Liver pathologies

Question 1

What is steatosis?

Answer 1

Excess micro/macrovesicular fat deposits in the liver- an example of reversible cell injury

Question 2

What is steatohepatitis?

Answer 2

Accumulation of fat with accompanying inflammatory changes, assc. w alcohol but can be seen w NAFLD or medication/drugs
Low grade chronic inflamm (NAFLD) or repeated bouts of hepatitis (alcohol) > fibrosis
Accm. of collagen and XC matrix

Question 3

Cause of cirrhosis

Answer 3

Fibrous septa subdividing liver parenchyma into structurally abnormal nodules- end stage of many prog. liver diseases
Alcohol, Hep B and C, iron overload, obesity, autoimmune, biliary disease

Question 4

Healing in the liver

Answer 4

Depends on nature of insult and amount of damage- recurrent, perseistent/ major damage > healing by repair with scarring (cirrhosis, loss of function)

Question 5

What are some of the complications of decompensated liver disease?

Answer 5

Jaundice- impaired breakdown/ accm. bilirubin
Coagulopathy- impaired synth. of blood CF’s
Encephalopathy- hyperammonaemia
Ascites- impaired albumin synthesis, portal HT
Splenomegaly- portal HT
GI bleeding- oesophageal varices

Question 6

Stigmata of chronic liver disease

Answer 6

Caput medusa- distended epigastric veins around umbilicus
Splenomegaly- screening tool for portal HT
Ascites- low albumen, ^ portal HT
Leukonchyia- white fingernails
Flapping tremor of outstretched hand

Question 7

Viral hepatitis

Answer 7

Specifically targets parenchymal liver hepatocytes- most present as acute hepatitis with clinical features w. effects of acute inflamm. and impaired liver function bc liver cell death, but B and C can present with chronic Hep

Question 8

Hepatitis A- characteristics

Answer 8

benign and self limiting, inc period 2-6 wks
Faecooral spread, endemic in countries w/ poor sanitation and hygiene
Liver damage by immune response to virus
Not assc. with chronic hepatitis, cirrhosis or carrier state
RNA virus related to picoravirus

Question 9

Hepatitis B- characteristics

Answer 9

present as acute hepatitis with recovery/fulminant hep w/ massive necrosis
blood, sexual transmission
chronic disease- 5% > cirrhosis, hepatocellular carcinoma
asymptomatic carrier state

Question 10

Hepatitis C- characteristics

Answer 10

Spread by blood products, contamination (tattoos/iv drug users) and haemophiliacs
often asymptomatic/ unrecognised initial infection
progression to chronic hep not uncommon w/ cirrh

Question 11

What are some examples of autoimmune liver diseases?

Answer 11

AI hepatitis- chronic hepatitis
Primary biliary cirrhosis (cholangiopathy)
Sclerosing cholangitis

Question 12

What is the difference between PBC and PSC?

Answer 12

PBC targets intrahepatic bile ducts, PSC can be both extra/intrahepatic bile ducts- both assc. w cholestasis

Question 13

What are the characteristics of autoimmune hepatitis?

Answer 13

Chronic which may have indolent/rapidly prog. course
- 70% female, absence of serologic evidence of viral infection
^ serum IgG
+ve autoantibodies, anti SM
Assc. with other forms of AI disease e.g rheumatoid arthritis, thyroiditis, sjorgens syndrome, UC

Question 14

Primary biliary cholangiopathy

Answer 14

Chronic AI progressive destruction of intrahepatic bile ducts- normal radiology
90% female
Positive anti- mitochondrial autoantibodies
may be ANA/ ANCA positive- assc. w/ sjorgen’s syndrome, scleroderma and thyroid disease

Question 15

Primary sclerosing cholangitis

Answer 15

Chronic inflamm. destruction of extra/intrahepatic ducts with beading of bile ducts on MRI/ ERCP
70% male, assc. with chronic inflam. bowel disease, AI pancreatitis
up to 2/3 positive ANCA antibodies