Liver disease (pathology)

Question 1

Why learn about liver disease?

Answer 1

Bleeding risk
-reduced synthesis of clotting factors
Infection risk
-pts may have hep B and C

Question 2

About liver

Answer 2

Lots of blood goes through liver
Big organ
From blood liver does lots of things e.g. produces bile
-bile goes down bile ducts into duodenum
Gall bladder stuck on side
-cul de sac
-bile can be produced here and squirted out when needed

Question 3

Too much work in

Answer 3

Prehepatic jaundice
Too many breakdown products for liver to deal with
E.g. haemolytic anaemia
-genetic variant –> RBCs fragile
-break down much more quickly than normal
-can cause jaundice
-breaking down goes on in spleen –> splenomegaly (if you remove spleen they won’t get jaundice)
-LOOK AT PICTURES OF BLOOD CELLS

Question 4

Too little liver tissue to process normal amounts

Answer 4

Hepatic jaundice
People end up with jaundice and liver failure
E.g. cirrhosis
-end stage of liver disease
-knobbly liver, lots of fibrosis and regenerative nodules

Question 5

Jaundice is indicated of

Answer 5

Too much bilirubin?

Question 6

General mechanism of cirrhosis

Answer 6

Damage to liver cells –> inflammation around liver cells –> regeneration of liver cells
If it goes on for long enough
Inflammation around liver cells leads to some healing by fibrosis –> cirrhosis

Question 7

Incidence of cirrhosis

Answer 7

Hepatitis viruses can cause cirrhosis
-high levels where Hep B and C are high
Old soviet union - alcohol consumption

Question 8

Causes of cirrhosis

Answer 8

Hepatitis viruses

Alcohol - damages liver

Question 9

Consequences of cirrhosis

Answer 9

Liver failure
-can't clear toxic products out of body including bilirubin --> jaundice
Portal hypertension
Ascites
Hepatocellular carcinoma
-rare but occurs in cirrhosis

Question 10

Ascites

Answer 10

Low albumin production

Increased blood pressure due to portal hypertension

Question 11

Portal hypertension

Answer 11

> in BP in the portal vein, which carries blood from bowel and spleen to liver
-p in portal vein may rise because the resistance in liver is > because of scarring (fibrosis) or cirrhosis
-> in p in the portal vein as a result
Big dilated veins in oesophagus can rupture –> people bleed to death
Rectal varices

Question 12

Blockage to flow of bile out of liver

Answer 12

Post hepatic jaundice
Toxins –> bile –> duodenum
Gall stones can block bile duct
-if they get out of gall bladder they can cause trouble
-causes jaundice
Tumours of duodenum or pancreas
-duct is dilated
-people don’t know about it until they get jaundiced
-painless progressive jaundice - very bad sign