Pathology of liver disease

Question 1

Define Steatosis

Answer 1

Accumulation of fat within the hepatocytes in the liver, injury to liver is reversible

Question 2

Define Steotohepatitis

Answer 2

Accumulation of fat accompanying inflammatory changes

• often alcohol related but can be NAFLD (non-alcohol fatty liver disease)
• if alcohol related can get bouts of hepatitis which lead to fibrosis
• if NAFLD can get low grade chronic inflammation which leads to fibrosis

Question 3

How is fibrosis tested for?

Answer 3

Ultrasound probe to measure stiffness (elastography) of liver can also measure degree of fatty change

Question 4

What are the three ways alcohol can affect the liver?

Answer 4

1) Hepatitis
2) Steatosis
3) hepatitis and steatosis can then lead to cirrhosis

Question 5

Definition cirrhosis

Answer 5

Diffuse process (i.e. affects whole liver) in which fibrous septa subdivide liver parenchyma to form abnormal nodules (scar) in the liver

Question 6

What factors may cause Cirrhosis?

Answer 6

• Alcohol
• Obesity
• Hep A and Hep B
• Autoimmune liver disease
• biliary disease
• Iron overload

Question 7

What are the complications which can occur form liver disease and what causes each

Answer 7

Jaundice
Splenomegaly - enlarged spleen caused by portal hypertension
Encephalopathy - damage to brain caused by hyperammonaemia
GI bleeds - caused by oesophageal varices
Coagulopathy - clotting factors aren’t synthesised
Ascites - cause portal hypertension and albumin not synthesised

Question 8

Signs of chronic liver disease

Answer 8

Distended epigastric veins (Caput medusa)
Enlarged spleen
White fingernails: Leukonychia 
Flapping tremor  
Distension of abdomen (ascites)

Question 9

Describe Autoimmune hepatitis?

Answer 9

• Chronic can progress rapidly
• Usually in females
• get elevated serum igG but no infection
• test presence of autoantibodies

Question 10

Describe pathology and test for Primary Biliary Cholangiopathy?

Answer 10

• chronic autoimmune progressive destruction of intra-hepatic bile ducts
• test for anti-mitochondrial autoantibodies
• can be positive for ANA or ANCA autoantibodies

Question 11

Describe Pathology and test fro Primary Sclerosing Cholangitis?

Answer 11

• Chronic inflammatory destruction of extra and intra hepatic bile ducts
• most are positive for ANCA autoantibodies