Pathology of the liver

Question 1

what separates the 2 lobes of the liver?

Answer 1

falciform ligament

Question 2

what is the porta hepatis?

Answer 2

fissure in liver for entry/exit of vessels and ducts into/out of the liver

Question 3

how can you distinguish the portal vein?

Answer 3

greenish bile ducts surround it

Question 4

what is contained within a portal area?

Answer 4

hepatic artery
hepatic vein
bile duct

Question 5

portal areas surround a central vein forming a hexagonal structure, what impact does this have?

Answer 5

hepatocytes closer to central vein have less blood flow

those closer to portal areas have more blood flow

Question 6

the liver is very resistant to injury, how?

Answer 6

large functional reserve
some insults can produce severe parenchymal necrosis but heal entirely by restitution
Can regenerate after partial resection

Question 7

what is the pathogenesis of cirrhosis?

Answer 7

insult to hepatocytes (viral, drugs, toxin, antibody etc)
Grading - degree of inflammation
Staging - degree of fibrosis
Cirrhosis (end stage disease)

Question 8

what is acute liver failure?

Answer 8

acute onset of jaundice

Question 9

what can cause acute liver failure?

Answer 9

viruses
alcohol
drugs (eg. paracetamol causes acute necrosis)
bile duct obstruction

Question 10

what are the consequences of acute liver failure?

Answer 10

complete recovery
chronic liver disease
death from liver failure

Question 11

what are the classifications of jaundice?

Answer 11

pre-hepatic
hepatic
post hepatic

conjugated
unconjugated
- depends on bilirubin

Question 12

what causes pre-hepatic jaundice?

Answer 12

TOO MUCH HAEM TO BREAK DOWN
haemolysis of any cause
haemolytic anaemia
unconjugated bilirubin

Question 13

what causes hepatic jaundice?

Answer 13

LIVER CELLS INJURED OR DEAD
acute liver failure
alcoholic hepatitis
cirrhosis
bile duct loss
pregnancy

Question 14

what causes post-hepatic jaundice?

Answer 14

BILE CANT ESCAPE INTO BOWEL
congenital biliary atresia
gallstones block CB duct
strictures of CB duct
tumours (Ca head of pancreas)

Question 15

what happens in cirrhosis?

Answer 15

irreversible bands of fibrosis separating non functioning nodules of hepatocytes
micronodular (alcohol) and macronodular

Question 16

what can cause cirrhosis?

Answer 16

alcohol
Hep B/C
Iron overload
Autoimmune liver disease
Gallstones

Question 17

what is ERCP?

Answer 17

Method of imaging/treatment of biliary and pancreatic issues

Question 18

what are the possible complications of cirrhosis/liver failure?

Answer 18

portal hypertension
- oesophageal varices
- caput medusa
- haemorrhoids
ascites
oedema
haematamesis
spider naevi
Purpura and bleeding
Coma
Infection

Question 19

what is the mechanism of alcoholic liver disease?

Answer 19

alcohol intake > release/synthesis of fatty acids > acetyaldehyde manifested by formation of Mallory’s hyaline > increased collagen synthesis

Question 20

what is acetylaldehyde?

Answer 20

product of alcohol metabolism responsible for liver cell injury

Question 21

which alcoholic liver diseases are reversible?

Answer 21

fatty liver

hepatitis

Question 22

which alcoholic liver diseases are irreversible?

Answer 22

fibrosis

cirrhosis

Question 23

what is steatosis?

Answer 23

formation of droplets of fat in the liver

occurs in fatty liver

Question 24

what can cause fatty liver?

Answer 24

Alcohol (weekend binge)
Drugs
NASH
pregnancy
Diabetes
Diet
HCV

Question 25

what are the features of alcoholic hepatitis?

Answer 25

Caused by weeks-months of heavy drinking
hepatocyte necrosis
neutrophils
Mallory bodies
pericellular fibrosis

Question 26

what is alcoholic fibrosis?

Answer 26

heavy drinking months-years

collagen is layed down around cells

Question 27

what is non-alcoholic steatohepatitis (NASH)?

Answer 27

non-drinkers
identical to alcoholic liver disease
occurs in:
- diabetes
- obesity
- hyperlipidaemia
May lead to fibrosis/cirrhosis