PC - Pathology of Liver & Cirrhosis

Question 1

Liver Function Tests

Answer 1

Bilirubin
Total protein
Albumin
Alanine Transaminase (ALT)
Aspartate Transaminase ( AST)
Alkaline Phosphatase( ALP)
Gamma Glutamyl Transferase ( GGT)
Prothrombin time (PT)

Question 2

Haematological Tests

Answer 2

Fe deficiency anaemia - ↓ Hb & ↓MCV
Folate & B12 deficiency - ↑ MCV
Clotting factors related abnormalities →Raised INR
Why do patients with chronic liver disease have the tendency to bleed

Question 3

Pathogenesis of Alcoholic Steatosis

Answer 3

Increased precursors for fat synthesis
Reduced breakdown of fat
Reduced hepatic excretion of fat
Fatty change of the liver is reversible on abstention

Question 4

Alcoholic Hepatitis

Answer 4

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

Question 5

Alcoholic Cirrhosis

Answer 5

Irreversible end stage liver disease
Hallmark of cirrhosis – fibrosis/scarring and nodularity
Repeated inflammation and the healing process → regeneration of hepatocytes into nodules separated by scar tissue
Classified according to size of the nodules
Macro-nodular >3 mm
Micro-nodular < 3 mm

Question 6

Complications of cirrhosis

Answer 6

Portal hypertension
Liver failure 
- Jaundice
- Hypoproteinaemia
- Bleeding
- Hepatic encephalopathy
Ascites
Hepatocellular carcinoma

Question 7

Portal Hypertension

Answer 7

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                           
Risk of bleeding from varices – medical emergency
Triad of portal hypertension
- Cirrhosis
- Oesophageal varices
- Splenomegaly

Question 8

Causes of bleeding in an alcoholic patient

Answer 8

Oesophageal varices
Peptic ulcer
Mallory Weiss tear
Haemorrhagic gastritis
Reflux oesophagitis with ulceration 
Combined mallory weiss tear and peptic ulcer: occur at the oesophago-gastric junction when the patient vomits and retches against a closed cardiac sphincter; main cause of Helibacter infection and non-steroidal anti-inflammatory drugs; alcohol irritates gastric mucosa & exacerbates effects above

Question 9

Complications of Gall Stones

Answer 9

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