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LC Gastroenterology Week 6 > Pathology of the Liver > Flashcards

Pathology of the Liver Flashcards

1
Q

Describe the pathogenesis of liver disease?

A

Insult to hepatocytes, viral, drug, toxin, antibody

Grading…. degree of inflammation

Staging… degree of fibrosis

Cirrhosis

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2
Q

What could be the consequences of acute liver failure?

A

Complete recovery
Chronic liver disease
Death from liver failure

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3
Q

Describe pre-hepatic jaundice?

A

Too much haem to break down (increased bilirubin entering the liver)

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin

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4
Q

What is heamolysis?

A

the rupture or destruction of red blood cells.

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5
Q

Describe intra-hepatic jaundice?

A

Liver cells are injured or dead - hepatocellular damage

caused by hepatitis, drugs, cirrhosis, pregnancy

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6
Q

Describe post hepatic jaundice?

A

Bile cannot escape into the bowel - obstruction of bile flow out of the liver (cholestasis)

(cause by, gallstones, biliary stricture, cardonima, sclerosing cholangitis)

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7
Q

What is cirrhosis of the liver?

A

The final common endpoint for liver disease
Irreversible
Alteration of hepatic microvasculature
Loss of hepatic function

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8
Q

What is cirrhosis of the liver usually defined by?

A

Defined by bands of fibrosis separating regenerative nodules of hepatocytes

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9
Q

What are some of the causes of liver cirrhosis?

A 
Alcohol 
Iron overload 
Hepatitis 
Autoimmune disease 
Gallstones
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10
Q

What are some complications of liver cirrhosis?

A

Portal hypertension - leading to varices, caput medusa, haemorrhoids

Ascites

Liver failure

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11
Q

Describe roughly the 4 stages of what happens to the liver depending how long you drink for?

A

Few days - fatty liver (Reversible)
Weeks - hepatitis (reversible)
Months - Fibrosis (irreversible)
Years - Cirrhosis (irreversible)

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12
Q

What might you see in an alcoholic fatty liver?

A

Fat vacuoles appears clear in hepatocytes

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13
Q

What might you see in alcoholic hepatitis?

A

Hepatocyte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis

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14
Q

What might you see in alcoholic fibrosis?

A

Collagen layed down around cells

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15
Q

What might you see in alcoholic cirrhosis?

A

Micronodular cirrhosis with abundant white scarring

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16
Q

What can be the complications of alcoholic liver disease?

A

Cirrhosis
Portal hypertension
Malnutrition
Hepatocellular carinoma

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17
Q

Describe non alcoholic steatohepatitis?

A

Deposition of fat in the liver in non drinkers
Pathologically identical to alcoholic liver disease
Occurs in patients with diabetes, obesity, hyperlipidaemia
May lead to fibrosis and cirrhosis.

18
Q

Describe Hep A - the transmission?

A

Face oral spread

19
Q

Describe hep A?

A 
Short incubation period
Common in gay men/IV drug users
Sporadic or endemic
Directly cytopathic 
No carrier state

Mild illness usually full recovery

20
Q

How is Hep B spread?

A

By blood products, sexually, vertically (in utero)

21
Q

Describe Hep B?

A

Long incubation period
Liver damage is by antiviral immune response
Carriers exist
Outcome is variable

22
Q

How is hep C spread?

A

Blood, sexual intercourse

23
Q

Describe Hep C?

A

Short incubation period
Often asymptomatic
Tends to become chronic

24
Q

What might be the outcome of hep B?

A 
Fulminant acute infection (death)
Chronic hepatitis 
Cirrhosis 
Hepatocellular carcinoma 
Asymptomatic (Carrier)
25
Q

What might be the outcome of hep C?

A

Chronic hepatits

Cirrhosis

26
Q

What is primary biliary cirrhosis?

A

Rare autoimmune disease - unknown aetiology

Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation causes cholestasis (build up of bile in liver) which may lead to fibrosis, cirrhosis and ports hypertension

27
Q

What is primary biliary cirrhosis associated with?

A

Autoantibodies to mitochondria

itch without a rash

28
Q

Describe primary biliary cirrhosis - who gets it more etc?

A

Females (90%) - middle aged
Indication for biopsy - to stage disease
May see granulomas and bile duct loss
Outcome - unpredictable

29
Q

What is autoimmune hepatitis?

A

Chronic condition, more common in females

30
Q

Describe chronic drug induced hepatitis?

A

Similar features to all other types of chronic hepatitis
May trigger an autoimmune hepatitis
Chronic active process

31
Q

What is primary sclerosing cholangitis?

A

Chronic inflammatory process affecting intra and extra-hepatic bile ducts

(progressive fibrosis and obliteration of the biliary tracts)

32
Q

Describe who is more likely to get primary sclerosing cholangitis?

A

Males

Associated with UC

33
Q

What does the chronic inflammation affecting the bile ducts in PSC cause?

A

Bile building up in the liver due to narrowing of bile ducts, bile can cause damage to the liver, can cause cirrhosis and liver failure

Cause jaundice

34
Q

What are the 3 storage diseases?

A

Haemochromatosis
Wilsons disease
Alpha-1-antitrypsiin deficiency

35
Q

What is haemochromatosis?

A

Excess iron within the liver

Primary: Genetic condition, increased absorption of iron

Secondary: Iron overload from diet, transfusions, iron therapy

36
Q

Describe primary haemochormatosis?

A

Inherited autosomal recessie condition
Excess absorption of iron from intestine, abnormal iron metabolism
Worse in men

Iron deposited in the liver for years - asymptomatic
Eventually deposited in the portal CT and stimulates fibrosis

Leads to cirrhosis
Predisposes to carcinoma

37
Q

What is wilsons disease?

A

Inherited autosomal recessvie disorder of copper metabolism

Copper accumulates in the liver and brain

38
Q

What might you find on investigation of wilsons disease?

A

Kayser-fleischer rings

Low serum caeruoplasmin

39
Q

What is alpha-1-antitrypsin deficieny?

A

Inherited autosomal recessive disorder of production of an enzyme inhibitor

40
Q

What does A1AD cause?

A

Emphysema and cirrhosis

41
Q

Describe hepatocellular adenoma?

A

BENIGN
Females
May become larger - can rupture or bleed
Most asymptomatic

42
Q

Describe hepatocullular carcinoma?

A

Rare
Associated with HBV, HCV and cirrhosis
Usually presents as a mass, pain, obstruction
Usually advanced unless discovered incidentally
Poor prognosis

LC Gastroenterology Week 6 (8 decks)

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