Pathology of the Liver Flashcards
What separated the two lobes of the liver
Ligamentum
What is the porta hepatic
entry/exit of vessels in/out of the liver
How to distinguish the portal vein
greenish bile ducts around it
What is in the portal area
Hepatic artery
hepatic portal vein
bile duct
What makes the liver so resistant to injury
Large functional reserve - regenerates
What is cirrhosis
Terminal fibrosis of the liver leading to liver failure and death
How does cirrhosis come about
Insult to hepatocytes
grading- degree of inflammation
staging - degreee of fibrosis
cirrhosis
Acute liver failure causes
Confluent necrosis produces massive acute necrosis of hepatosites and liver failure
Common cause of acute liver failure
Paracetamol overdoses, attempted suicide
Consequences of acute liver failure
complete recovery
chronic liver disease
death from liver failure
What is jaundice
yellowing of the sun/sclera of the eyes due to excess bilirubin
All patients with liver disease have jaundice true/false
False
jaundice isn’t just caused by the liver either
How is jaundice classified
by site and type pre-hepatic hepatic post-hepatic conjugated or uncongugated
What is pre-hepatic jaundice
too much haemoglobin break down
haemolysis of all causes
haemolytic anaemia
unconjugated bilirubin
What causes hepatic jaundice
LIVER CELLS INJURED/DEAD Acute liver failure alcoholic hepatitis cirrhosis bile duct loss pregnancy
What causes post-hepatic jaundice
Bile cannot escape into bowel congenital biliary atresia gallstones strictures of CBD tumours
What is cirrhosis
Irreversible fibrosis
final common end point for liver disease
defined by bands of fibrosis separating regenerative nodules of hepatocytes
What are the complications of cirrhosis
Portal hypertension Oesophageal varies Caput medusa Haemorrhoids Ascites Liver failure
Cirrhosis is the cause of portal hypertension true/false
True but NOT the only cause
What causes alcoholic liver disease
alcohol intake
realise/syntehsis of fatty acids
acetylaldhyde manifested by formation of mallory’s hyaline, increased collagen synthesis
What is acetylaldehyde
product of alcohol metabolism- TOXIC
What happens to liver after 2-3 days of heavy drinking
Fatty liver
REVERSIBLE
What happens to liver after 4-6 weeks of heavy drinking
Hepatitis
REVERSIBLE
What happens to liver after heavy drinking for months-years
Fibrosis
IRREVERSIBLE
What happens after years of heavy drinking
CIRRHOSIS
IRREVERSIBLE
Why do you feel so awful after 2-3 days drinking
Liver so busy trying to get rid of acetylaldehyde it is not carrying out its normal functions
Causes of non-alcoholic fatty liver disease
Diabetes Pregnancy Drugs Nutrition Hep C
What is the outcome of alcoholic hepatitis
Reversible if you stop drinking
Features of alcoholic hepatitis
Hepatocyte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis
What does alcoholic fibrosis look like
Collagen layer down around cells separating hepatocytes from their blood supply causing neucrosis
What is NASH
non-alcoholic steatohepatitis
non-drinkers
occurs in patients with diabetes, obesity, hyperlipidemia
toxic levels of fat building up within hepatocytes
What is the commonest cause of chronic liver cancer
NASH not alcohol
