Pathology of the liver

Question 1

What are the 3 zones of the liver?

Answer 1

Pericentral, Periportal and mid acinar

Question 2

How does Cirrhosis manifest?

Answer 2

Insult to hepatocytes ..viral, drug, toxin, antibody

Grading -> degree of inflammation

Staging -> degree of fibrosis

Cirrhosis

Question 3

What are the causes of Acute liver failure?

Answer 3

viruses
alcohol
drugs
bile duct obstruction

Question 4

What is the clinical sign of Acute liver failure?

Answer 4

acute onset of jaundice

Question 5

What is Acetoaminophen Toxicity?

Answer 5

Confluent necrosis produces massive acute necrosis and liver failure
- caused by overdose of drugs (mainly in suicidal patients)

Question 6

What are the consequences of acute liver failure?

Answer 6

complete recovery
chronic liver disease
death from liver failure

Question 7

What can cause pre-hepatic jaundice?

Answer 7

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin

i.e. too much haem to break down

Question 8

What can cause hepatic jaundice?

Answer 8

Acute liver failure (virus,drugs,alcohol)
Alcoholic hepatitis
Cirrhosis (decompensated)
Bile duct loss (atresia, PBC, PSC)
Pregnancy

i.e. liver cells injured of dead

Question 9

What can cause post-hepatic jaundice?

Answer 9

Congenital biliary atresia
Gallstones block CB Duct
Strictures of CB Duct
Tumours (Ca head of pancreas)

i.e. bile cannot escape into the bowel - deadly

Question 10

What are the characteristics of cirrhosis?

Answer 10

Irreversible
Defined by bands of fibrosis separating regenerative nodules of hepatocytes
Macronodular or micronodular (alcoholic)
Alteration of hepatic microvasculature - blood leaving the liver is different to that of a normal person ->
Loss of hepatic function

Question 11

What can cause Cirrhosis?

Answer 11

alcohol
drugs
too much iron 
gallstones
autoimmune liver disease

Question 12

What are the complications of Cirrhosis?

Answer 12

Portal hypertension

Ascites - no albumin so fluid is not drawn back in

Liver Failure

Question 13

What happens when ethanol enters the body?

Answer 13

Ethanol -> acetaldehyde -> acetate

Question 14

What is the effect of acetaldehyde on the body?

Answer 14

toxic and causes liver cell injury

Question 15

What occurs in the liver after 2-3 days of heavy drinking?

Answer 15

Fatty liver

Reversible

Question 16

What occurs in the liver after 4-6 weeks of heavy drinking?

Answer 16

Hepatitis

Reversible

Question 17

What occurs in the liver after months of heavy drinking?

Answer 17

Fibrosis

Irreversible

Question 18

What occurs in the liver after years of heavy drinking?

Answer 18

Cirrhosis

Irreversible

Question 19

What is a fatty liver called?

Answer 19

Steatosis

Question 20

Apart from alcohol, what can also cause fatty liver disease?

Answer 20

NASH - Non-alcoholic steatohepatitis

Pregnancy
Drugs
Nutritional
Diabetes
HCV (type 3)

Question 21

What are the consequences of alcoholic liver disease?

Answer 21

Cirrhosis
Portal hypertension… varices and ascites
Malnutrition
Hepatocellular carcinoma
Social disintegration

Question 22

Describe NASH?

Answer 22

Non-drinkers
Pathologically identical to alcoholic liver disease
Occurs in patients with diabetes,obesity, hyperlipidaemia
May lead to fibrosis, cirrhosis and very common cause of carcinoma

Question 23

What are the rare causes of viral hepatitis?

Answer 23

Ebstein-Barr virus
Yellow fever virus
Herpes Simplex virus
Cytomegalovirus
Delta agent

Question 24

What are the common causes of viral hepatitis?

Answer 24

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E

Question 25

What are the characteristics of Hep A?

Answer 25

Faecal-oral spread Short incubation period Mild illness, usually full recovery No carrier state

Question 26

What are the chracteristics of Hep B?

Answer 26

Spread by blood, blood products, sexually, vertically (in utero) Long incubation period Liver damage is by antiviral immune response Carriers exist Outcome is variable

Question 27

What are the characteristics of Hep C?

Answer 27

``` Spread by blood, blood products, possibly sexually Short incubation period Often asymptomatic Disease waxes and wanes Tends to become chronic or cirrhosis ```

Question 28

What are the outcomes of Hep B?

Answer 28

``` Fulminant acute infection (Death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma Assymptomatic (Carrier) ```

Question 29

What can cause chronic hepatitis?

Answer 29

``` Hepatitis B Hepatitis C Primary Biliary Cirrhosis (PBC) Autoimmune hepatitis Drug induced hepatitis Primary Sclerosing Cholangitis (PSC) ```

Question 30

What is a key indicator of Primary Biliary Cirrhosis?

Answer 30

High anti mitochondria antibodies May see granulomas and bile duct loss

Question 31

Describe the characteristics of autoimmune hepatitis?

Answer 31

``` Commoner in females Associated with other AI diseases Chronic hepatitis pattern Numerous plasma cells Autoantibodies to smooth muscle, nuclear or LKM, raised IgG May have triggers, including some drugs ```

Question 32

What may trigger an autoimmune hepatitis?

Answer 32

chronic drug induced hepatitis

Question 33

Describe Primary Sclerosing Cholongitis?

Answer 33

Chronic inflammatory process affecting intra - and extra-hepatic bile ducts Leads to periductal fibrosis, duct destruction, jaundice and fibrosis Associated with Ulcerative Colitis Males Increased risk of malignancy in bile ducts and colon

Question 34

Name some storage diseases?

Answer 34

Haemochromatosis Wilsons disease Alpha-1-antitrypsin deficiency

Question 35

What is the cause of primary Haemochromatosis?

Answer 35

Genetic condition - excess absorbtion of iron from intestine, abnormal iron metabolism

Question 36

What are the causes of secondary Haemochromatosis?

Answer 36

Iron overload from diet, transfusions, iron therapy

Question 37

What are the consequences of primary haemochromatosis?

Answer 37

Iron deposited in liver, assymptomatic for years Eventually deposited in portal connective tissue and stimulates fibrosis Cirrhosis if not treated and predisposes to carcinoma Also causes diabetes, cardiac failure and impotence

Question 38

What is the therapy for haemochromatosis?

Answer 38

venesection

Question 39

What is Wilsons Disease?

Answer 39

Inherited autosomal recessive disorder of copper metabolism Copper accumulates in liver and brain (basal ganglia)

Question 40

What are the signs and outcomes of Wilsons Disease?

Answer 40

Kayser-Fleischer rings at corneal limbus Low serum caeruloplasmin Causes chronic hepatitis and neurological deterioration

Question 41

What is Alpha-1-antitrypsin deficiency?

Answer 41

Inherited autosomal recessive disorder of production of an enzyme inhibitor Causes empysema and cirrhosis Cytoplasmic globules of unsecreted globules of protein in liver cells