Liver Pathology

Question 1

What is the function of the liver

Answer 1

Fat and carb metabolism via production of bile
Protein synthesis
Removal of toxins

Question 2

What are causes of acute live injury

Answer 2

Hepatitis from viruses alcohol and drugs

Bile duct obstruction

Question 3

List the different hepatitis viruses

Answer 3

A,B,C,E

Question 4

How do the different hepatitis viruses differ from one another

Answer 4

Structurally and mode of transmission

Question 5

What is the pathology of viral hepatitis

Answer 5

Causes cell death and damage to individual cells

Leads to inflammation

Question 6

What percentage of cells need to die for viral hepatitis to cause liver failure

Answer 6

Around 70%

Question 7

What viral hepatitis may resolve acute inflammation

Answer 7

A and E

Question 8

What viral hepatitis may lead to sever damage to liver

Answer 8

A,B and E

Question 9

What viral hepatitis may lead to chronic hepatitis and cirrhosis

Answer 9

A and B

Question 10

What is the pathology of alcoholic liver hepatitis

Answer 10

Acute inflammation 
Liver cell death
Liver failure 
Same as viral 
Can lead to cirrhosis

Question 11

What are the 3 phases for bilirubin metabolism

Answer 11

Pre hepatic
Hepatic
Post hepatic

Question 12

Describe the pre-hepatic stage of bilirubin metabolism

Answer 12

Separation of haemaglobin to haem And globin

Haem is then converted to bilirubin which is released into circulation

Question 13

What is the hepatic stage to bilirubin metabolism

Answer 13

Bilirubin is conjugated in the hepatocytes and released into bilary system

Question 14

Describe post-hepatic bilirubin metabolism

Answer 14

Conjugated bilirubin is more water soluble allowing it to be transported to the small intestine and break it down

Question 15

What is the enterprise-hepatic circulation of bilirubin

Answer 15

Re-absorption of bilirubin back to the liver

Question 16

How can jaundice be classified

Answer 16

By the stage of bilirubin metabolism effected

Question 17

Describe pr-hepatic jaundice

Answer 17

Lysis of red blood cells

Though this is usually small amount of bilirubin

Question 18

What are hepatic causes of jaundice

Answer 18

Cholestatsis

Intra-hepatic bile duct obstruction

Question 19

In relation to hepatic jaundice, what is cholestasis

Answer 19

Accumulation of bile within hepatocytes or bile canaliculi

Question 20

In relation to hepatic jaundice, what are the causes of cholestsasis

Answer 20

Viral hepatitis
Alcoholic hepatitis
Liver failure any cause
Drugs

Question 21

In drug induced cholestasis, are therapeutic drugs most likely to cause predictable or non-predictable reactions

Answer 21

Non-predictable

Question 22

What does it mean if a drug is predictable vs un predictable reaction

Answer 22

Predictable is dose related

Unpredictable is non dose related

Question 23

What are causes of intros-hepatic bile obstruction

Answer 23

Primary bilary cholangitis
Primary sclerosing cholangitis
Tumours of the liver

Question 24

What is primary biliary cholangitis

Answer 24

Organ specific autoimmune disease

Question 25

In someone with primary bilary cholangitis what clinical things should you consider

Answer 25

Female Anti-mitochondrial auto antibodies Raised serum alkaline phosphotase

Question 26

What is the pathology of primary biliary cholangitis

Answer 26

Granulomatous inflammations involving bile ducts Loss of intra-hepatic bile ducts Progression to cirrhosis

Question 27

What is primary sclerosing cholangitis

Answer 27

Chronic inflammation and fibrous obliteration of bile ducts | Loss of intra-hepatic bile ducts

Question 28

Someone presents with inflammatory bile disease, what else may you want to check for

Answer 28

Primary sclerosing cholangitis

Question 29

What is th pathology of primary sclerosising cholangitis

Answer 29

Profession to cirrhosis

Question 30

What specifically causes increased risk of cholangiocarcinoma

Answer 30

Primary sclerosing cholangitis

Question 31

Define hepatic cirrhosis

Answer 31

End stage chronic liver disease effecting whole of liv r

Question 32

What are the causes to cirrhosis

Answer 32

``` Alcohol Hep B and C Immune mediated Metabolic disorders: excess iron (primar haemochromatosis), excess copper (Wilson’s) Obesity, diabetes mellitus ```

Question 33

What are the associated complications with liver cirrhosis

Answer 33

Altered liver function > liver failure Abnormal blood flow > portal hypertension Increased risk of hepstocellulaf carcinoma

Question 34

What are the different liver tumours

Answer 34

``` Hepatocellular carinoma (associate with cirrhosis Cholangiocarcinoma (assoicated with primary biliary cholangitis Metastatic (other alimentary tumours) ```

Question 35

What are post hepatic jaundice causes

Answer 35

Cholelithiasis (gall( Disease of gall Extra-hepatic duct obstruction

Question 36

What are the risk factors for gallstones

Answer 36

Obesity | Diabetes

Question 37

What is the pathology of gall stones

Answer 37

Acute cholecystitis | Chronic cholecystitis

Question 38

What are the outcomes of acute cholecystitis

Answer 38

1) empyema 2) perforation leading to bilary peritonitis 3) progression to chronic

Question 39

What are th symptoms of chronic cholecystitis

Answer 39

Pain when eating | Especially fatty foods

Question 40

What is ascending cholangitis

Answer 40

Inflammation of bile duct due to California organism

Question 41

How is ascending cholangitis formed

Answer 41

Usually secondary to obstruction , gall stones for example