Liver Diseases 2 Flashcards
Cirrhosis
- A histological diagnosis
- A diffuse and irreversible process
- End results of a variety of diseases causing chronic liver injury
- Resulting from necrosis of liver cells followed by fibrosis and nodule formation
The end result of cirrhosis
- Impairment of liver cell function
- Gross distortion of the liver architecture
- Portal vein hypertension Inefficient organ→ liver failure
Causes of cirrhosis
- Viral, most common world-wide
−HBV, HCV & others (Hep D) - Alcohol, most common in the West
- Autoimmune hepatitis
- Wilson’s disease
- Other causes (e.g., drugs; non-alcohol fatty liver disease)
Pathology of cirrhosis
Fibrosis
Regeneration nodules
- micronodular
- macronodular
- mixed
Clinical features of cirrhosis
- Secondary to portal hypertension & liver cell failure
- Jaundice, fever, loss of body hair, spider angioma, scleral icterus, palmar erythema, gynaecomastia
- De-compensated: with severely impaired liver function & complications
- Compensated cirrhosis: without any of complications
De-compensated
with severely impaired liver function & complications
Compensated cirrhosis
without any of complications
Complications of cirrhosis
- Portal hypertension (variceal haemorrhage)
- Liver failure(portosystemic encephalopathy;hepatorenal syndrome)
- Hepatocellular carcinoma
- Others (e.g. ascites)
Liver tumour
The most common malignant liver tumours are metastatic, particularly those from the GI tract, breast or bronchus
Primary liver tumours may be either benign or malignant
HCC
- HBV and HCV carriers - extremely high risk of developing HCC
- Cirrhosis, particularly due to viral hepatitis
- Others: –Aflatoxin, Androgenic steroids etc, Contraceptive pill (weak association)
Pathology of HCC
- HCC is a stepwise progression: cirrhosis- dysplastic nodules- tumours
- One mass lesion, or multiple masses within the liver
HCC Histological features
- –Most common: liver cells cords lined by endothelial cells, thicker than normal
- –In well-differentiated tumour: neoplastic cells show features of normal hepatocytes
- –In poorly differentiated tumour: the cells are pleomorphic with giant cells
HCC Clinical features
- Signs/symptoms: weight loss, fever, anorexia, ascites & abdominal pain
- Cirrhosis + asymptomatic: identified by AFP & liver US - features → likely HCC
- Cirrhosis + rapid development of above - AFP & liver US
- Cirrhosis + a focal lesion in the liver→ highly likely to be HCC
Cirrhosis + a focal lesion in the liver
highly likely to be HCC
Cirrhosis + asymptomatic
identified by AFP & liver US - features → likely HCC
Cirrhosis + rapid development of above
AFP & liver US
Investigations of HCC
- Serum AFP mayincrease(in 2/3 patients)
- Ultrasound or CT scanning: large filling defects (90% cases)
- MRI or angiography:used when diagnostic doubt
- Biopsy: only performed when diagnostic doubt
- Cirrhosis & a liver mass d>2cm:HCC
Management and Prognosis of HCC
- Surgical resection or liver transplantation: occasionally possible
- Chemoembolisation in selected patients
- Chemotherapy & radiotherapy unhelpful
- Prognosis: survival often < 6month
Alcoholic liver disease
- The most common cause of chronic liver disease in the West
- More common in men, 4thand 5thdecades, although also in 20s.
How does the alcohol act in alcoholic liver disease
Alcohol acts as hepatotoxin; also genetic predisposition and immune mechanisms
Alcoholic liver disease - Major pathological lesions
Alcoholic fatty liver−Alcoholic hepatitis−Alcoholic cirrhosis
Alcoholic fatty liver
- The most common biopsy finding in alcoholic individuals
- Alcohol→fat→accumulation in hepatocytes (steatosis)
Alcoholic fatty liver symptoms
Symptoms usually absent
What do you find in alcohol fatty liver symptoms during examination
Hepatomegaly
Alcoholic fatty liver Lab test
often normal; ↑MCV – heavy drinking;
-GT usually elevated
What happens to alcoholic fatty liver if you keep having alcohol and if you stop?
Fat disappears on cessation of alcohol intake but continued drinking→ fibrosis and cirrhosis
Alcoholic hepatitis pathology
- Liver cell necrosis, infiltration of polymophonuclear leucocytes,
- Mallory body
- May progress to cirrhosis, particularly continued alcohol consumption
Alcoholic hepatitis presentation
a broad spectrum - asymptomatic to very ill with hepatic failure
Alcoholic hepatitis investigations
leucocytosis with elevated bilirubin and transferases (AST and ALT < 500IU/L)
albumin↓
prothrombin time prolonged
Alcoholic hepatitis treatment
Supportive and adequate nutritional intake - Corticosteroids - of benefit in severe disease
What occurs during the final stage of liver disease from alcohol abuse?
Alcoholic cirrhosis
What happens during alcoholic cirrhosis?
Destruction and fibrosis, with regenerating nodules producing a classicmicronodularcirrhosis
Alcoholic cirrhosis symptoms
Patients may be asymptomatic, although often with one of the complications of cirrhosis and signs of chronic liver disease
Alcoholic cirrhosis investigation
Investigation as for cirrhosis in general
Alcoholic cirrhosis management
directed at the complications of cirrhosis, advise patients to stop drinking for life
Alcoholic cirrhosis abstinence improvement
Abstinence improves the 5-year survival rate
