T2 PC Pathology of the liver & cirrhosis

Question 1

What is the weight of a normal liver?

Answer 1

~ 1.5kg

Question 2

What is the legal driving limit?

Answer 2

80mg/dl

Question 3

What does it take to get a naive drinker very drunk?

Answer 3

200mg/dl

Question 4

Is there an antidote for alcohol toxicity?

Answer 4

no

Question 5

What does it put a naive drinker at risk of death?

Answer 5

300mg/dl

Question 6

What does it put a chronic drinker at risk of death?

Answer 6

≥350mg/dl

Question 7

What is the maximum amount of alcohol that can be tolerated before death?

Answer 7

600mg/dl

Question 8

What is the maximum amount of alcohol that can be tolerated before death?

Answer 8

600mg/dl

Question 9

What are features of Chronic Alcoholic Liver Disease?

Answer 9

Fatty change (steatosis)
Hepatitis
Cirrhosis

Question 10

What are the different Liver Function Tests?

Answer 10

Bilirubin, Total protein, Albumin
ALT, AST, ALP
GGT, PT

Question 11

What are the features of alcoholic steatosis (fatty liver)?

Answer 11

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

Question 12

What condition might acute hepatitis be associated with?

Answer 12

jaundice

Question 13

What are features of acute hepatitis be associated with?

Answer 13

Patient will be very unwell
Polymorphs / neutrophils in the liver
Chronic hepatitis
Lymphocytes infiltrate in the liver

Question 14

What happens if acute hepatitis patients do not abstain?

Answer 14

there is a risk of progression to fibrosis and cirrhosis

Question 15

What are hallmarks of cirrhosis?

Answer 15

fibrosis / scarring and nodularity

Question 16

What are features of cirrhosis?

Answer 16

Repeated inflammation and the healing process → regeneration of hepatocytes into nodules separated by scar tissue

Question 17

What are the two main sizes of the nodules in cirrhosis?

Answer 17

Macro-nodular >3 mm

Micro-nodular < 3 mm

Question 18

What are other causes of cirrhosis?

Answer 18

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

Question 19

What are the complications of cirrhosis?

Answer 19

Portal hypertension
Liver failure
Ascites
Hepatocellular carcinoma

Question 20

What conditions are associated with liver failure and result from complications of cirrhosis?

Answer 20

Jaundice
Hypoproteinaemia
Bleeding
Hepatic encephalopathy

Question 21

What is the causal effect of fibrosis on portal hypertension?

Answer 21

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

Question 22

How might portal hypertension result in a medical emergency?

Answer 22

bc there is a risk of bleeding from varices

Question 23

What are the Triad of portal hypertension?

Answer 23

Cirrhosis
Oesophageal varices
Splenomegaly

Question 24

What might causes bleeding in an alcoholic patient?

Answer 24

Oesophageal varices
Peptic ulcer
Mallory Weiss tear
Haemorrhagic gastritis
Reflux oesophagitis with ulceration

Question 25

Where do Mallory Weiss tears occur at?

Answer 25

at the oesophago-gastric junction

Question 26

When do Mallory Weiss tears occur?

Answer 26

when the patient vomits and retches against a closed cardiac sphincter

Question 27

What are the main causes of peptic ulcers?

Answer 27

Helicobacter infection and NSAIDS

Question 28

What are the complications of gall stones?

Answer 28

Acute cholecystitis, Ascending cholangitis
Biliary colic
Carcinoma of gallbladder
Empyema of gallbladder 
Gallstone ileus
Liver abscess
Mucocoele of gallbladder
Obstructive jaundice
Pancreatitis
Perforation of gallbladder
Porcelain gallbladder
Secondary biliary cirrhosis