Liver pathology Flashcards
What is the definition of acute liver disease?
Any insult causing damage to a previously healthy liver, over a duration of less than 6 months
What is acute liver failure defined as?
Encephalopathy and prolonged coagulation
How might acute liver disease present clinically?
Jaundice Lethargy Nausea Anorexia Pain Itch Arthralgia (joint pain) Abnormal LFTs
What are ten causes of acute liver disease?
Viral (hepatitis, EBV etc.) Drugs (ask about paracetamol) Shock liver Cholangitis Alcohol Malignancy Chronic liver disease Budd Chiari Acute fatty liver of pregnancy Cholestasis of pregnancy
What is shock liver?
Hepatic ischaemia
What investigations should be done in acute liver disease?
History Examination LFT's Prothrombin time Ultrasound Virology Liver biopsy (rarely)
What treatment can be given to soothe itch associated with liver disease?
Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid
What antibiotics might cause liver disease?
Co-amoxiclav
Flucloxacillin
NSAIDs
Which self-bought drugs do patients often talk about in history for liver disease?
“Fat burners”
“Protein powders”
What is the definition of fulminant hepatic failure?
Jaundice and encephalopathy in a patient with a previously normal liver
What are some of the complications of fulminant hepatic failure?
Encephalopathy Hypoglycaemia Coagulopathy Circulatory failure Renal failure Infection
Where are the anastomoses between the portal system and the systemic venous system?
Oesophageal & gastric venous plexus (base of oesophagus)
Umbilical vein
Retroperitoneal collateral vessels
Haemorrhoidal venous plexus (rectum)
What may happen to the anastomoses between the systemic and portal venous systems in portal hypertension?
Dilatation
May become varicosed
Rupture
What defines portal hypertension?
Portal vein pressure above the normal range of 5 to 8 mm Hg
What are some prehepatic causes of portal hypertension?
Portal vein thrombosis
Occlusion secondary to congenital portal venous abnormalities
What are some intrahepatic causes of portal hypertension?
Distortion of liver architecture:
Presinusoidal: schistosomiasis, non-cirrhotic portal hypertension
Postsinusoidal: cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis
What is Budd-Chiari syndrome?
A condition caused by occlusion of the hepatic veins
What are some of the signs and symptoms in Budd-Chiari syndrome?
Jaundice Right upper quadrant pain Hepatomegaly Ascites Elevated liver enzymes
What are the three commonest causes of liver cirrhosis?
Alcohol
Hepatitis C
Non-alcoholic fatty liver disease
What is compensated cirrhosis?
Cirrhosis of the liver with an otherwise clinically normal patient - may be an incidental finding
What is decompensated cirrhosis?
Liver failure
What are some of the signs of compensated liver cirrhosis?
Spider naevi Palmar erythema Clubbing Gynaecomastia Hepatomegaly Splenomegaly
What are some of the signs of decompensated liver cirrhosis?
Jaundice
Ascites
Encephalopathy
Bruising
What is encephalopathy?
Brain injury arising from advanced cirrhosis of the liver
In patients with excess alcohol intake, what vitamin supplementation is necessary?
Vitamin B supplements - thiamine
What are two common complications of vitamin deficiency associated with liver cirrhosis?
Osteoporosis
Osteomalacia
How is ascites treated?
Improvement of underlying liver disease
Treatment of infection, if any
Reduce salt intake
Diuretics - preferably spironolactone, add loop in recurrent ascites
What is a transjugular intrahepatic portosystemic shunt?
An artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein
What is spontaneous bacterial peritonitis?
The development of peritonitis (infection in the abdominal cavity) despite the absence of an obvious source for the infection
Can be a translocated bacterial infection of ascites
How is the diagnosis of spontaneous bacterial peritonitis made?
Aspiration of fluid
Neutrophil count >250 cells/mm3
What treatment is given in spontaneous bacterial peritonitis?
Antibiotics and albumin infusion
What is non-alcoholic fatty liver disease?
Fatty liver or steatohepatitis in the absence of another cause
What is the “two-hit” theory of NAFLD?
First hit - excessive fat accumulation
Second hit - oxidative stress, pro-inflammatory cytokine release e.g. TNF-alpha, ischaemia-reperfusion injury
What antibodies can be found in the blood in autoimmune hepatitis?
Antinuclear antibodies
Anti-smooth muscle antibodies
Raised IgG
What is primary biliary cirrhosis?
An autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts of the liver
What antibodies are present in the blood in primary biliary cirrhosis?
Anti-mitochondrial antibodies
Raised IgM
What is liver failure?
Inadequate synthesis of albumin, clotting factors and glucose and inadequate metabolism and elimination of endogenous products e.g. bilirubin, nitrogenous waste, hormones etc.
What are some of the causes of hepatomegaly?
CRAM & FAIL
Cancer
Right heart failure
Alcoholic liver disease
Myeloproliferative diseases
Fatty liver
Amyloidosis
Iron - haemochromatosis
Lymphoma & leukaemia
Why might right heart failure cause hepatomegaly?
The IVC has no valves - backlog of pressure from right heart will extend to liver
What is haemochromatosis?
An issue with iron metabolism & secretion leading to build up in the body
Can be congenital
What are some of the signs of haemochromatosis?
Skin discolouration Diabetes Joint involvement (e.g. arthritis) Pituitary - sexual dysfunction Heart failure
How is haemochromatosis treated?
Removal of a pint of blood every week until ferratin falls below 100
Then - remove 3/4 units a year
What three markers in blood characterise autoimmune hepatitis?
Increased IgG
Antibodies against liver specific and non-liver specific proteins
Infiltration of: monocytes, macrophages, lymphocytes, plasma cells, macrophages and mast cells
What antibodies may be present in autoimmune hepatitis?
Anti-smooth muscle antibodies
Anti-nuclear antibodies
