Pathology of the Liver

Question 1

What separated the two lobes of the liver

Answer 1

Ligamentum

Question 2

What is the porta hepatic

Answer 2

entry/exit of vessels in/out of the liver

Question 3

How to distinguish the portal vein

Answer 3

greenish bile ducts around it

Question 4

What is in the portal area

Answer 4

Hepatic artery
hepatic portal vein
bile duct

Question 5

What makes the liver so resistant to injury

Answer 5

Large functional reserve - regenerates

Question 6

What is cirrhosis

Answer 6

Terminal fibrosis of the liver leading to liver failure and death

Question 7

How does cirrhosis come about

Answer 7

Insult to hepatocytes
grading- degree of inflammation
staging - degreee of fibrosis
cirrhosis

Question 8

Acute liver failure causes

Answer 8

Confluent necrosis produces massive acute necrosis of hepatosites and liver failure

Question 9

Common cause of acute liver failure

Answer 9

Paracetamol overdoses, attempted suicide

Question 10

Consequences of acute liver failure

Answer 10

complete recovery
chronic liver disease
death from liver failure

Question 11

What is jaundice

Answer 11

yellowing of the sun/sclera of the eyes due to excess bilirubin

Question 12

All patients with liver disease have jaundice true/false

Answer 12

False

jaundice isn’t just caused by the liver either

Question 13

How is jaundice classified

Answer 13

by site and type 
pre-hepatic 
hepatic 
post-hepatic 
conjugated or uncongugated

Question 14

What is pre-hepatic jaundice

Answer 14

too much haemoglobin break down
haemolysis of all causes
haemolytic anaemia
unconjugated bilirubin

Question 15

What causes hepatic jaundice

Answer 15

LIVER CELLS INJURED/DEAD Acute liver failure
alcoholic hepatitis 
cirrhosis 
bile duct loss 
pregnancy

Question 16

What causes post-hepatic jaundice

Answer 16

Bile cannot escape into bowel 
congenital biliary atresia 
gallstones 
strictures of CBD 
tumours

Question 17

What is cirrhosis

Answer 17

Irreversible fibrosis
final common end point for liver disease
defined by bands of fibrosis separating regenerative nodules of hepatocytes

Question 18

What are the complications of cirrhosis

Answer 18

Portal hypertension 
Oesophageal varies 
Caput medusa 
Haemorrhoids 
Ascites 
Liver failure

Question 19

Cirrhosis is the cause of portal hypertension true/false

Answer 19

True but NOT the only cause

Question 20

What causes alcoholic liver disease

Answer 20

alcohol intake
realise/syntehsis of fatty acids
acetylaldhyde manifested by formation of mallory’s hyaline, increased collagen synthesis

Question 21

What is acetylaldehyde

Answer 21

product of alcohol metabolism- TOXIC

Question 22

What happens to liver after 2-3 days of heavy drinking

Answer 22

Fatty liver

REVERSIBLE

Question 23

What happens to liver after 4-6 weeks of heavy drinking

Answer 23

Hepatitis

REVERSIBLE

Question 24

What happens to liver after heavy drinking for months-years

Answer 24

Fibrosis

IRREVERSIBLE

Question 25

What happens after years of heavy drinking

Answer 25

CIRRHOSIS

IRREVERSIBLE

Question 26

Why do you feel so awful after 2-3 days drinking

Answer 26

Liver so busy trying to get rid of acetylaldehyde it is not carrying out its normal functions

Question 27

Causes of non-alcoholic fatty liver disease

Answer 27

Diabetes 
Pregnancy 
Drugs 
Nutrition 
Hep C

Question 28

What is the outcome of alcoholic hepatitis

Answer 28

Reversible if you stop drinking

Question 29

Features of alcoholic hepatitis

Answer 29

Hepatocyte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis

Question 30

What does alcoholic fibrosis look like

Answer 30

Collagen layer down around cells separating hepatocytes from their blood supply causing neucrosis

Question 31

What is NASH

Answer 31

non-alcoholic steatohepatitis
non-drinkers
occurs in patients with diabetes, obesity, hyperlipidemia
toxic levels of fat building up within hepatocytes

Question 32

What is the commonest cause of chronic liver cancer

Answer 32

NASH not alcohol