Liver Disease

Question 1

What is the anatomy of the liver in terms of its anatomical lobes, function division and the things that divide them

Answer 1

Anatomical lobes:
L, R, Caudate (top), Quadrate

Functional division:
L: L lobe, caudate, quadrate
R: R lobe

The H is formed by:
Top left: ligamentum venosum
Top right: hepatic vein
Bottom left: ligamentum teres (aka. round ligament) embryological remnant of umbilical vein
Bottom right: gall bladder
Middle: portal triad (hepatic vein, artery and duct)

Question 2

What determines grade and stage?

Answer 2

Grade: amount of hepatitis
Stage: amount of fibrosis

Question 3

What is the rule of three for causes of chronic liver disease?

Answer 3

3 common:
HCV
HBV
Alcohol

3 autoimmune:
Primary Sclerosing Cholangitis
Primary biliary cirrhosis
Autoimmune hepatitis

3 metabolic:
Cu: Wilsons
Fe: Haemachromatosis
alpha 1 antitrypsin deficiency

3 other:
NASH
Budd Chiari
Chronic Biliary Cirrhosis (tumour, cystic fibrosis)

Question 4

Clinical presentation of compensated CLD

Answer 4

Peripheral stigmata:

• dupuytren’s contracture
• palmar erythema
• clubbing
• leukonychia (hypoalbunaemia)
• spider naevi
• brusing
• gynacomastia and atrophic testes
• hair loss