Liver Pathology Flashcards
What is ascites?
Fluid within the peritoneal cavity
What four symptoms together characterise decompensated liver disease?
Jaundice, Oedema/ascites, Bleeding, Confusion.
What causes confusion in liver disease?
Build up of ammonia as the liver fails to metabolise and detoxify it
Why should aspirin not be given to children?
It can cause acute liver failure
In what three ways does alcohol affect the liver?
- Fatty change (reversible) (over weeks)
- Alcoholic hepatitis (over years)
- Cirrhosis (irreversible)
What is NAFLD?
What is NASH?
Non alcoholic fatty liver disease - associated with insulin resistance.
Non alcoholic steatohepatitis.
How does hereditary haemachromatosis damage the liver?
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.
What is Wilson’s disease?
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.
How can you differentiate between primary biliary cirrhosis and primary sclerosing Cholangitis clinically?
PBC is AMA positive, PSC is AMA negative
AMA - Antimitochondrial antibodies
What are the treatment differences between hepatitis B and C?
Hepatitis B has a vaccine but no cure,
Hepatitis C has a cure but no vaccine.
Hepatitis C may also be symptomatic.
What types of antibody present in a blood test would indicate autoimmune hepatitis?
ANA (antinuclear antibody)
ASMA (anti smooth muscle antibody)
What does the inferior mesenteric vein drain?
What does the superior mesenteric vein drain?
Inferior - descending colon and rectum
Superior - ascending colon and midgut structures
What three veins meet to form the portal vein?
Superior mesenteric,
Inferior mesenteric,
Splenic.
What are some causes of portal hypertension?
Cirrhosis, malignancy, hepatitis, alcoholic liver disease.
What does portal hypertension lead to?
Ascites - fluid in peritoneum
Splenomegaly due to backup of pressure into splenic circulation
Varices - distension of vessels linking portal and systemic circulation
Where might Varices occur?
Which are most concerning?
Oesophagus - vulnerable to rupture, causing haemoptosis
Anorectal - usually painless and rarely bleed
Umbilicus - very rare
Explain the pathophysiological process of hepatorenal syndrome
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
What are the signs of acute pancreatitis?
What is a common cause?
Epigastric pain radiating to the back,
Nausea and vomiting,
Amylase and lipase found in stystemic circulation.
Gallstones occluding the pancreatic duct opening
What is jaundice?
What is it a clinical manifestation of?
Yellow discolouration of sclera and skin,
Hyperbilirubinaemia
After conjugation by the liver, where is bilirubin excreted and in what forms?
Stercobilin in the duodenum and stool,
Urobilinogen in the kidney and urine.
It may also remain in the enterohepatic circulation.
What are prehepatic causes of jaundice?
What type of bilirubin is often found?
Haemolysis,
Haemaglobinopathies.
Unconjugated.
What are hepatic causes of jaundice?
What type of bilirubin is found?
Chronic liver disease,
Acute liver disease,
Conjugated and unconjugated.
What post hepatic causes are there for jaundice?
Obstruction of biliary tree (most common) by gallstones, malignancy or cirrhosis
What signs indicates jaundice is caused by conjugated bilirubin and therefore likely a post hepatic source?
Pale stool and dark urine
