Systems Pathology: Liver Failure Flashcards

1
Q

Causes of pre-hepatic jaundice

A
  • Usually anything causing increased RBC destruction
  • Unconjugated Bilrubin
  • Most Bilrubinn comes from Haem in RBC
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2
Q

RBC membrane related issues in pre-hepatic jaundice

A

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
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3
Q

RBC cytoplasm related issues in pre-hepatic jaundice

A

Genetic - G6PDH deficiency causes RBCs to be unstable

  • Haemaglobinopathies; sickle cell, Thalassemia

Acquired: Malaria get into RBC and make it unstable

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4
Q

Causes of hepatic jaundice

A
  • Conjugated plus unconjugated Bilrubin
  • Due to abnormality in Liver
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5
Q

Congenital causes of hepatic jaundice

A
  • Immaturity of liver enzymes - prematurity
  • Enzyme defects in processing of Bilirubin e.g. Criglar Najar, Gilbert’s
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6
Q

Acquired causes of hepatic jaundice

A

Viral Hepatitis, Acohol hepatitis

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7
Q

Cause of Post-Hepatic jaundice

A

Conjugated bilrubin

Obstruction to bile flow e.g. gall stone

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8
Q

Congenital and acquired causes of post-hepatic jaundice

A

Cong: Biliary Atresia

Acq: Bile duct problem

  • Lumen: gall stone, tumuour, worm
  • In wall: tumour, bening structure(fibrosis)
  • Outside wall: tumour
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9
Q

2 main pathways leading to Acute liver failure

A
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10
Q

Specific causes of acute liver failure

A
  • Alcoholic liver disease
  • Paracetamol overdose
  • Viral hepatitis(A, B, E)
  • Idiosyncratic response to medication e.g. statins
  • Acute fatty liver of pregnancy
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11
Q

Features of liver failure

A
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12
Q

Classification of Chronic hepatitis by causation

A
  • Hep B, C and D
  • Autoimmune
  • Drugs
  • Metabolic disease
    • a1antitrypsin deficiency
    • Wilson’s disease
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13
Q

Signs/pathology in chronic hepatitis

A
  • Liver necrosis and inflammation
  • Portal tracts, periportal hepatocyte, bridging between portal tracts
  • Fibrosis
  • Portal expansion, periportal, bridges between portal tracts
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14
Q

Which feature is assesed in GRADE and STAGE of chronic hepatitis

A

GRADE: severity of necrosis and inflammation

STAGE: Extent of fibrosis

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15
Q

Pathological feature of cirrhossis

A
  • 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
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16
Q

Consequences of increased portal pressure (from cirrhosis)

A

Spelomegaly - consumption of blood cells

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

Ascites - fluid in abdominal cavity

17
Q

Complications of Cirrhosis

A
  • Variceal haemorrhage
  • Spontaneous bacterial peritonitis
  • Hepatic encephalopathy
  • Chronic liver failure
  • Hepatocellular carcinoma
18
Q
A