T2 PC Pathology of the liver & cirrhosis Flashcards
What is the weight of a normal liver?
~ 1.5kg
What is the legal driving limit?
80mg/dl
What does it take to get a naive drinker very drunk?
200mg/dl
Is there an antidote for alcohol toxicity?
no
What does it put a naive drinker at risk of death?
300mg/dl
What does it put a chronic drinker at risk of death?
≥350mg/dl
What is the maximum amount of alcohol that can be tolerated before death?
600mg/dl
What is the maximum amount of alcohol that can be tolerated before death?
600mg/dl
What are features of Chronic Alcoholic Liver Disease?
Fatty change (steatosis)
Hepatitis
Cirrhosis
What are the different Liver Function Tests?
Bilirubin, Total protein, Albumin
ALT, AST, ALP
GGT, PT
What are the features of alcoholic steatosis (fatty liver)?
Increased precursors for fat synthesis
Reduced breakdown of fat
Reduced hepatic excretion of fat
Fatty change of the liver is reversible on abstention
What condition might acute hepatitis be associated with?
jaundice
What are features of acute hepatitis be associated with?
Patient will be very unwell
Polymorphs / neutrophils in the liver
Chronic hepatitis
Lymphocytes infiltrate in the liver
What happens if acute hepatitis patients do not abstain?
there is a risk of progression to fibrosis and cirrhosis
What are hallmarks of cirrhosis?
fibrosis / scarring and nodularity
What are features of cirrhosis?
Repeated inflammation and the healing process → regeneration of hepatocytes into nodules separated by scar tissue
What are the two main sizes of the nodules in cirrhosis?
Macro-nodular >3 mm
Micro-nodular < 3 mm
What are other causes of cirrhosis?
alcohol (60 - 70% ) viral hepatitis ( B, C, D, E etc ) primary biliary cirrhosis primary haemochromatosis Wilson’s disease alpha-1-antitrypsin deficiency Cryptogenic
What are the complications of cirrhosis?
Portal hypertension
Liver failure
Ascites
Hepatocellular carcinoma
What conditions are associated with liver failure and result from complications of cirrhosis?
Jaundice
Hypoproteinaemia
Bleeding
Hepatic encephalopathy
What is the causal effect of fibrosis on 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
How might portal hypertension result in a medical emergency?
bc there is a risk of bleeding from varices
What are the Triad of portal hypertension?
Cirrhosis
Oesophageal varices
Splenomegaly
What might causes bleeding in an alcoholic patient?
Oesophageal varices Peptic ulcer Mallory Weiss tear Haemorrhagic gastritis Reflux oesophagitis with ulceration
Where do Mallory Weiss tears occur at?
at the oesophago-gastric junction
When do Mallory Weiss tears occur?
when the patient vomits and retches against a closed cardiac sphincter
What are the main causes of peptic ulcers?
Helicobacter infection and NSAIDS
What are the complications of gall stones?
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
