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Year 2 - Clinical Pathology > Liver disease > Flashcards

Liver disease Flashcards

1
Q

what is jaundice and the different types

A

visible in white of eye - abnomrmialty of metabolism of bilirubin >40umol/L
most common sign of lier disease
pre hepatic - too much produced
hepatic - too few functioning liver cells
post hepatic - bile duct obstruction

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2
Q

what are the various causes of jaundice and the effect on appearance

A

pre hepatic - haemolytic anaemia, gilberts syndrome (enzyme deficiency), unconjugated and bound to albumin = yellow skin

hepatic - onstage liver disease, mainly conjugated soluble = yellow eyes and dark urine

post hepatic - conjugated - yellow eyes, pale stool and dark urine

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3
Q

describe the simplified production pathways of bilirubin

A

produced by RBC breakdown = unconjugated
conjugated in the liver and excreted in bile
reabsorbed in the gut for enterohepatic circulation

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4
Q

what liver enzyme tests can be done and what do they show

A

ALT and AST from liver cells = mild increase = chronic disease, sudden rise = acute

leak from bile ducts = all phos - high obstructive jaundice and chronic biliary disease

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5
Q

what investigations can be done for jaundice

A

ultrasound for dilated ducts or liver biopsy

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6
Q

what are the features in he liver of obstructive jaundice

A

bile in the liver parenchyma - yellow skin
oedema, portal tract expansion, ductular reaction
bile salts in the skin = itchy

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7
Q

describe hepatitis

A

inflammation in the liver - non-neoplastic
raised liver enzymes
acute vs chronic

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8
Q

what are the causes and pathology of acute liver disease

A

asymptomatic, malaise, jaundice, coagulophathy
damage to hepatocytes - inflammatory injury, viral, drug, autoimmune alcohol drugs
cell death inflammation and regeneration

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9
Q

what is the most common cause of severe liver cell injury

A

alcohol and paracetamol toxicity

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10
Q

which viral disease cause severe liver damage

A

hep ABE

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11
Q

what are the causes of chronic liver disease

A 
virus, autoimmune drugs 
fatty liver disease, alcohol, NAFLD
iron copper genetic error alpha 1 antitrypsin 
biliary disease
vascular disease
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12
Q

what is the pathology of chronic liver disease

A

injury to liver cells - scar tissue and regen - dependant on the cause

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13
Q

describe the progression of chronic liver disease

A

scaring forms bridges with vascular structures = nodule development and cirrhosis

remodelling = bands of fibrosis bridge between portal tracts and hepatic veins

portal blood entering th e liver can flow through vessels in fibrous tissue and not percolate through sinusoids

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14
Q

describe how different viruses affect the liver

A

ABC
D only with B
E waterborne associated with zoonosis
EBV CMV HSV usually in immuncompromised

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15
Q

how does alcohol affect the liver

A

spectrum of fatty change with inflammation = steatohepatitis - cirrhosis
liver biopsy = collagen stained red (van geison stain) - collagen surrounds cells like chicken wire and portal tract fibrosis

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16
Q

describe what NAFLD is in the liver

A

non-alcoholic fatty liver disease

associated with metabolic syndrome such as obesity T2DM, hyperlipidaemia

17
Q

what is the most common cause of liver disease

A

disease associated with NAFLD

18
Q

how does NAFLD change the liver

A

insulin resistance
obesity - long term fat storage in liver = steatohepatitis - fibrosis and inflammation, oxidative stress
slow evolution into cirrhosis

19
Q

what is DILI and how is it classified

A

drug induced liver injury
intrinsic - paracetamol and predictable
idiosyncratic - rare unpredictable (metabolic and immune)

20
Q

what is the most common symptom of DILI

A

jaundice

21
Q

what is the most common cause of acute liver failure

A

paracetamol toxicity

22
Q

what are three types of inherited liver disease

A

haemochromatosis
wilsons
alpha 1 antitrypsin deficiency

23
Q

describe haemochromatosis

A

failure of iron absorption regulation - high serum levels of transferrin (HFE C282Y mutation)
high iron = liver cell damage = cirrhosis and carcinoma
t = frequent venesection - remove iron

24
Q

what is the test for haemochromoatosis

A

perls stain = blue for iron

25
Q

what does iron accumulation cause in different organs

A 
liver - cirrhosis 
pancreas - diabetes 
skin - pigment 
joint - arthritis 
heart - cardiomyopathy
26
Q

describe inherited wilsons disease

A

copper metab
little caeruloplasmin
copper accumulates in eyes, liver brain
high urinary copper low serum copper and high in liver tissue

27
Q

what are copper accumulation in the eye called

A

Keyser Fleischer rings

28
Q

what is the treatment of Wilson disease

A

chelate copper

29
Q

describe alpha 1 antitrypsin deficiency

A

normally it neutralises proteolytic enzymes from active state
abnormal A1AT - forms globules of glycoprotein - damage liver cells = fibrosis and cirrhosis

30
Q

how can you test for alpha 1 antitryspin deificney

A

posiitve with PAS diastase stain

31
Q

what do low levels of A1AT lead to

A

emphysema

32
Q

what is the diagnosis of autoimmune hepatitis

A

common in women and auto-antibodies against hepatocytes
raised IgG, ALT
can do liver biopsy

33
Q

describe two types of autoimmune liver disease

A

primary biliary cholangitis - antimitochondrial antibodies, IgM raised ALP - more common in women

primary sclerosis cholangitis - more sinister -more common in men
high ALP and associated with UC

34
Q

what can be used to treat PBC and PSC

A

urso-deocycholic acid

35
Q

what is a major risk factor for hepatocelualr carcinoma

A

cirrhosis

36
Q

what is cirrhosis and pathogenesis

A

diffuse hepatic process, fibrosis and conversion of oral liver architectures not abnormal nodules
portal vein blood bypasses sinusoids so hepatocytes can perform function
portal hypertension

37
Q

what are the complications of cirrhosis

A 
oedema bruising muscle wasting 
lack of detoxifying 
ascites 
jaundice and itching from bile salts 
infection risk
38
Q

what happens during hepatic failure

A

acute and chronic (end stage liver disease)

lead to caput medusa, spider naevi, ascites and muscle wasting

Year 2 - Clinical Pathology (67 decks)

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