Liver disease Flashcards
what is jaundice and the different types
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
what are the various causes of jaundice and the effect on appearance
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
describe the simplified production pathways of bilirubin
produced by RBC breakdown = unconjugated
conjugated in the liver and excreted in bile
reabsorbed in the gut for enterohepatic circulation
what liver enzyme tests can be done and what do they show
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
what investigations can be done for jaundice
ultrasound for dilated ducts or liver biopsy
what are the features in he liver of obstructive jaundice
bile in the liver parenchyma - yellow skin
oedema, portal tract expansion, ductular reaction
bile salts in the skin = itchy
describe hepatitis
inflammation in the liver - non-neoplastic
raised liver enzymes
acute vs chronic
what are the causes and pathology of acute liver disease
asymptomatic, malaise, jaundice, coagulophathy
damage to hepatocytes - inflammatory injury, viral, drug, autoimmune alcohol drugs
cell death inflammation and regeneration
what is the most common cause of severe liver cell injury
alcohol and paracetamol toxicity
which viral disease cause severe liver damage
hep ABE
what are the causes of chronic liver disease
virus, autoimmune drugs fatty liver disease, alcohol, NAFLD iron copper genetic error alpha 1 antitrypsin biliary disease vascular disease
what is the pathology of chronic liver disease
injury to liver cells - scar tissue and regen - dependant on the cause
describe the progression of chronic liver disease
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
describe how different viruses affect the liver
ABC
D only with B
E waterborne associated with zoonosis
EBV CMV HSV usually in immuncompromised
how does alcohol affect the liver
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
describe what NAFLD is in the liver
non-alcoholic fatty liver disease
associated with metabolic syndrome such as obesity T2DM, hyperlipidaemia
what is the most common cause of liver disease
disease associated with NAFLD
how does NAFLD change the liver
insulin resistance
obesity - long term fat storage in liver = steatohepatitis - fibrosis and inflammation, oxidative stress
slow evolution into cirrhosis
what is DILI and how is it classified
drug induced liver injury
intrinsic - paracetamol and predictable
idiosyncratic - rare unpredictable (metabolic and immune)
what is the most common symptom of DILI
jaundice
what is the most common cause of acute liver failure
paracetamol toxicity
what are three types of inherited liver disease
haemochromatosis
wilsons
alpha 1 antitrypsin deficiency
describe haemochromatosis
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
what is the test for haemochromoatosis
perls stain = blue for iron
what does iron accumulation cause in different organs
liver - cirrhosis pancreas - diabetes skin - pigment joint - arthritis heart - cardiomyopathy
describe inherited wilsons disease
copper metab
little caeruloplasmin
copper accumulates in eyes, liver brain
high urinary copper low serum copper and high in liver tissue
what are copper accumulation in the eye called
Keyser Fleischer rings
what is the treatment of Wilson disease
chelate copper
describe alpha 1 antitrypsin deficiency
normally it neutralises proteolytic enzymes from active state
abnormal A1AT - forms globules of glycoprotein - damage liver cells = fibrosis and cirrhosis
how can you test for alpha 1 antitryspin deificney
posiitve with PAS diastase stain
what do low levels of A1AT lead to
emphysema
what is the diagnosis of autoimmune hepatitis
common in women and auto-antibodies against hepatocytes
raised IgG, ALT
can do liver biopsy
describe two types of autoimmune liver disease
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
what can be used to treat PBC and PSC
urso-deocycholic acid
what is a major risk factor for hepatocelualr carcinoma
cirrhosis
what is cirrhosis and pathogenesis
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
what are the complications of cirrhosis
oedema bruising muscle wasting lack of detoxifying ascites jaundice and itching from bile salts infection risk
what happens during hepatic failure
acute and chronic (end stage liver disease)
lead to caput medusa, spider naevi, ascites and muscle wasting
