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M104 Symposia > M104 Alcohol Micha Koenig Synposia > Flashcards

M104 Alcohol Micha Koenig Synposia Flashcards

1
Q

What microstructure makes up the liver?

A

hepatic globules

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2
Q

What are the features of the hepatic globules that make up the liver?

A

chevron pattern
roughly hexagonal in shape
delineated by thin fibrous tissue

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3
Q

What is a portal triad otherwise known as?

A

PORTAL canal, field, area, or tract

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4
Q

What structures does each hepatic lobule consist of?

A

a portal triad, hepatocytes arranged in linear cords between a capillary network, and a central vein

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5
Q

What structures does each portal triad consist of?

A

the portal vein
the bile duct
hepatic arteriole

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6
Q

What structure is in the center of each hepatic lobule?

A

the central vein which ultimately leads out of the liver and ends up at the inferior vena cava

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7
Q

What is present in the sinusoid space?

A

mixed blood flow of hepatic arterial blood and portal field blood being mixed together

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8
Q

How does the lining hepatocytes interact with the contents of the sinusoid space?

A

hepatocytes on either side of the sinusoid have time to interact with mixed blood, to remove toxic metabolites and nutrients for processing

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9
Q

What structure is present between the rows of hepatocytes?

A

bile ductules < bile duct < gall bladder < duodenum

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10
Q

What are the three different zones in the Space of Disse? (PTC)

A

zone 1 - periportal zone
zone 2 - transitional zone
zone 3 - centrilobular zone

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11
Q

What are features of the periportal zone?

A

Lots of arterial blood, so lots of oxygen

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12
Q

What processes occur in the centrilobular zone?

A

oxygen is already mostly used up by all the hepatocytes

most of the metabolism of drugs and antibiotics

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13
Q

Which zone is most vulnerable to injury and why?

A

the centrilobular zone bc this is the area of most metabolic activity, but of least oxygen availability

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14
Q

What is the best investigation performed for patients with suspected liver disease?

A

liver biopsy

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15
Q

What four benefits are obtained from using a liver biopsy to investigate liver disease?

A

a diagnosis can be made
the disease can be staged / graded
treatment can be monitored
prognosis can be informed

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16
Q

What features of a liver biopsy would indicate an increased risk of progression?

A

Microvesicular fatty change
Extensions of fibrosis
the amount of Mallory Denk bodies present
if intrahepatic cholestasis is occuring or not

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17
Q

What are Mallory bodies otherwise known as?

A

Mallory-Denk bodies

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18
Q

What is the amount of Mallory-Denk bodies present an expression of?

A

of how much toxic load goes into the liver

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19
Q

What are the two routes of access to the liver IOT perform a liver biopsy?

A

percutaneous

venous access

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20
Q

Why is the percutaneous method of reaching the liver difficult?

A

bc usually the liver is hidden underneath the diaphragm, so that is a difficult approach often bc you need to go upwards towards the liver
but depending on know what you’re trying to do, it can be possible

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21
Q

What does the venous approach of accessing the liver for biopsy look like?

A

go retrograde through the superior vena cava into the liver, then go through the vessel wall

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22
Q

Is there a problem with using the venous approach to access the liver?

A

No bc the liver is excellent at healing and all that’s being done is a little hole is put into the venous system

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23
Q

Is there a risk to using the venous approach to access the liver?

A

bleeding risk like with any other medical procedure, not usually a problem

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24
Q

What are the three features of alcoholic liver disease?

A

Steatosis
Steatohepatitis
Fibrosis / cirrhosis

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25
Q

What is alcoholic liver disease caused by?

A

liver disease induced by alcohol use a long term alcohol use

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26
Q

What are the two versions of steatosis in alcoholic liver disease?

A

macrovesicular (SINGLE large fat droplets in cells, reversible relatively quickly)
microvesicular (much smaller vesicles of fat filling the cytoplasm, more persistant)

27
Q

What are the two versions of steatohepatitis in alcoholic liver disease?

A

ballooning of hepatocytes
inflammation via neutrophils
necrosis of hepatocytes
the formation of Mallory Denk bodies

28
Q

Is steatosis reversible?

A

if it’s in the early stages and fibrosis has not yet developed, it is completely reversible
macrovesicular streatosis is much more reversible than microvesicular steatosis

29
Q

What are features of Steatohepatitis?

A

microvascular steatosis

ballooning cells

30
Q

How can the early stages of necrosis be seen in the liver?

A

by changes in the liver metabolism

31
Q

What is the process of ballooning in steatohepatitis?

A

cells that are starting to disintegrate and to break up
leads to ballooning where the cells become much bigger but the cytoplasm begins to fragment
AAR, all the cytoplasmic structures start to break down, so the cells die - early stages of necrosis

32
Q

What is associated with balloning in steatohepatitis?

A

inflammation

33
Q

What causes acute inflammation in steatohepatitis?

A

hepatocytes are attacked by neutrophils

34
Q

What causes acute inflammation in steatohepatitis lead to?

A

fibrosis

35
Q

What causes fibrosis in steatohepatitis?

A

there are dead tissues from where hepatocytes have been attacked by neutrophils during acute inflammation
these dead cells are then progressively healed by granulation tissue and deposition of fibrosis - healing by fibrosis / scarring

36
Q

What causes the permanent long term consequences of alcoholic liver disease and why?

A

fibrosis and cirrhosis bc if there is a constant toxic environment of alcohol surrounding all the hepatocytes, then long term change that eventually becomes irreversible is the fibrosis, the healing

37
Q

Does steatosis / fatty change and inflammation cause the permanent long term consequences of alcoholic liver disease and why?

A

no, bc they are acute short term processes, but they will stay on for a long time if alcohol use persists

38
Q

Where does the fibrosis associated with alcoholic liver disease start and why?

A

it starts in zone 3 where there is very little oxygen and lots of metabolism of the toxic metabolites bc this is where most of the damage and the ballooning happens

39
Q

What is the effect of inflammation and necrosis on the substances present during cirrhosis?

A

causes an increase in cytokines and growth factors (TGF-beta, MCP-1) that activate (myo)fibroblasts to deposit collagen in Disse’s space

40
Q

What are the two types of fibrosis in the liver and are they reversible?

A

centrilobular fibrosis - reversible

septal fibrosis - increasingly irreversible

41
Q

What is the effect of macronodular cirrhosis on portal hypertension?

A

increased cirrhosis constricts the portal tract, so that it is surrounded by massive amount of fibrosis, compressing the structures it contains
that is what increases the portal tension or the pressure in the portal venous system

42
Q

What is an uncommon complication of long term fibrosis?

A

hepatocellular carcinoma

43
Q

What is an increased risk associated with hepatocellular carcinoma?

A

it carries a much increased risk of the hepatocytes becoming malignant and making this hepatocellular carcinoma

44
Q

How does fibrosis lead to portal hypertension?

A

a large increase in fibrosis means that there’s an increase in the resistance of blood flowing through the liver, so the pressure in every venous system that drains into the portal vein increases

45
Q

What are the physiologicial effects of portal hypertension?

A

impaired intestinal function and malabsorption
splenomegaly with anaemia and thrombocytopenia
portal bypass circulations
vasodilatation and compensatory increase in cardiac output
toxic metabolites bypass the liver and may cause portosystemic hepatic encephalopathy

46
Q

Where does portal hypertension mainly occur?

A

in the gut - the stomach, the SI, the LI and the spleen.

47
Q

How does portal hypertension cause impaired intestinal function?

A

bc the bp in the intestines rises, the venous pressure also rises so the flow out of the intestines is impaired, resulting in malabsorption

48
Q

Why does portal hypertension cause splenomegaly?

A

bc the total venous outflow of the splenic vein moves into the hepatic portal vein

49
Q

How does splenomegaly cause anaemia and thrombocytopenia?

A

bc it is responsible for increased destruction of blood cells in the in the spleen

50
Q

What are the three types of portal bypass circulations?

A

haemorrhoids
caput medusae
oesophageal veins

51
Q

How does portal hypertension cause portal bypass circulations?

A

bc there is so much resistance going into the liver, so the bypass circulation’s established themselves

52
Q

What venous connection is established in a portal bypass circulation that bypasses the haemorrhoids?

A

between the portal vein and the iliac veins

53
Q

Where do haemorrhoidal venous connections go through?

A

the anal venous plexus

54
Q

How are the caput medusae portal bypass circulation formed?

A

the para umbilical subcutaneous veins swell up so the veins under the skin

55
Q

Where do the caput medusae portal bypass circulation go through?

A

paraumbilical veins

56
Q

What is the most clinically significant bypass circulation?

A

the one travelling via the oesophageal vein

57
Q

What structure do oesophageal vein connections bypass?

A

the liver through the oesophageal plexus

58
Q

Where is the oesophageal plexus located?

A

at the interface between the lower end of the oesophagus and the stomach

59
Q

What structure are oesophageal vein connections associated with?

A

oesophageal veins

60
Q

How does portal hypertension cause vasodilatation?

A

bc it increases venous pressures in the abdominal cavity, so there is an increase in vasodilatation factors released

61
Q

How is vasodilatation caused by portal hypertension compensated?

A

vasodilatation = lowered bp
lowered bp is compensated for by an increase in cardiac output = increased frequency and output volume
causes hyperperfusion

62
Q

What are examples of toxic metabolites that can bypass the liver?

A

NH3, fatty acids, biogenic amines

63
Q

What condition can be caused from toxic metabolites entering the systemic circulation?

A

portosystemic (hepatic) encephalopathy

bc the metabolites are neurotoxic so they impair brain functions

64
Q

What condition can be caused from toxic metabolites entering the systemic circulation and why?

A

portosystemic (hepatic) encephalopathy

bc the metabolites are neurotoxic so they impair brain functions

M104 Symposia (11 decks)

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