Liver Problems/diseases Flashcards
What is cirrhosis?
End stage liver disease - result of chronic inflammation over many years
Briefly describe the pathogenesis of cirrhosis.
Firstly, hepatocyte injury leads to progressive liver cell loss.
This then causes chronic inflammation (leading to fibrosis) and hepatocyte regeneration (leading to hyperplastic nodules).
Both of those things cause architectural abnormalities, which leads to cirrhosis and ischaemia (ischaemia causes more progressive liver cell loss and then the problem worsens)
Name some of the causes of cirrhosis (acquired and inherited).
Alcohol or alcohol-like
Biliary disease
Unknown
Heamochromatosis
Name some of the complications of cirrhosis.
Portal hypertension
Liver failure
Hepatocellular (liver) cancer
What are the common complications of portal hypertension?
Portal systemic shunts
Varices
Splenomeagly
What are the three main types of alcoholic liver disease?
Fatty liver - steatosis
Alcohol hepatitis - with and without hepatic fibrosis
Cirrhosis
In hepatic alcohol metabolism, there are two main metabolic pathways. How do they both lead to fatty acid formation?
Both pathways form acetaldehyde.
Acetaldehyde is converted into acetate and then acetyl-CoA.
Acetyl-CoA enters the tricarboxylic acid cycle in the mitochondria, leading to fatty acid formation
Name the two routes of alcohol metabolism
Cytoplasmic alcohol dehydrogenase (ADH)
Microsomes ethanol oxidising system (MEOS)
What are the differences between the two metabolic pathways involved in alcohol metabolism?
ADH - main route, non-inducible MEOS - occurs in the SER - inducible - this route is increased by alcoholism - it uses cP450, which affects the metabolism of other drugs when alcohol is in the system
How does alcohol increase hepatic lipid? (3 ways)
Altered hepatocyte fat metabolism
Increased peripheral fat mobilisation
Rescued lipoprotein synthesis
What are other causes of fatty liver disease? (Excluding alcohol)
Obesity
DM2
Nutritional imbalance
Drugs - e.g. Methotrexate
How can fatty liver disease be seen in microscopy?
Lipid droplet are in the Hepatocytes.
What histological features can be seen in an alcoholic hepatitis liver?
Fatty liver Ballooning of hepatocyte Malory bodies in hepatocyte cytoplasm Hepatocyte necrosis Neutrophil polymorph inflammation Fibrosis
How does alcoholic hepatitis resemble acute hepatitis?
Increased transaminases
How many of chronic alcoholics get alcoholic cirrhosis?
10%
