Liver disease

Question 1

what is jaundice and the different types

Answer 1

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

Question 2

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

Answer 2

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

Question 3

describe the simplified production pathways of bilirubin

Answer 3

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

Question 4

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

Answer 4

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

Question 5

what investigations can be done for jaundice

Answer 5

ultrasound for dilated ducts or liver biopsy

Question 6

what are the features in he liver of obstructive jaundice

Answer 6

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

Question 7

describe hepatitis

Answer 7

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

Question 8

what are the causes and pathology of acute liver disease

Answer 8

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

Question 9

what is the most common cause of severe liver cell injury

Answer 9

alcohol and paracetamol toxicity

Question 10

which viral disease cause severe liver damage

Answer 10

hep ABE

Question 11

what are the causes of chronic liver disease

Answer 11

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

Question 12

what is the pathology of chronic liver disease

Answer 12

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

Question 13

describe the progression of chronic liver disease

Answer 13

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

Question 14

describe how different viruses affect the liver

Answer 14

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

Question 15

how does alcohol affect the liver

Answer 15

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

Question 16

describe what NAFLD is in the liver

Answer 16

non-alcoholic fatty liver disease

associated with metabolic syndrome such as obesity T2DM, hyperlipidaemia

Question 17

what is the most common cause of liver disease

Answer 17

disease associated with NAFLD

Question 18

how does NAFLD change the liver

Answer 18

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

Question 19

what is DILI and how is it classified

Answer 19

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

Question 20

what is the most common symptom of DILI

Answer 20

jaundice

Question 21

what is the most common cause of acute liver failure

Answer 21

paracetamol toxicity

Question 22

what are three types of inherited liver disease

Answer 22

haemochromatosis
wilsons
alpha 1 antitrypsin deficiency

Question 23

describe haemochromatosis

Answer 23

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

Question 24

what is the test for haemochromoatosis

Answer 24

perls stain = blue for iron

Question 25

what does iron accumulation cause in different organs

Answer 25

``` liver - cirrhosis pancreas - diabetes skin - pigment joint - arthritis heart - cardiomyopathy ```

Question 26

describe inherited wilsons disease

Answer 26

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

Question 27

what are copper accumulation in the eye called

Answer 27

Keyser Fleischer rings

Question 28

what is the treatment of Wilson disease

Answer 28

chelate copper

Question 29

describe alpha 1 antitrypsin deficiency

Answer 29

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

Question 30

how can you test for alpha 1 antitryspin deificney

Answer 30

posiitve with PAS diastase stain

Question 31

what do low levels of A1AT lead to

Answer 31

emphysema

Question 32

what is the diagnosis of autoimmune hepatitis

Answer 32

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

Question 33

describe two types of autoimmune liver disease

Answer 33

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

Question 34

what can be used to treat PBC and PSC

Answer 34

urso-deocycholic acid

Question 35

what is a major risk factor for hepatocelualr carcinoma

Answer 35

cirrhosis

Question 36

what is cirrhosis and pathogenesis

Answer 36

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

Question 37

what are the complications of cirrhosis

Answer 37

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

Question 38

what happens during hepatic failure

Answer 38

acute and chronic (end stage liver disease) | lead to caput medusa, spider naevi, ascites and muscle wasting