Liver Diseases 2

Question 1

Cirrhosis

Answer 1

• 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

Question 2

The end result of cirrhosis

Answer 2

• Impairment of liver cell function
• Gross distortion of the liver architecture
• Portal vein hypertension Inefficient organ→ liver failure

Question 3

Causes of cirrhosis

Answer 3

• 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)

Question 4

Pathology of cirrhosis

Answer 4

Fibrosis

Regeneration nodules
- micronodular
- macronodular
- mixed

Question 5

Clinical features of cirrhosis

Answer 5

• 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

Question 6

De-compensated

Answer 6

with severely impaired liver function & complications

Question 7

Compensated cirrhosis

Answer 7

without any of complications

Question 8

Complications of cirrhosis

Answer 8

• Portal hypertension (variceal haemorrhage)
• Liver failure(portosystemic encephalopathy;hepatorenal syndrome)
• Hepatocellular carcinoma
• Others (e.g. ascites)

Question 9

Liver tumour

Answer 9

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

Question 10

HCC

Answer 10

• 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)

Question 11

Pathology of HCC

Answer 11

• HCC is a stepwise progression: cirrhosis- dysplastic nodules- tumours
• One mass lesion, or multiple masses within the liver

Question 12

HCC Histological features

Answer 12

• –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

Question 13

HCC Clinical features

Answer 13

• 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

Question 14

Cirrhosis + a focal lesion in the liver

Answer 14

highly likely to be HCC

Question 15

Cirrhosis + asymptomatic

Answer 15

identified by AFP & liver US - features → likely HCC

Question 16

Cirrhosis + rapid development of above

Answer 16

AFP & liver US

Question 17

Investigations of HCC

Answer 17

• 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

Question 18

Management and Prognosis of HCC

Answer 18

• Surgical resection or liver transplantation: occasionally possible
• Chemoembolisation in selected patients
• Chemotherapy & radiotherapy unhelpful
• Prognosis: survival often < 6month

Question 19

Alcoholic liver disease

Answer 19

• The most common cause of chronic liver disease in the West
• More common in men, 4thand 5thdecades, although also in 20s.

Question 20

How does the alcohol act in alcoholic liver disease

Answer 20

Alcohol acts as hepatotoxin; also genetic predisposition and immune mechanisms

Question 21

Alcoholic liver disease - Major pathological lesions

Answer 21

Alcoholic fatty liver−Alcoholic hepatitis−Alcoholic cirrhosis

Question 22

Alcoholic fatty liver

Answer 22

• The most common biopsy finding in alcoholic individuals
• Alcohol→fat→accumulation in hepatocytes (steatosis)

Question 23

Alcoholic fatty liver symptoms

Answer 23

Symptoms usually absent

Question 24

What do you find in alcohol fatty liver symptoms during examination

Answer 24

Hepatomegaly

Question 25

Alcoholic fatty liver Lab test

Answer 25

often normal; ↑MCV – heavy drinking;
-GT usually elevated

Question 26

What happens to alcoholic fatty liver if you keep having alcohol and if you stop?

Answer 26

Fat disappears on cessation of alcohol intake but continued drinking→ fibrosis and cirrhosis

Question 27

Alcoholic hepatitis pathology

Answer 27

• Liver cell necrosis, infiltration of polymophonuclear leucocytes,
• Mallory body
• May progress to cirrhosis, particularly continued alcohol consumption

Question 28

Alcoholic hepatitis presentation

Answer 28

a broad spectrum - asymptomatic to very ill with hepatic failure

Question 29

Alcoholic hepatitis investigations

Answer 29

leucocytosis with elevated bilirubin and transferases (AST and ALT < 500IU/L)

albumin↓

prothrombin time prolonged

Question 30

Alcoholic hepatitis treatment

Answer 30

Supportive and adequate nutritional intake - Corticosteroids - of benefit in severe disease

Question 31

What occurs during the final stage of liver disease from alcohol abuse?

Answer 31

Alcoholic cirrhosis

Question 32

What happens during alcoholic cirrhosis?

Answer 32

Destruction and fibrosis, with regenerating nodules producing a classicmicronodularcirrhosis

Question 33

Alcoholic cirrhosis symptoms

Answer 33

Patients may be asymptomatic, although often with one of the complications of cirrhosis and signs of chronic liver disease

Question 34

Alcoholic cirrhosis investigation

Answer 34

Investigation as for cirrhosis in general

Question 35

Alcoholic cirrhosis management

Answer 35

directed at the complications of cirrhosis, advise patients to stop drinking for life

Question 36

Alcoholic cirrhosis abstinence improvement

Answer 36

Abstinence improves the 5-year survival rate