Liver Histology Flashcards
What are the parts of the liver acini?
Central vein (middle drains into hepatic vein)
Hepatic artery, vein and bile ductule
Between these two areas are hepatocytes which are split up with venules, arterioles and bile canaliculi as well as sinusoids
What are the causes of raised BR?
Pre hepatic (unconjugated - haemolysis - FBC and blood film) Hepatic (disease, repeat LFTs) Post hepatic (obstructive)
What is the van den Bergh reaction?
The van den Bergh reaction measures serum bilirubin via fractionation.
How does the van den Bergh reaction work?
A DIRECT reaction measures CONJUGATED bilirubin. The addition of methanol causes a complete reaction, which measures total bilirubin (conjugated plus unconjugated); the difference measures UNCONJUGATED bilirubin (an INDIRECT reaction).
Is paediatric jaundice normal?
Yes - should be unconjugated BR due to liver immaturity, may also have Hb drop early on
In which conditions do abnormal paediatric jaundice present?
> Hypothyroidism
> Causes of haemolysis (Coombes test/ DAT)
What is phototherapy?
Converts bilirubin into two other compounds, lumirubin and photobilirubin which are isomers that do not need conjugation for excretion.
In an adult with isolated raised BR, what is the next step?
Repeat with fasting BR to exclude other causes
What condition would cause an isolated and asymptomatic raised BR?
Gilbert’s syndrome
How common is Gilbert’s disease and how is it inherited?
Common- 1 in 20 (5-6% of the population)
Recessive
How do we elucidate gilbert’s?
Worsened by fasting
However, phenobarbital reduces levels
What causes Gilbert’s?
UDP glucuronyl transferase activity reduced to 30%
Unconjugated bilirubin tightly albumin bound and does NOT enter urine.
How is liver function measured?
Albumin
Clotting factors
Bilirubin
How is liver damage measured?
ALT
AST
ALP
GGT
Name some causes for prehepatic, hepatic and post hepatic jaundice
Pre hepatic: Gilberts and haemolysis
Hepatitis: Viral, alcoholic, cirrhosis
Post hepatic: gallstones, pancreatic ca.
How do you discern hepatitis causes?
Viral: titres blood
AI: Biopsy
Alcoholic: Hx and biopsy
Which Antibodies are related to HepA?
IgM and IgG
Which molecules are related to HepB?
HBsAg HBeAg Anti-HBc Anti-HBc IgM Anti HBs Anti HBe
What are the defining histological features of alcoholic hepatitis?
Liver damage: Ballooning, Mallory Denk bodies
Inflammation (neutrophilia)
Fibrosis (collagen around every cell)
Fatty change and mega mitochondria
What is the treatment for alcoholic hepatitis?
Supportive care
Alcohol cessation
Nutritional support incl. vitamins like B1
Occasionally steroids
What are signs of chronic stable liver disease?
Gynaecomastia
Spider naevi
Palmar erythema
Dupytrens contractures
What does caput medusae signify?
Portal hypertension- pressure in the umbilical vein
What are signs of portal hypertension?
Visible veins
Splenomegaly
Ascites
What is lost in liver failure?
> Synthetic function
failed clotting factor and albumin
failed clearance of BR
failed clearance of ammonia
> (encephalopathy)
What is the sequelae of alcoholic hepatitis?
Alcoholic hepatitis
Chronic stable liver disease
Portal hypertension
Liver failure
What are the sites of porto-systemic anastomosis?
Oesophageal varices
Rectal varices
Umbilical vein recanalising
Spleno-renal shunt
What causes itching in jaundice?
Bile salts in obstructive jaundice
What is courvoisiers law?
In the presence of jaundice, if the gall bladder is palpable, the cause is unlikely to be gall stones.
(This is because a gall bladder with stones is usually small and fibrotic and incapable of being large.)
What investigations are appropriate for obstructive jaundice?
US Abdo
-> dilated bile ducts
What is the coombes test for?
Autoimmune haemolytic anaemia
What is a sign that the enterohepatic circulation is intact?
Urobilinogen in the urine
What is PT time?
12-14s
What is the best marker of liver function?
Prothrombin time (function: clotting)
If AST and ALT are very high and Alk Phos is high where is the issue in a jaundice patient?
Hepatic jaundice
What is the timeline of hepatitis A?
virus in faeces/ infectious 2-6 weeks
IgM 3-12 weeks
IgG 5+ weeks
What is the timeline of Hepatitis B?
HBs Ag - 1-6wks HBe Ag - 1.5-4 wks Anti HBc - 2 wks + Anti HBc IgM - 2-9 wks Anti HBe (true infection not vaccine) - 3-10+ wks Anti HBs - 6.5 + (Chronic Hep B in notes)
What does Kwashiorkor cause?
Fatty Liver
Which vein is involved in caput medusa?
Umbilical vein
What happens to the gallbladder when there are gallstones?
Small
