tutorial 13 - liver disease & peptic ulcer

Question 1

What are histological findings of the liver in acute viral hepatitis?

Answer 1

Infiltration with T cells and neutrophils, swollen (balloon) and necrosed hepatocytes

Question 2

How does acute viral hepatitis cause obstructive jaundice?

Answer 2

Swollen hepatocytes obstruct bile canaliculi, preventing bile from draining from the liver and resulting in excess conjugated bilirubin.

Question 3

What are the histological findings in chronic viral hepatitis?

Answer 3

Inflammatory infiltrate in portal tracts, with fibrosis starting at the portal tracts and eventually resulting in cirrhosis

Question 4

What is the end stage condition with chronic hepatitis?

Answer 4

Cirrhosis

Question 5

What is the pathogenesis of alcoholic liver disease?

Answer 5

Ethanol oxidation uses up NAD, which is also required for fatty acid oxidation in the liver. Thus, there is accumulation of fat in liver cells. Alcohol also produces reactive oxygen species that damage hepatocytes

Question 6

What are the 3 main forms of alcoholic hepatic injury?

Answer 6

Hepatocellular steatosis (fatty liver), Alcoholic hepatitis, steatofibrosis

Question 7

What is liver steatosis?

Answer 7

Build up of fat in the liver, causing it to become enlarged

Question 8

What can reverse liver steatosis?

Answer 8

Abstinence from alcohol

Question 9

Which liver cell type are involved in fibrosis that results in cirrhosis?

Answer 9

Stellate cells

Question 10

What is the gross morphology of a liver with alcoholic cirrhosis?

Answer 10

Enlarged, pale, yellow, greasy with small nodules

Question 11

What are the common sites of portal-systemic anastomoses in patients with portal hypertension?

Answer 11

Oesophagus (varices), rectum (haemorrhoids), around umbilicus (caput medusae)

Question 12

What are the neurological complications of portal hypertension?

Answer 12

Hepatic encephalopathy - disturbances in the brain due to build up of ammonia and other toxins in the blood that has been shunted away from the liver without being detoxified.

Question 13

What organ becomes enlarged with portal hypertension?

Answer 13

Spleen - congestive splenomegaly where blood pools in spleen

Question 14

Why does portal hypertension cause ascites?

Answer 14

Increased portal pressure pushes fluid from the veins into the peritoneal cavity

Question 15

What are the haematological consequences of liver cirrhosis?

Answer 15

Coagulopathy due to decreased synthesis of clotting factors, decreased plasma albumin levels

Question 16

What is the definition of an ulcer?

Answer 16

An area of loss of surface epithelium and variable amounts of sub-epithelial tissue

Question 17

What is the most common cause of chronic gastritis?

Answer 17

H. pylori infection

Question 18

What part of the stomach does H. pylori predominantly colonise?

Answer 18

The mucus of the pyloric antrum

Question 19

What is the treatment for H. pylori gastritis?

Answer 19

triple therapy - omeprazole, clarithroymycin, amoxicillin

Question 20

Which part of the stomach do gastric ulcers typically occur on?

Answer 20

The lesser curvature of the antrum

Question 21

What is the gross morphology of benign peptic ulcers?

Answer 21

Straight edges with clean/smooth base (cookie-cutter)

Question 22

What are the 2 key complications of peptic ulcer disease?

Answer 22

Bleeding, perforation