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104 Theme 2 - Liver and Metabolism > Pathology of the liver and cirrhosis > Flashcards

Pathology of the liver and cirrhosis Flashcards

1
Q

How much does a normal liver weigh?

A

Normal liver ~1,500g

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2
Q

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
A
  • 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
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3
Q

How is alcohol toxicity treated?

A

•No antidote for alcohol toxicity

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4
Q

What is chronic alcoholic liver disease?

A
  • Fatty change (steatosis)
  • Hepatitis
  • Cirrhosis
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5
Q

List the liver function tests

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 haematological tests will be abnormal in liver disease?

A
  • Fe deficiency anaemia - ↓ Hb & ↓MCV
  • Folate & B12 deficiency - ↑ MCV
  • Clotting factors related abnormalities →Raised INR
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7
Q

What is the pathogenesis of Alcoholic Steatosis ( fatty liver)?

A

(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

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8
Q

What does this show?

A

Fatty liver

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9
Q

What does this show?

A

Histology of fatty liver

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10
Q

What is NASH?

A

When non-alcoholic fatty liver is complicated

by inflammation/hepatitis → non – alcoholic

steatohepatitis ( NASH)

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11
Q

What is the difference between alcoholic hepatitis leading to chronic/acute hepatitis?

A

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
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12
Q

What is this and what does it show?

A

Alcoholic hepatitis in a liver biopsy.

The inflammation starts in the portal tracts.

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13
Q

Label the diagram of a liver biopsy specimen

A
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14
Q

What does this show?

A

This collagen stain (green) highlights the development of fibrosis in alcoholic liver disease in the biopsy

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15
Q

What is alcoholic cirrhosis?

A
  • Irreversible end stage liver disease
  • Repeated inflammation and the healing process → regeneration of hepatocytes into nodules separated by scar tissue
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16
Q

What is the hallmark feature of alcoholic cirrhosis?

A

•Hallmark of cirrhosis – fibrosis/scarring and nodularity

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17
Q

How is alcoholic cirrhosis classified?

A
  • Classified according to size of the nodules
  • Macro-nodular >3 mm

Micro-nodular < 3 mm

18
Q

What does this show?

A

Micro and macro-nodular cirrhosis

19
Q

Label the 2 key features

A
20
Q

What type of liver is shown?

A
21
Q

What does each slide show?

A
22
Q

What are the non-alcohol causes of cirrhosis?

A
  • alcohol (60 - 70% )
  • viral hepatitis ( B, C, D, E etc )
  • primary biliary cirrhosis
  • primary haemochromatosis
  • Wilson’s disease
  • alpha-1-antitrypsin deficiency
  • Cryptogenic
23
Q

What are the complications of cirrhosis?

A
  • Portal hypertension
  • Liver failure
  • Jaundice
  • Hypoproteinaemia
  • Bleeding
  • Hepatic encephalopathy
  • Ascites
  • Hepatocellular carcinoma
24
Q

How does portal hypertension work?

A
  • 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
25
Q

When does portal hypertension become a medical emergency?

A

•Risk of bleeding from varices – medical emergency

26
Q

What is the triad of portal hypertension?

A

–Cirrhosis

–Oesophageal varices

–Splenomegaly

27
Q

Label the oesophogeal varices

A
28
Q

What are the causes of bleeding in an alcoholic patient?

A
  • Oesophageal varices
  • Peptic ulcer
  • Mallory Weiss tear
  • Haemorrhagic gastritis
  • Reflux oesophagitis with ulceration
29
Q

What is a mallory-weiss tear?

A

•Mallory Weiss tears occur at the oesophago-gastric junction when the patient vomits and retches against a closed cardiac sphincter

30
Q

What are peptic ulcers?

A

•The main causes of peptic ulcers are Helicobacter infection and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

31
Q

What exacerbates mallory-weiss tears and peptic ulcers?

A

•Alcohol irritates the gastric mucosa and exacerbates the effects of above

32
Q

What is this?

A

Mallory weiss tear

33
Q

What is this?

A

Peptic ulcer

34
Q

What does this show?

A

Reflux Oesophagitis at endoscopy

35
Q

What are the 5 main alcohol related deaths?

A

1.Alcohol Toxicity:

≤ 300mg/dl - novice drinker

≥ 350mg/dl - habitual drinker

  1. RTAs: Legal limit - 35mg/dl in breath ; 80mg/dl in blood
  2. Sudden death in fatty liver due to metabolic acidosis resulting in cardiac arrhythmias
  3. Haemorrhage: oesophageal varices; acute gastritis and peptic ulcers
  4. Liver failure – acute/cirrhosis
36
Q

What tumours of the liver is there?

A
  • Most common tumours are metastatic from the GIT
  • Primary cancer:

–Hepatocellular carcinoma

–Associated with raised alpha-feto protein

37
Q

What does this show?

A

CT Scan of metastatic bowel cancer in the liver

38
Q

Are metastatic liver cancers usually single or multiple tumours?

A

Multiple

39
Q

What does this show?

A

Metastatic liver cancers are usually multiple

40
Q

What are the complications of gallstones?

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

104 Theme 2 - Liver and Metabolism (15 decks)

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