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FHHD > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What separates the 2 main lobes of the liver

A

The falciform ligament

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2
Q

How many segments is the liver split into

A

8

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3
Q

What supplies blood to the liver

A 
Hepatic artery (oxygenated blood)
Hepatic portal vein (nutrients)
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4
Q

What connects the gall bladder to the common hepatic duct

A

cystic duct

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5
Q

What cells make up the liver and how are they arranged

A

Hepatocytes
Sheets of hepatocytes are separated by sinusoids
Hepatic tissue can be arranged into lobules - hexagons

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6
Q

What is found in the centre and corners of each lobule

A

Central vein located at the centre

Portal tract at the corner of each lobule

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7
Q

What is the portal tract made up of

A

Hepatic artery
Portal vein
Bile duct

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8
Q

What functional units are found in hepatic tissue and where are they found

A

Acini are functional units of hepatic tissue found between 2 central veins

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9
Q

Where are the 3 zones of acini found in hepatic tissue

A

Zone 1 = closest to portal tract
Zone 3 = closest to central vein
Zone 2 = found between the 2 other zones

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10
Q

What is the metabolic function of the liver

A

Detoxification and breakdown of toxins, hormones and drugs

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11
Q

What are the synthetic functions of the liver

A
  • Bile (emulsification of fat)
  • Protein (production and activation)
  • Carbohydrate (gluconeogenesis)
  • Lipid (cholesterol, triglycerides)
  • Red blood cells (in foetal liver)
  • Clotting factors
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12
Q

What responses does the liver have to injury

A
  • Hepatocyte degeneration and intracellular accumulation
  • Hepatocyte necrosis and apoptosis
  • Inflammation
  • Regeneration
  • Fibrosis
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13
Q

What symptoms are associated with liver injury

A
  • Jaundice
  • Oedema
  • Ascites
  • Cerebral dysfunction
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14
Q

What is jaundice cause by and what does it look like

A

Increased serum bilirubin and bilirubin deposition in tissues and causes discolouration of skin and sclera

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15
Q

What is ascites

A

Accumulation of fluid in the abdominal cavity

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16
Q

Describe how bilirubin is formed

A
  • Hb in RBCs is released
  • Heme from Hb is oxygenised by Heme Oxygenase
  • This forms Biliverdin
  • Biliverdin is reduced to unconjugated bilirubin by biliverdin reductase
  • Unconjugated bilirubin gains a glucuronate to form conjugated bilirubin
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17
Q

What are the 3 site classifications of jaundice and what does each mean

A

Prehepatic - takes place before the bilirubin reach the liver
Intrahepatic - Takes place within the liver
Post-hepatic - takes place after the bilirubin leaves the liver

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18
Q

What are the prehepatic causes of jaundice

A

Excess bilirubin production:

  • haemolytic anaemia
  • Internal bleeding
  • Ineffective erythropoiesis
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19
Q

What are the intrahepatic causes of jaundice

A

Impaired conjugation
Impaired excretion
Reduced Uptake

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20
Q

What can cause impaired conjugation in intrahepatic jaundice

A
  • Physiological jaundice in newborns/ can occur in breast feeding
  • Diffuse hepatocellular disease
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21
Q

What can cause impaired excretion in intrahepatic jaundice

A
  • Intrahepatic bile duct disease

- Drugs

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22
Q

What can cause reduced uptakes in intrahepatic jaundice

A

drugs

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23
Q

What is the mechanism of postheaptic of jaundice

A

Extrahepatic biliary obstruction

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24
Q

What can cause extra hepatic biliary obstruction and cause post hepatic jaundice

A

Gallstones
Pancreatic cancer
Extrahapetic biliary atresia
Biliary strictures

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25
Q

What can cause hepatic oedema/ascites

A

Portal hypertension - high blood pressure in the portal venous system

Hypoalbuminaemia - low level of albumin in the circulation

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26
Q

How can cerebral dysfunction occur with liver injury and what symptoms are associated with it

A
  • Increased production of ammonia in liver injury
  • Ammonia disrupts neurotransmission
  • Symptoms include disturbance in consciousness, rigidity, hyper-reflexia, asterixis
27
Q

What is hepatitis

A

Inflammation of the liver following injury, can be acute or chronic

28
Q

Name some causes of hepatitis

A

Viral
Alcohol
Drugs/toxins
Autoimmune

29
Q

How is Hepatitis A spread and is it chronic or acute

A

Faecal-oral spread

not chronic

30
Q

How is Hepatitis B spread and is it chronic or acute and how can it progress

A

Parenteral spread
Chronic in 5-10%
Can progress to chronic hepatitis and hepatocellular carcinoma

31
Q

How is Hepatitis C spread and is it chronic or acute and how can it progress

A

Parenteral spread
Chronic in 5-10%
Can progress to chronic hepatitis and hepatocellular carcinoma

32
Q

When does hepatitis D tend to occur

A

Tends to occur as a co infection with hepatitis B = fulminant disease

33
Q

What can super infection of hepatitis D cause

A

Chronic progressive hepatitis

34
Q

How is hepatitis E spread and is it chronic

A

Spread via water droplets and not chronic

35
Q

What are the symptoms of acute hepatitis

A
  • Mostly non-specific symptoms initially, like nausea, vomiting and pain
  • Specific symptoms = profound loss of appetite, dark urine and jaundice
  • Some progress to acute liver failure
36
Q

Describe the macroscopy of acute hepatitis

A

Mild hepatomegaly

Congestion

37
Q

Describe the microscopy of acute hepatitis

A
  • Scattered foci of lobular necrosis and inflammation
  • Apoptotic bodies (councilman bodies)
  • Hepatocyte ballooning and necrosis
  • Disruption of architecture (lobular disarray)
  • Inflammation of portal tracts
38
Q

How long do symptoms have to show for before you can diagnose chronic hepatitis

A

> 6 months

39
Q

What are the causes of chronic hepatitis

A
  • Hepatitis B or B + D
  • Hepatitis C
  • Autoimmune Hepatitis
  • Drug-induced hepatitis
40
Q

What 3 histological features of chronic hepatitis can be seen

A

Inflammation (predominantly lymphocytic)
Hepatocyte necrosis
Fibrosis

41
Q

Where can you see inflammation histologically in chronic hepatitis

A

Portal tracts
Periportal interface hepatitis (piecemeal necrosis)
Lobular

42
Q

What is periportal interface hepatitis

A

Inflammation within the lobular boundaries

43
Q

What types of necrosis can you see histologically in chronic hepatitis and describe them

A
  • Bridging necrosis - portal tract to central vein or portal tract to portal tract
  • Confluent necrosis - larger area necrosis
44
Q

What is fibrosis and what can it result in

A

This is the replacing of the liver tissue for scar tissue and can eventually cause cirrhosis

45
Q

What is cirrhosis

A

Cirrhosis is irreversible end stag liver disease that disrupts the vascular architecture and blood flow of the liver

46
Q

Name some of the causes of cirrhosis

A
  • Alcohol
  • Viral hepatitis (B,C and D)
  • Autoimmune hepatitis
  • Primary and secondary biliary cirrhosis
  • Metabolic causes e.g. haemochromatosis, Wilson’s disease, Alpha-1-antitrypsin deficiency
  • Drugs
  • Idiopathic
  • Venous outflow obstruction
47
Q

What complications can cirrhosis cause

A

Hepatic failure
Portal hypertension
Hepatic encephalopathy
Oesophageal varices - obstructed portal veins

48
Q

Describe the mechanism of how cirrhosis causes hepatic encephalopathy

A
  • Portal blood bypasses liver

- Toxic or metabolic effect on the brain

49
Q

Describe the mechanisms by which portal hypertension can cause ascites

A 
High intrasinusoidal pressure
Leakage from hepatic lymphatics 
Hypoalbuminaemia 
Na+
Water Retention
50
Q

What are ascites

A

Build up of fluid in the abdomen

51
Q

Portal hypertension results in what

A

Ascites
Portal systemic venous shunts
Splenomegaly (congestive)

52
Q

Describe the effects of portal systemic venous shunts

A
  • Oesophagus: varices
  • Rectum: haemorrhoids
  • Falciform ligament
  • Anterior abdominal wall
53
Q

What problems come about as a result of hepatic failure

A
  • Jaundice
  • Hypoalbuminaemia
  • Coagulopathy
  • DIC - disseminated intravascular coagulation
  • Raised serum area
  • Hepatorenal syndrome
  • Gynaecomastia, spider nave
  • Encephalopathy
54
Q

What are the 3 stages of Alcoholic liver disease

A
  1. Alcoholic Steatosis
  2. Alcoholic Hepatitis
  3. Alcoholic Cirrhosis
55
Q

What happens in alcoholic steatosis

A
  • Fatty change in the liver = soft yellow liver

- Fibrosis

56
Q

What happens alcoholic hepatitis

A
  • Fatty cahnge
  • Fibrosis
  • Hepatocyte necrosis
  • Inflammation
  • Iron deposition
  • Mallory’s hyaline (protein) deposition
57
Q

What are benign primary liver tumours called

A

Liver cell adenoma

58
Q

What kinds of malignant primary liver tumour can you get

A
  • Hepatocellular carcinoma
  • Cholangiocarcinoma
  • Angiosarcoma
  • Hepatoblastoma (mainly children)
59
Q

Describe the morphology of secondary liver tumours

A
  • Hepatomegaly

- Typically multiple nodules; rarely a solitary nodule

60
Q

When do hepatocellular carcinomas often develop

A

In a cirrhotic liver

61
Q

List the aetiologies (factors) of hepatocellular carcinomas

A
  • Hep B virus
  • Hep C virus
  • Haemochromatosis
  • Aflatoxin
  • Alcohol, age, gender
62
Q

Describe the clinical features of hepatocellular carcinomas

A
  • Abdominal pain
  • Weight loss
  • Hepatomegaly
  • Raised serum alpha-feto protein (also seen in cirrhosis, yolk sac tumours)
  • Metastases occur later: lungs
  • Survival <6 months usually
  • Death due to cachexia, varices, encephalopathy
63
Q

Describe the macroscopy of hepatocellular carcinoma

A

Hepatomegaly -

  1. univocal mass: yellow/white, soft, haemorrhage, necrotic
  2. Multifocal
  3. Diffusely infiltrative
64
Q

Describe the microscopy of hepatocellular carcinoma

A
  • Well differentiated tumours resemble normal liver trabeculae
  • Poorly differentiated tumours may mimic metastases

FHHD (21 decks)

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