Liver Pathology

Question 1

What are the normal functions of the liver?

Answer 1

Storage

• glycogen
• vitamins
• iron
• copper

Synthesis

• glucose
• protein
• lipids & cholesterol
• bile
• coagulation factors
• albumin

Metabolism

• bilirubin
• ammonia
• drugs
• alcohol
• carbohydrate/lipids

Question 2

What is cirrhosis?

Answer 2

Irreversible scarring of the liver

Question 3

What happens to the liver in cirrhosis?

Answer 3

Ongoing inflammation
Fibrosis
Hepatocyte necrosis

Question 4

What is the end result of cirrhosis?

Answer 4

Impairment of liver function

Vascular changes - portal hypertension

Question 5

What can cause cirrhosis?

Answer 5

Drugs

• alcohol
• iatrogenic

Infection

• hep b
• hep c

Deposition

• fat
• iron
• copper

Autoimmune

• hepatitis
• primary biliary cirrhosis
• primary sclerosing cholangitis

Other

• α1 antitrypsin
• glycogen storage disease
• budd-chiari disease

Question 6

What are 3 main mechanisms alcohol can affect the liver?

Answer 6

Fatty change
Alcoholic hepatitis
Cirrhosis

Question 7

What are the signs of fatty liver?

Answer 7

Hepatomegaly

Question 8

Is fatty liver reversible?

Answer 8

Yes

Question 9

What are the signs of alcoholic hepatitis?

Answer 9

Rapid onset jaundice
Tender hepatomegaly
Nausea
Oedema

Question 10

Is alcoholic hepatitis reversible?

Answer 10

Yes initially

Question 11

Does hepatitis B have a vaccine?

Answer 11

Yes

Question 12

Does hepatitis B have a cure?

Answer 12

No

Question 13

Does hepatitis C have a vaccine?

Answer 13

No

Question 14

Does hepatitis C have a cure?

Answer 14

Yes

Question 15

What is non-alcoholic liver disease?

Answer 15

Accumulation of triglycerides in hepatocytes - causes similar pathogensis to ALD

Question 16

What is hereditary haemochromatosis?

Answer 16

Abnormal iron metabolism

Question 17

What is the inheritance pattern of hereditary haemochromatosis?

Answer 17

Autosomal recessive

Question 18

What is the effect of hereditary haemochromatosis?

Answer 18

Increased absorption of iron
- excess deposition

Elevated serum iron
Abnormal LFTs

Question 19

How is hereditary haemochromatosis managed?

Answer 19

Venesection

Question 20

What is Wilson’s disease?

Answer 20

Abnormal copper metabolism

Question 21

What is the inheritance pattern of Wilson’s disease?

Answer 21

Autosomal recessive

Question 22

What is the effect of Wilson’s disease?

Answer 22

Reduced secretion of copper from biliary system

- accumulates in tissues

Question 23

What is a sign of Wilson’s disease?

Answer 23

Kayser-Fleischer ring around iris

Question 24

How is Wilson’s disease managed?

Answer 24

Chelating agents

Zinc

Question 25

What is primary sclerosing cholangitis?

Answer 25

Fibrosis of intra and extra hepatic bile ducts

Question 26

Who is more commonly affected by primary sclerosing cholangitis?

Answer 26

Men

Question 27

What are the symptoms of primary sclerosing cholangitis?

Answer 27

Asymptomatic Pruritus Cholangitis Jaundice

Question 28

Which antibody is present in primary sclerosing cholangitis?

Answer 28

ANCA

Question 29

What is primary biliary cirrhosis?

Answer 29

Destruction of intrahepatic bile ducts

Question 30

Who is more commonly affected by primary biliary cirrhosis?

Answer 30

Women

Question 31

What are the symptoms of primary biliary cirrhosis?

Answer 31

Asymptomatic Pruritus +/- jaundice

Question 32

What antibody is present in primary biliary cirrhosis?

Answer 32

AMA

Question 33

What is portal hypertension?

Answer 33

Build up of blood in the portal venous system

Question 34

What cause portal hypertension?

Answer 34

Fibrotic liver - No very expandable - compresses veins entering liver - increased hydrostatic pressure in portal system

Question 35

What are the effects of portal hypertension?

Answer 35

Ascites - increased hydrostatic pressure Varices - shunt from portal to systemic system

Question 36

What are the common sites of varices?

Answer 36

Oesophageal Umbilical Anorectal

Question 37

What are umbilical varices also known as?

Answer 37

Caput medusa

Question 38

What is hepatorenal syndrome?

Answer 38

Development of AKI in the presence of cirrhosis

Question 39

How does hepatorenal syndrome occur?

Answer 39

Portal hypertension Arterial vasodilation - splanchnic artery RAAS activated Renal artery vasoconstriction