Liver Failure & Cirrhosis

Question 1

How many hepatocytes are affected in acute liver failure?

Answer 1

it is a sudden overwhelming insult that kills off a large number of liver cells

Question 2

What usually causes acute liver failure?

Answer 2

1. drugs e.g. paracetamol overdose

2. viruses - Hepatitis A, B, D and E

Question 3

How does the liver regenerate in acute liver failure?

What is the treatment?

Answer 3

the liver cannot regenerate

it requires a super-urgent liver transplant

Question 4

What are the 5 main causes of chronic liver failure?

Answer 4

1. drugs
2. infections and viruses (e.g. Hep B and C)
3. autoimmune disease
4. alcohol
5. obesity

Question 5

What is the background behind how chronic liver failure develops?

Answer 5

through repeated episodes of damage and repair through inflammation, regeneration of residual hepatocytes and repair through scar tissue

Question 6

What happens if chronic liver failure is not treated?

Answer 6

Nodules and fibrosis lead to development of cirrhosis

Question 7

What is significant about the cause of chronic inflammation?

Answer 7

The cause of the injury doesn’t go away

Question 8

What cells tend to be present in chronic inflammation?

Why is this significant?

Answer 8

lymphocytes, eosinophils, plasma cells, macrophages, granulomas

looking at the location of inflammatory cells allows you to try and find the underlying cause of inflammation

Question 9

What is the outcome of chronic inflammation that has progressed?

Answer 9

Fibroblast and blood vessel formation

then formation of scar tissue and fibrosis

Question 10

What is the normal lifespan of liver cells?

How fast can they regenerate?

Answer 10

Lifespan is 6 months

They can regenerate very quickly when they need to

Question 11

What happens when the liver undergoes repair, opposed to regeneration?

Answer 11

The original tissue is replaced by scar tissue

The original structure and function is lost

Question 12

How does increasing damage to liver cells over time affect regeneration?

Answer 12

Increasing damage leads to more scarring and less regenerative potential

Question 13

Why does cirrhosis develop?

Answer 13

Cirrhosis is the end stage of chronic liver disease

It develops when the cause of the liver injury persists alongside the body’s attempts to repair it

Question 14

What happens if cirrhosis is not treated?

Answer 14

There will eventually be insufficient regeneration and this results in liver failure

Question 15

What is the only cure for end stage liver disease?

Answer 15

liver transplantation

Question 16

What is the appearance of a normal liver like?

Answer 16

The surface is smooth and shiny

It is red-brown in colour

Question 17

What is significant about the appearance of a cirrhotic liver?

Answer 17

There are regenerative nodules of hepatocytes

with intervening fibrous septae

Question 18

What are the 2 main causes of chronic liver disease?

Answer 18

1. if the cause of the disease persists
   e. g. infection, autoimmune, alcohol, metabolic
2. chronic inflammation

Question 19

What are the 2 processes that must be present in order for cirrhosis to be diagnosed?

Answer 19

1. nodule formation

2. fibrosis (fibrous septae present)

Question 20

How must cirrhosis be diagnosed?

Answer 20

liver biopsy

Question 21

What viruses commonly cause cirrhosis?

Answer 21

Hepatitis B and C

Question 22

What are common metabolic causes of cirrhosis?

Answer 22

iron and copper storage

obesity

Question 23

Why can bile duct obstruction cause cirrhosis?

Answer 23

it causes continuing inflammation which continues to damage the liver during repair and regeneration

Question 24

What are the 4 main consequences/problems of cirrhosis?

Answer 24

1. portal hypertension
2. oedema
3. risk of infection
4. carcinogenesis

Question 25

What causes portal hypertension?

Answer 25

In a stiffed scarred liver the portal vein blood bypasses the sinusoids The liver cells cannot perform their function There is increased blood flow from the portal vein that increases the pressure inside the liver

Question 26

What can portal hypertension result in?

Answer 26

bleeding oesophageal varices

Question 27

What causes oedema in cirrhosis?

Answer 27

Inadequate liver cell function leads to fluid build-up Hormonal changes and low albumin influence this

Question 28

Why does cirrhosis increase risk of infection?

Answer 28

due to changes in the immune system

Question 29

Why does cirrhosis lead to carcinogenesis?

Answer 29

Liver cells attempt to regenerate themselves so many times This increases the risk of errors occurring and cancer developing

Question 30

What is ascites?

Answer 30

a consequence of cirrhosis where there is a build up of fluid in the abdomen

Question 31

What causes ascites?

Answer 31

when there is low albumin and high portal pressure there is also a change in hormonal regulation of fluid balance this leads to a transudate of fluid into the peritoneal cavity

Question 32

Why is ascites very serious?

Answer 32

it is a very poor prognostic sign that rapidly reduces life expectancy

Question 33

Why must percutaneous liver biopsies only be performed when absolutely necessary?

Answer 33

liver biopsies can lead to intra-abdominal bleeding and even death

Question 34

After someone has had a liver transplant, what symptoms and signs are present post-op?

Answer 34

1. jaundice 2. pruritus (itching) 3. dark urine 4. pale stools 5. high ALP

Question 35

When looking at biopsies, what is a sign of acute cellular rejection after a transplant?

Answer 35

Inflammatory cells around the portal vein Eosinophils and lymphocytes attacking the endothelium of the portal vein