Systems Pathology: Liver Failure

Question 1

Causes of pre-hepatic jaundice

Answer 1

• Usually anything causing increased RBC destruction
• Unconjugated Bilrubin
• Most Bilrubinn comes from Haem in RBC

Question 2

RBC membrane related issues in pre-hepatic jaundice

Answer 2

Genetic - Heriditary Speherocytosis (RBC membrane abnormal and unstable - prone to haemolysis so large turn-over of RBCs)

Acquired - Autoimmune heamolotyic anaemia

• Blood group incompatability in blood transfusion

Question 3

RBC cytoplasm related issues in pre-hepatic jaundice

Answer 3

Genetic - G6PDH deficiency causes RBCs to be unstable

• Haemaglobinopathies; sickle cell, Thalassemia

Acquired: Malaria get into RBC and make it unstable

Question 4

Causes of hepatic jaundice

Answer 4

• Conjugated plus unconjugated Bilrubin
• Due to abnormality in Liver

Question 5

Congenital causes of hepatic jaundice

Answer 5

• Immaturity of liver enzymes - prematurity
• Enzyme defects in processing of Bilirubin e.g. Criglar Najar, Gilbert’s

Question 6

Acquired causes of hepatic jaundice

Answer 6

Viral Hepatitis, Acohol hepatitis

Question 7

Cause of Post-Hepatic jaundice

Answer 7

Conjugated bilrubin

Obstruction to bile flow e.g. gall stone

Question 8

Congenital and acquired causes of post-hepatic jaundice

Answer 8

Cong: Biliary Atresia

Acq: Bile duct problem

• Lumen: gall stone, tumuour, worm
• In wall: tumour, bening structure(fibrosis)
• Outside wall: tumour

Question 9

2 main pathways leading to Acute liver failure

Answer 9

Question 10

Specific causes of acute liver failure

Answer 10

• Alcoholic liver disease
• Paracetamol overdose
• Viral hepatitis(A, B, E)
• Idiosyncratic response to medication e.g. statins
• Acute fatty liver of pregnancy

Question 11

Features of liver failure

Answer 11

Question 12

Classification of Chronic hepatitis by causation

Answer 12

• Hep B, C and D
• Autoimmune
• Drugs
• Metabolic disease
  
  • a1antitrypsin deficiency
  • Wilson’s disease

Question 13

Signs/pathology in chronic hepatitis

Answer 13

• Liver necrosis and inflammation
• Portal tracts, periportal hepatocyte, bridging between portal tracts
• Fibrosis
• Portal expansion, periportal, bridges between portal tracts

Question 14

Which feature is assesed in GRADE and STAGE of chronic hepatitis

Answer 14

GRADE: severity of necrosis and inflammation

STAGE: Extent of fibrosis

Question 15

Pathological feature of cirrhossis

Answer 15

• Fibrosis
• Nodules of regenerated hepatocytes
• Distorted liver architecture
• Final common pathway of chronic liver injury
• Widespread nidules separated by firbours bands
• may be asymptomatic
• Increases portal pressure

Question 16

Consequences of increased portal pressure (from cirrhosis)

Answer 16

Spelomegaly - consumption of blood cells

Varices - enlarged veins shunting blood past liver to systemic circulation, may bleed

Ascites - fluid in abdominal cavity

Question 17

Complications of Cirrhosis

Answer 17

• Variceal haemorrhage
• Spontaneous bacterial peritonitis
• Hepatic encephalopathy
• Chronic liver failure
• Hepatocellular carcinoma