Liver Diseases

Question 1

Portal vein thrombosis

Case: A 46-year-old man is brought to the emergency department by paramedics after an episode of large-volume hematemesis.

• He was going over some papers at work when he suddenly felt nauseous and started vomiting up bright red blood.
• Physical examination reveals a palpable spleen. Endoscopy shows bleeding esophageal varices
• liver biopsy performed 2 days later shows no abnormalities.

Answer 1

• patient is exhibiting signs of portal hypertension, including esophageal varices and splenic enlargement.
• Varices form in portal hypertension due to increased hydrostatic pressure in the portal system that causes blood to be shunted through anastomoses.
• patient’s normal liver biopsy indicates that a presinusoidal process is responsible for the portal hypertension.
• causes obstruction in portal venous flow upstream from the liver, causing portal hypertension while leaving the liver unaffected.
• Ascites is uncommon with portal vein thrombosis since sinusoidal hypertension does not develop.

Question 2

Acetaminophen toxicity

Answer 2

causes centrilobular hepatic necrosis and liver failure 24-48 hours following ingestion, depending on the amount consumed.

Question 3

Long-term alcohol consumption

Answer 3

• causes hepatic cirrhosis, in which hepatocyte damage and death stimulate fibroblast proliferation and fibrosis.
• With continued alcohol consumption, fibrosis outpaces the liver’s regenerative capacity.

Question 4

Budd-Chiari syndrome,

Answer 4

• there is occlusion of the hepatic vein
• hepatic vein drains blood from the liver and portal circulation into the systemic circulation.
• Liver biopsy shows centrilobular congestion and fibrosis.