Week 13 - GI/Liver Flashcards
Describe the vasculature of the liver?
- Incoming portal vein and hepatic artery
- Outgoing hepatic vein
How is the normal liver structure arranged?
Portal tracts & parenchyma
List the 7 broad causes of injury to the liver?
- Drugs or toxins incl. alcohol
- Abnormal nutrition/metabolism
- Infection
- Obstruction to bile or blood flow
- Autoimmune liver disease
- Genetic/deposition disease
- Neoplasia
What is inflammation generally?
Body’s response to injury
What is acute inflammation?
Agent causes injury but is the removed (days to weeks)
What is fulminant inflammation?
Severe acute, rapidly progressing towards liver failure
What is chronic inflammation?
Agent causes injury then persists (months to years)
What is acute-on-chronic inflammation?
Chronic liver disease often presents with acute exacerbation plus evidence of underlying chronicity e.g. fibrosis
What does the injurious agent cause?
Cell damage and sometimes death, often with inflammatory cell infiltrate
What is the main location of liver injury?
Parenchyma (hepatocytes) or bile ducts
What 4 structures are interdependent in the liver?
- Parenchyma
- Bile ducts
- Blood vessels
- Connective tissue
What is cirrhosis equal to?
End-stage liver disease
What is the 3-fold definition of cirrhosis?
Diffuse process with Fibrosis + Nodule formation
What is the main aim of diagnosing and treating chronic hepatitis?
Avoid progression to cirrhosis
What are the 2 types of investigations for liver disease?
- Blood tests: LFTs, haematology, viral and autoimmune serology, metabolic tests
- Radiology: at least ultrasound
List the 7 brand patterns/types of liver disease?
- Acute hepatitis
- Acute cholestasis
- Fatty liver disease
- Chronic hepatitis
- Chronic biliary disease
- Hepatic vascular disease
- Deposition/genetic disease
What 2 patterns/types of liver disease may progress to cirrhosis?
Fatty & chronic liver disease
Describe the histological appearance of acute hepatitis of autoimmune cause?
- Diffuse hepatocyte injury seen as swelling
- A few have died, described as “spotty necrosis”
- There is an inflammatory cell infiltrate in all areas: portal tracts, interface and parenchyma
What are dying hepatocytes called?
Acidophil body
What are the 2 causes of acute cholestasis/cholestatic hepatitis?
- Extrahepatic biliary obstruction
2. Drug injury e.g. antibiotics
Describe the histological appearance of acute cholestasis/cholestatic hepatitis?
Brown bile (bilirubin) pigment +/- acute hepatitis
What are 2 causes of chronic biliary/cholestatic disease?
- Primary biliary cirrhosis (PBC)
2. Primary sclerosing cholangitis (PSC)
Describe the histological appearance of chronic biliary/cholestatic disease?
Focal, portal-predominant inflammation and fibrosis with bile duct injury; granulomas (arrow) in PBC
Give 3 examples of Genetic/deposition liver disease?
- Haemochromatosis (iron)
- Wilson’s disease (copper)
- Alpha-1-antitrypsin deficiency