Liver Pathology

Question 1

What is ascites?

Answer 1

Fluid within the peritoneal cavity

Question 2

What four symptoms together characterise decompensated liver disease?

Answer 2

Jaundice, Oedema/ascites, Bleeding, Confusion.

Question 3

What causes confusion in liver disease?

Answer 3

Build up of ammonia as the liver fails to metabolise and detoxify it

Question 4

Why should aspirin not be given to children?

Answer 4

It can cause acute liver failure

Question 5

In what three ways does alcohol affect the liver?

Answer 5

1. Fatty change (reversible) (over weeks)
2. Alcoholic hepatitis (over years)
3. Cirrhosis (irreversible)

Question 6

What is NAFLD?

What is NASH?

Answer 6

Non alcoholic fatty liver disease - associated with insulin resistance.
Non alcoholic steatohepatitis.

Question 7

How does hereditary haemachromatosis damage the liver?

Answer 7

Increased iron absorption leads to increased deposition in the liver. Iron in large quantities is toxic to cells and causes hepatocellular damage and cirrhosis. Treated via venesection.

Question 8

What is Wilson’s disease?

Answer 8

Inability of the body (liver) to incorporate copper into caeruloplasmin, causing a toxic build up and cirrhosis. Also presents with CNS symptoms. Liver transplant inevitably required.

Question 9

How can you differentiate between primary biliary cirrhosis and primary sclerosing Cholangitis clinically?

Answer 9

PBC is AMA positive, PSC is AMA negative

AMA - Antimitochondrial antibodies

Question 10

What are the treatment differences between hepatitis B and C?

Answer 10

Hepatitis B has a vaccine but no cure,
Hepatitis C has a cure but no vaccine.
Hepatitis C may also be symptomatic.

Question 11

What types of antibody present in a blood test would indicate autoimmune hepatitis?

Answer 11

ANA (antinuclear antibody)

ASMA (anti smooth muscle antibody)

Question 12

What does the inferior mesenteric vein drain?

What does the superior mesenteric vein drain?

Answer 12

Inferior - descending colon and rectum

Superior - ascending colon and midgut structures

Question 13

What three veins meet to form the portal vein?

Answer 13

Superior mesenteric,
Inferior mesenteric,
Splenic.

Question 14

What are some causes of portal hypertension?

Answer 14

Cirrhosis, malignancy, hepatitis, alcoholic liver disease.

Question 15

What does portal hypertension lead to?

Answer 15

Ascites - fluid in peritoneum
Splenomegaly due to backup of pressure into splenic circulation
Varices - distension of vessels linking portal and systemic circulation

Question 16

Where might Varices occur?

Which are most concerning?

Answer 16

Oesophagus - vulnerable to rupture, causing haemoptosis
Anorectal - usually painless and rarely bleed
Umbilicus - very rare

Question 17

Explain the pathophysiological process of hepatorenal syndrome

Answer 17

1.Portal hypertension leads to decreased kidney function.
2. splanchnic vasodilation occurs to increase perfusion.
3. Decrease in perceived circulating volume
4. Activation of RAAS
5. Renal artery vasoconstriction
6. Decreased kidney function and perfusion.
Cycle repeats

Question 18

What are the signs of acute pancreatitis?

What is a common cause?

Answer 18

Epigastric pain radiating to the back,
Nausea and vomiting,
Amylase and lipase found in stystemic circulation.
Gallstones occluding the pancreatic duct opening

Question 19

What is jaundice?

What is it a clinical manifestation of?

Answer 19

Yellow discolouration of sclera and skin,

Hyperbilirubinaemia

Question 20

After conjugation by the liver, where is bilirubin excreted and in what forms?

Answer 20

Stercobilin in the duodenum and stool,
Urobilinogen in the kidney and urine.
It may also remain in the enterohepatic circulation.

Question 21

What are prehepatic causes of jaundice?

What type of bilirubin is often found?

Answer 21

Haemolysis,
Haemaglobinopathies.
Unconjugated.

Question 22

What are hepatic causes of jaundice?

What type of bilirubin is found?

Answer 22

Chronic liver disease,
Acute liver disease,
Conjugated and unconjugated.

Question 23

What post hepatic causes are there for jaundice?

Answer 23

Obstruction of biliary tree (most common) by gallstones, malignancy or cirrhosis

Question 24

What signs indicates jaundice is caused by conjugated bilirubin and therefore likely a post hepatic source?

Answer 24

Pale stool and dark urine

Question 25

What is measured in an LFT and why?

Answer 25

Albumin - decreased in chronic liver damage
ALT and AST - raised when hepatocytes are damaged
ALP - indicates damage to bile duct
Bilirubin

Question 26

Why would we order an LFT?

Answer 26

Healthy patient - to get baseline before starting drugs.
Monitor liver conditions.
Help diagnose suspected pathology

Question 27

When else may alkaline phosphatase levels be raised?

What other marker helps differentiate from these?

Answer 27

Bone resorption due to growing bone or malignancy.

Gamma-GT

Question 28

What is the danger for neonates of unconjugated bilirubin?

Answer 28

It can cross the blood brain barrier and cause damage to the developing brain

Question 29

What does raised bilirubin with normal ALT, AST and ALP indicate?

Answer 29

Pre hepatic cause of jaundice - likely haemolytic

Question 30

What does raised ALT and AST with normal bilirubin and ALP indicate?

Answer 30

Hepatocellular damage and no likely jaundice

Question 31

What does raised ALP and bilirubin with raised amylase (normal ALT, AST) indicate?

Answer 31

Post hepatic cause - acute pancreatitis

Question 32

What might a raised ALT, AST, ALP and bilirubin suggest?

Answer 32

Malignancy. These can cause direct hepatocellular damage and obstruction of bile ducts