liver pathology

Question 1

liver functions

Answer 1

energy metabolism = stores glycogen, synth glucose + cholesterol
protein synth
solubilisation of fats
protective + clearance functions eg conversion of ammonia to urea

Question 2

describe bile production + secretion

Answer 2

bile = secreted by liver + stored in gall bladder to be injected into small intestine
water, bile salts, cholesterol, bilirubin
eliminates bilirubin (+non water soluble things)
promote emulsification + absorption

Question 3

describe acute and chronic hepatitis

Answer 3

acute = inflam <6 months -= anorexia, nausea, jaundice, right upper quandratn pain 
chronic = >6 months = asymptomatic or vauge sumptoms  (poor appetite)

Question 4

describe acute fulminant hepatitis

Answer 4

liver failure
underlying is not affected
hyperbilirubinarmia (jaundice), hepatic ecenphalopathy

Question 5

describe steatosis

Answer 5

accumulation of lipid in
hepatocytes
white blobs histologically
can be bc obesity or metabolic syndrome, or alcohol, drugs/toxins

Question 6

describe steatohepatitis

Answer 6

accumulation fat + inflam
hepatocyte death
chronic alcohol consumption + NASH

Question 7

describe cirrhosis

Answer 7

end stage liver disease
scar tissue, liver failure, portal hypertension
irreversible
distorted bile ducts + bv

Question 8

describe cirrhosis patho

Answer 8

injury + loss hepatocytes = inflam mediators -> hyperplasia + angiogenesis -> impinge normal structures -> stellate cells -> dec vit A + proliferative + scar tissue in sinusoidal space -> detioration of hepatocyte function -> fibrosis

Question 9

clinical presentiation about cirrhosis

Answer 9

jaundice, hepatic encephalopathy, coagulability, increased oestrogen,

Question 10

describe jaundice

Answer 10

yellow discolouration bc deposition of bile pigment
inc breakdown rbc
failure liver uptake bilirubin from blood
failure liver conjugate or excretion
obstruction biliary excretion into intestine

Question 11

describe hyperoestrogenism

Answer 11

MEN = gynaecomastia
women = menstrual irregularities
spider noevi = dilated small bv

Question 12

describe portal hypertension

Answer 12

scarring distorts vascular architecure = blood cant flow from portal -> hepatic vein = inc pressure

Question 13

describe porto-systemic anastomoses

Answer 13

compensate for portal hypertension => inc blood flow through veins
causes: oesphageal varices, dilations of umbilical veins, haemorrhoids

Question 14

what is caput medusae

Answer 14

appearance of distended + engorged superficial epigastric veins
radiating from umbilicus across abdomen

Question 15

what is oesophageal varices

Answer 15

dilates oes. veins

common comp = bleeding, exacerabted by coagulopathy from cirrhosis

Question 16

describe splenomegaly

Answer 16

inc pressure prevents draining og splenic cein => engorged spleen with blood
=> hypersplenism => inc removal platelets, inc rbc, dec wbc

Question 17

describe ascites

Answer 17

Increased extravascular fluid accumulates in the peritoneal
cavity
inc presure in caps -> dec albumin = dec oncotic pressure
big bloating of stomach

Question 18

describe hepatic encephalopathy

Answer 18

inc ammonia w/bloodstream
bc dec functon hepatocutes => shunting ammonia from intestine to circulation
ammonia -> BBB -> atrocyte process to glutamine -> ICP ->inc distance between caps and neuorons => preventing nutrients reaching -> glutamine = ntsm imbalance

Question 19

waht are the symptoms of encephalopathy

Answer 19

astrerixis (flapping hand motion)

imbalance, cant concentrate, mood change, disordered sleep

Question 20

describe cirrhosis and heaptocellular carcinoma

Answer 20

primary risk factor

repeated hepatocyte damage -> cirrhosis -> HCC

Question 21

describe hep A

Answer 21

faecal oral
acute
anorecia, nausea, jaundiace
benign + self limiting

Question 22

describe hep B

Answer 22

Blood, semen, vaginal fluid Perinatal (through deliery)
acute or chronic
asymptomatic but infectious
ground glass cytoplasmic inclusions

Question 23

describe hep C

Answer 23

Blood
acute
progress to chronic hep
inflammation, variable steatosis, progressive fibrosis
highly variable, hard for immune system to respond

Question 24

describe hep D

Answer 24

blood 
HBV to enter hepatocytes 
coinfection = HBV + HDV 
superinfection = chronic HBV then HDV 
bad prognosis -> cirrhosis

Question 25

describe hep E

Answer 25

faecal-oral (water-borne)
rare
acute
can cause fulminant hep when assoiciated with pregnancy

Question 26

effects of excess alcohol intake

Answer 26

metabolism process alcohol -> accumulation of fat in hepatocytes (steatosis) -> damage protein export -> inflam cells -> stellate cells -> fibrosis -> steatohepatitis -> cirrhosis

Question 27

what is the progression of alcoholic liver disease

Answer 27

chronic alcohol consumption -> healthy liver -> alcoholic fatty liver -> alcoholic steatohepatitis -> (can get alcoholic hepatitis) -> alcoholic cirrhosis -> hepatocellular cancer

Question 28

describe non-alcoholic steatohepatitis (NASH)

Answer 28

metabolic syndrome associated
- obesity, hyperlipidaemia, hypertension, insulin resistance
lipid accumulation liver => hepatocellular lipotoxicity -> inflam response
10-30% develop cirrhosis