Pathology of the liver and cirrhosis Flashcards
How much does a normal liver weigh?
Normal liver ~1,500g
What are the following values of alcohol toxicity
- Legal driving limit = ___mg/dl
- Naïve drinker very drunk = ___mg/dl
- Naïve drinker, risk of death = ___mg/dl
- Chronic drinker, risk of death ≥___mg/dl
- Some patients tolerate up to ___mg/dl before death
- Legal driving limit = 80mg/dl
- Naïve drinker very drunk = 200mg/dl
- Naïve drinker, risk of death = 300mg/dl
- Chronic drinker, risk of death ≥350mg/dl
- Some patients tolerate up to 600mg/dl before death
How is alcohol toxicity treated?
•No antidote for alcohol toxicity
What is chronic alcoholic liver disease?
- Fatty change (steatosis)
- Hepatitis
- Cirrhosis
List the liver function tests
- Bilirubin
- Total protein
- Albumin
- Alanine Transaminase (ALT)
- Aspartate Transaminase ( AST)
- Alkaline Phosphatase( ALP)
- Gamma Glutamyl Transferase ( GGT)
- Prothrombin time (PT)
What haematological tests will be abnormal in liver disease?
- Fe deficiency anaemia - ↓ Hb & ↓MCV
- Folate & B12 deficiency - ↑ MCV
- Clotting factors related abnormalities →Raised INR
What is the pathogenesis of Alcoholic Steatosis ( fatty liver)?
(i) Increased precursors for fat synthesis
(ii) Reduced breakdown of fat
(iii) Reduced hepatic excretion of fat
(iv) Fatty change of the liver is reversible on abstention
What does this show?
Fatty liver
What does this show?
Histology of fatty liver
What is NASH?
When non-alcoholic fatty liver is complicated
by inflammation/hepatitis → non – alcoholic
steatohepatitis ( NASH)
What is the difference between alcoholic hepatitis leading to chronic/acute hepatitis?
Acute hepatitis
- May be associated with jaundice
- Patient will be very unwell
- Polymorphs/neutrophils in the liver
Chronic hepatitis
- If the patient does not abstain, there is a risk of progression to fibrosis and cirrhosis
- Lymphocytes infiltrate in the liver
What is this and what does it show?
Alcoholic hepatitis in a liver biopsy.
The inflammation starts in the portal tracts.
Label the diagram of a liver biopsy specimen
What does this show?
This collagen stain (green) highlights the development of fibrosis in alcoholic liver disease in the biopsy
What is alcoholic cirrhosis?
- Irreversible end stage liver disease
- Repeated inflammation and the healing process → regeneration of hepatocytes into nodules separated by scar tissue
What is the hallmark feature of alcoholic cirrhosis?
•Hallmark of cirrhosis – fibrosis/scarring and nodularity
How is alcoholic cirrhosis classified?
- Classified according to size of the nodules
- Macro-nodular >3 mm
Micro-nodular < 3 mm
What does this show?
Micro and macro-nodular cirrhosis
Label the 2 key features
What type of liver is shown?
What does each slide show?
What are the non-alcohol causes of cirrhosis?
- alcohol (60 - 70% )
- viral hepatitis ( B, C, D, E etc )
- primary biliary cirrhosis
- primary haemochromatosis
- Wilson’s disease
- alpha-1-antitrypsin deficiency
- Cryptogenic
What are the complications of cirrhosis?
- Portal hypertension
- Liver failure
- Jaundice
- Hypoproteinaemia
- Bleeding
- Hepatic encephalopathy
- Ascites
- Hepatocellular carcinoma
How does portal hypertension work?
- The fibrosis causes portal hypertension
- Blood flow through the liver is impeded
- Blood finds an alternative route to the heart via the spleen and oesophagus -> collateral circulation -> enlarged spleen & oesophageal varices
When does portal hypertension become a medical emergency?
•Risk of bleeding from varices – medical emergency
What is the triad of portal hypertension?
–Cirrhosis
–Oesophageal varices
–Splenomegaly
Label the oesophogeal varices
What are the causes of bleeding in an alcoholic patient?
- Oesophageal varices
- Peptic ulcer
- Mallory Weiss tear
- Haemorrhagic gastritis
- Reflux oesophagitis with ulceration
What is a mallory-weiss tear?
•Mallory Weiss tears occur at the oesophago-gastric junction when the patient vomits and retches against a closed cardiac sphincter
What are peptic ulcers?
•The main causes of peptic ulcers are Helicobacter infection and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
What exacerbates mallory-weiss tears and peptic ulcers?
•Alcohol irritates the gastric mucosa and exacerbates the effects of above
What is this?
Mallory weiss tear
What is this?
Peptic ulcer
What does this show?
Reflux Oesophagitis at endoscopy
What are the 5 main alcohol related deaths?
1.Alcohol Toxicity:
≤ 300mg/dl - novice drinker
≥ 350mg/dl - habitual drinker
- RTAs: Legal limit - 35mg/dl in breath ; 80mg/dl in blood
- Sudden death in fatty liver due to metabolic acidosis resulting in cardiac arrhythmias
- Haemorrhage: oesophageal varices; acute gastritis and peptic ulcers
- Liver failure – acute/cirrhosis
What tumours of the liver is there?
- Most common tumours are metastatic from the GIT
- Primary cancer:
–Hepatocellular carcinoma
–Associated with raised alpha-feto protein
What does this show?
CT Scan of metastatic bowel cancer in the liver
Are metastatic liver cancers usually single or multiple tumours?
Multiple
What does this show?
Metastatic liver cancers are usually multiple
What are the complications of gallstones?
- 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
