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module 104 - theme 2 > pathology of the liver and cirrhosis > Flashcards

pathology of the liver and cirrhosis Flashcards

1
Q

what is the legal driving limit?

A

80mg/dl

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2
Q

what is the level of alcohol that puts a naive drinker at risk of death?

A

300mg/dl

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3
Q

what is the level of alcohol that puts a chronic drinker at risk of death?

A

> 350mg/dl

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4
Q

what are the 3 signs of chronic alcohol liver disease?

A
  • fatty change
  • hepatitis
  • cirrhosis
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5
Q

what are the liver function tests (LFT’s)?

A
  • bilirubin
  • total protein
  • albumin
  • alanine transaminase (ALT)
  • aspartate transaminase (AST)
  • alkaline phosphatase (ALP)
  • gamma glutamyl transferase (GGT)
  • prothrombin time (PT)
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6
Q

what is shown on a haematological test if someone has iron deficiency anaemia?

A

decreased Hb and decreased MCV

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7
Q

what is shown on a haematological test if someone has folate ad B12 deficiency?

A

increased MCV

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8
Q

what is shown on a haematological test if someone has a clotting factor related abnormality?

A

raised INR

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9
Q

what is the pathogenesis of alcohol steatosis?

A

1) increased precursors for fat synthesis
2) reduced fat breakdown
3) reduced hepatic excretion of fat
4) fatty change of liver is reversible on abstention

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10
Q

what are the key features of acute hepatitis?

A
  • may be associated with jaundice
  • patient may be very unwell
  • polymorphs/neutrophils in the liver
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11
Q

what are the key features of chronic hepatitis?

A
  • if the patient does not abstain, there is a risk of progression to fibrosis and cirrhosis
  • lymphocytes infiltrate in the liver
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12
Q

what is alcoholic cirrhosis?

A

irreversible end stage liver disease

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13
Q

what are the hallmarks or cirrhosis?

A

fibrosis/scarring and modularity

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14
Q

what does repeated inflammation and the healing process lead to in alcoholic cirrhosis?

A

regeneration of the hepatocytes into nodules separated by scar tissues

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15
Q

what size is a macro-nodule?

A

> 3mm

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16
Q

what size is a micro-nodule?

A

<3mm

17
Q

what are the other causes of cirrhosis?

A
  • alcohol
  • viral hepatitis (B, C, D, E etc…)
  • primary biliary cirrhosis
  • primary haemochromatosis
  • Wilson’s disease
  • alpha-1-antitrypsin deficiency
  • cryptogenic
18
Q

what are the complications of cirrhosis?

A
  • portal hypertension
  • liver failure (jaundice, hypoproteinaemia, bleeding, hepatic encephalopathy)
  • ascites
  • hepatocallular carcinoma
19
Q

what causes portal hypertension?

A

fibrosis

20
Q

what happens with portal hypertension?

A
  • blood flow through the liver is impeded
  • blood finds an alternative route to the heart via the spleen and oesophagus leading to collateral circulation and an enlarged spleen and oesophageal varices
21
Q

what is the triad of portal hypertension?

A
  • cirrhosis
  • oesophageal varices
  • splenomegaly
22
Q

what are the causes of bleeding in alcoholic patients?

A
  • oesophageal varices
  • peptic ulcer
  • mallory weiss tear
  • haemorrhagic gastritis
  • reflux oesophatitis with ulceration
23
Q

where does a Mallory Weiss tear occur?

A

oesophagi-gastric junction

24
Q

when does a Mallory Weiss tear occur?

A

when the patient vomits and retches against a closed cardiac sphincter

25
Q

what is the main cause of peptic ulcers?

A

Helicobacter infection and non-steroidal anti-inflammatory drugs (NSAIDS)

26
Q

what are the main causes of alcohol related deaths?

A

1) alcohol toxicity
2) RTAs
3) sudden death in fatty liver due to metabolic acidosis resulting in cardiac arrhythmias
4) haemorrhage: oesophageal varices; acute gastritis and peptic ulcers
5) liver failure: acute/cirrhosis

27
Q

what are the most common tumours of the liver?

A

metastatic from the GIT

28
Q

what is the primary cancer of the liver?

A
  • hepatocellular carcinoma

- associated with raised alpha-feto protein

29
Q

what are the complications of gall stones?

A
  • biliary colic
  • acute cholecystitis
  • empyema of gallbladder
  • perforation of gallbladder
  • mucocoele of gallbladder
  • porcelain gallbladder
  • carcinoma of gallbladder
  • obstructive jaundice
  • secondary biliary cirrhosis
  • ascending cholangitis
  • liver abscess
  • pancreatitis
  • gallstone ileus

module 104 - theme 2 (18 decks)

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