Pathology of the liver Flashcards
What is the pathology of Alcoholic liver disease?
Production of globules of fatty acids in zone 3, TAG accumulation
Aldehyde production -> liver cell injury, inflammation, fibrosis
Cell necrosis -> cytokine production
Increased production of collagen, neutrophils and mallory cells
What happens after a weekend alcohol binge?
Acute reversible in jury with Steatosis or fatty change
What happens after years of heavy alcohol drinking?
Fibrosis and Micro-nodular Cirrhosis
Masson’s trichome - bands of fibrosis seperating the regenerative tissue
Progression of fatty liver disease
1) Fatty liver - 2-3 weeks
2) Alcoholic hepatitis - 4-6 weeks
3) Fibrosis - months-yrs
4) Micro-nodular cirrhosis - Many years
Is alcoholic hepatitis reversible?
Yes, if the person stops drinking
Is steaosis reversible?t
Yes, if the person stops drinking
Is fibrosis and cirrhosis reversible?
No it isn’t, however its progression can be slowed if the person stop alcohol consumption
What are the outcomes of heavy alcohol consumption?
Cirrhosistes Malnutrition Social disintegration Portal Hypertension HCC Ascites
What are the leading causes of Non-alcoholic liver diseases(NALD)?
type 2 diabetes, hyperlipidaemia, obesity, Features of other metabollic syndromes
“Insulin-resistant state with oversupply of fatty acids”
What is the mechanism of alcoholic liver injury?
Endotoxins->activation of the Kupffer cells =Inflammation
Aldehyde -> Inflammation
-> Hepatocyte injury
-> Stellate cell activation = Fibrosis
Oxidant stress -> Stellate cell activation = Fibrosis
what is alcoholic hepatitis?
It occurs after fatty liver on continued alcoholic consumption for upto 4-6 weeks
Causes the hepatocytes to become balloned and hydropic
How is cirrhosis staged?
It is staged with the Child-Pugh Score
It uses 5 clinical measures - Prothrombin time, Encephalopathy, Jaundice, Serum Albumin and Bilirubin
What is the measure of mortality risk in patients with end-stage liver disease?
MELD score- Model for end stage liver disease
What are the presenting features of Alcoholic Hepatitis?
Onset after 4-6 weeks of continuous alcohol drinking
Fever
Jaundice
Leukocytosis
Hepatomegaly
Hepatic bruit
LFT - Bilirubin > 80 micromol/l
AST < 500 ( AST : ALT > 1.5)What is the management and treatment used for Alcoholic hepatitis?
Stop drinking alcohol
IV Thiamine
Prednisolone ( to reduce mortality in severe cases, only works short term)
Pentoxifylline ( anti - TNF)
