pathology of the liver and cirrhosis Flashcards
weight of normal liver
1500g
what is the driving limit
80mg/dl
naive drinker, very drunk 200mg/dl to 300mg/dl for risk of dying (>350mg/dl if chronic)
some tolerate up to 600mg/dl before dying of alcohol toxicity
what is chronic alcoholic liver disease
fatty change (steatosis)
hepatitis)
cirrhosis
what enzyme is raised in chronic alcohol misuse
gamma-glutamyltransferase (GGT)
ALT (alanine transaminase)
AST (aspartate aminotransferase)
both raised upon liver damage, ALT more specific
what does an LFT test for
bilirubin total protein albumin ALT AST ALP (alkaline phosphatase) GGT Prothrombin time (PT)
what do haematological tests find in chronic alcohol misuse
Fe deficiency anaemia (dec Hb and MCV)
Folate and B12 deficiency (inc MCV)
Raised INR - clotting abnormalities
Tendency to bleed
what is the pathogenesis of alcoholic steatosis
inc precursors of fat synthesis
reduced breakdown of fat
reduced hepatic excretion of fat
fatty change of liver is reversible on abstention
what are other causes of steatosis
known as non alcoholic fatty liver disease (complicated by inflammation/hepatitis to become non alcoholic steatohepatitis) T2 DM Obesity High BP/cholesterol metabolic syndrome 50+ smoke
what is alcoholic heaptitis
acute hepatitis (ass with jaundice, unwell, polymorphs or neutrophils in liver) chronic hepatitis (doesn't abstain so progression of fibrosis to cirrhosis, lymphocytes infiltrate liver)
what is done when alcoholic hepatitis is suspected
liver biopsy
fibrosis (loss of colour, fatty change, lymphocytes)
what are the complications of a liver biopsy
bleeding
pain
infection
accidental injury to nearby organ
what irreversible cirrhosis
irreversible stage of liver disease
fibrosis/scarring and modularity
repeated inflammation and healing process to regenerate hepatocytes into nodules separated by scars
classified by nodule size (macro-nodular >3mm, micro-nodular <3mm)
how does normal liver compare to fatty liver and cirrhosis
normal - pink
fatty liver - large droplets of fat visible
cirrhosis - fibrosis (dark) surrounding (lighter) nodules
what are other causes of cirrhosis
alcohol (60-70%) viral hepatitis (B, C, D, E etc) primary biliary cirrhosis primary haemochromatosis wilsons disease alpha-1-antitrypsin deficiency cryptogenic
complications of cirrhosis
portal hypertension
liver failure (jaundice, hypoproteinanaemia, bleeding, hepatic encephalopathy)
ascites
hepatocellular carcinoma
what is portal hypertension
caused by fibrosis
blood flow through liver impeded so blood finds alternative via spleen or oesophagus (collateral circulation causing splenomegaly and oesophageal varices)
what is the triad of portal hypertension
cirrhosis
oesophageal varices (bleeding ME)
splenomegaly
causes of bleeding in alcoholic patient
oesophageal varies epic ulcer mallory weiss tear haemorrhagic gastritis reflux oesophagi's with ulceration
what is a mallory Weiss tear
occur at oesophagi-gastric junction when patent vomits and retches against closed cardiac sphincter
what is a peptic ulcer
main cause is helicobacter infection and NSAIDS
alcohol irritates gastric mucosa and exacerbates
alcohol related deaths
alcohol toxicity RTAs Sudden death in fatty liver due to metabolic acidosis resulting in cardiac arrhythmia haemorrhage liver failure (cirrhosis)
what are the most common tumours in the liver
most are metastatic from GIT (usually multiple)
primary cancer - hepatocellular carcinoma or associated raised alpha-feto protein
complications of gall stones
biliary colic acute cholecystitis empyema of GB perforation of GB mucocoele of GB porcelain GB carcinoma obstructive jaundice secondary biliary cirrhosis ascending cholangitis liver abscess pancreatitis gallstone ileus
