocellular carcinoma.
Wilson’s disease: reduced secretion of copper from biliary system leading to accumulation in tissues. Reduced serum copper. Rare, autosomal recessive. Use cheating agents and liver transplants. Look for Kaiser-Fleisher rings of gold round iris.
Describe autoimmune causes of cirrhosis. (8)
Primary sclerosing cholangitis: fibrosis of intra- and extra-hepatic bile ducts. Common in men.
Primary biliary cirrhosis: destruction of intrahepatic bile ducts. Common in women.
Autoimmune hepatitis: autoantibodies attack hepatocytes.
List 3 other causes of cirrhosis.
Alpha 1 antitripsin deficiency
Budd-Chiari
Glycogen storage disorders
Explain the presentation of a patient with cirrhosis of the liver. (4)
Jaundice - bilirubin disturbances due to reduced liver function
Oedema and ascites - hypoalbuminaemia due to reduced liver function causing reduced oncotic pressure.
Bleeding and easy bruising - clotting factors deficiency due to reduced liver function.
Confusion - ammonia build up causing hepatic encephalopathy.
Describe portal hypertension and its venous consequences. (9)
A build up of blood in the portal system because a fibrotic liver is compressing the portal veins.
This shunts blood to the systemic circulation causing dilation of veins where these shunts occur.
Oesophageal varices - distal portion. Can lead to life-threatening haematemesis.
Umbilical - ligamentum teres can reopen and cause caput medusa.
Anorectal - haemorrhoids.
Describe hepatorenal syndrome. (6)
Development of AKI due to cirrhosis.
Portal hypertension > arterial vasodilation > kidney thinks blood is pooling > RAAS activation > renal artery vasoconstriction > ischaemia.
Describe gallstones.
Formation (2)
Occurrence (2)
Diagnosis (1)
Formed from bile contents - cholesterol, bile pigments, phospholipids.
Common in “4 F’s” - female, fat, forty, fair.
Radiolucent - diagnosed by USS.
Describe biliary colic. (3)
Temporary blockage of bile flow leading to temporary RUQ pain but no features of inflammation.
Describe acute cholangitis.(5)
Permanent impaction of a stone in the cystic duct. Causes inflammatory features and positive Murphey’s sign - pain with inhalation and liver palpation.
Describe acute ascending cholangitis. (7)
Infection to the biliary tree from stasis from an impacted stone. Causes pain, inflammation and jaundice - Charchot’s triad.
Describe acute pancreatitis (7)
A complication of gallstones that presents with epigastric pain radiating to the back (retroperitoneal and foregut).
Also can be caused by alcohol, steroids or (rarer) mumps, drugs or autoimmune.
Causes umbilical and flank bruising
Will have high amylase.
