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104 Theme 2 > pathology of the liver and cirrhosis > Flashcards

pathology of the liver and cirrhosis Flashcards

1
Q

weight of normal liver

A

1500g

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2
Q

what is the driving limit

A

80mg/dl
naive drinker, very drunk 200mg/dl to 300mg/dl for risk of dying (>350mg/dl if chronic)
some tolerate up to 600mg/dl before dying of alcohol toxicity

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3
Q

what is chronic alcoholic liver disease

A

fatty change (steatosis)
hepatitis)
cirrhosis

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4
Q

what enzyme is raised in chronic alcohol misuse

A

gamma-glutamyltransferase (GGT)
ALT (alanine transaminase)
AST (aspartate aminotransferase)
both raised upon liver damage, ALT more specific

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5
Q

what does an LFT test for

A 
bilirubin 
total protein 
albumin 
ALT
AST
ALP (alkaline phosphatase)
GGT
Prothrombin time (PT)
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6
Q

what do haematological tests find in chronic alcohol misuse

A

Fe deficiency anaemia (dec Hb and MCV)
Folate and B12 deficiency (inc MCV)
Raised INR - clotting abnormalities
Tendency to bleed

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7
Q

what is the pathogenesis of alcoholic steatosis

A

inc precursors of fat synthesis
reduced breakdown of fat
reduced hepatic excretion of fat
fatty change of liver is reversible on abstention

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8
Q

what are other causes of steatosis

A 
known as non alcoholic fatty liver disease (complicated by inflammation/hepatitis to become non alcoholic steatohepatitis)
T2 DM
Obesity 
High BP/cholesterol 
metabolic syndrome 
50+
smoke
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9
Q

what is alcoholic heaptitis

A 
acute hepatitis (ass with jaundice, unwell, polymorphs or neutrophils in liver)
chronic hepatitis (doesn't abstain so progression of fibrosis to cirrhosis, lymphocytes infiltrate liver)
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10
Q

what is done when alcoholic hepatitis is suspected

A

liver biopsy

fibrosis (loss of colour, fatty change, lymphocytes)

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11
Q

what are the complications of a liver biopsy

A

bleeding
pain
infection
accidental injury to nearby organ

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12
Q

what irreversible cirrhosis

A

irreversible stage of liver disease
fibrosis/scarring and modularity
repeated inflammation and healing process to regenerate hepatocytes into nodules separated by scars
classified by nodule size (macro-nodular >3mm, micro-nodular <3mm)

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13
Q

how does normal liver compare to fatty liver and cirrhosis

A

normal - pink
fatty liver - large droplets of fat visible
cirrhosis - fibrosis (dark) surrounding (lighter) nodules

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14
Q

what are other causes of cirrhosis

A 
alcohol (60-70%)
viral hepatitis (B, C, D, E etc)
primary biliary cirrhosis
primary haemochromatosis
wilsons disease
alpha-1-antitrypsin deficiency 
cryptogenic
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15
Q

complications of cirrhosis

A

portal hypertension
liver failure (jaundice, hypoproteinanaemia, bleeding, hepatic encephalopathy)
ascites
hepatocellular carcinoma

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16
Q

what is portal hypertension

A

caused by fibrosis
blood flow through liver impeded so blood finds alternative via spleen or oesophagus (collateral circulation causing splenomegaly and oesophageal varices)

17
Q

what is the triad of portal hypertension

A

cirrhosis
oesophageal varices (bleeding ME)
splenomegaly

18
Q

causes of bleeding in alcoholic patient

A 
oesophageal varies
epic ulcer
mallory weiss tear
haemorrhagic gastritis 
reflux oesophagi's with ulceration
19
Q

what is a mallory Weiss tear

A

occur at oesophagi-gastric junction when patent vomits and retches against closed cardiac sphincter

20
Q

what is a peptic ulcer

A

main cause is helicobacter infection and NSAIDS

alcohol irritates gastric mucosa and exacerbates

21
Q

alcohol related deaths

A 
alcohol toxicity 
RTAs
Sudden death in fatty liver due to metabolic acidosis resulting in cardiac arrhythmia 
haemorrhage 
liver failure (cirrhosis)
22
Q

what are the most common tumours in the liver

A

most are metastatic from GIT (usually multiple)

primary cancer - hepatocellular carcinoma or associated raised alpha-feto protein

23
Q

complications of gall stones

A 
biliary colic
acute cholecystitis 
empyema of GB
perforation of GB
mucocoele of GB
porcelain GB
carcinoma 
obstructive jaundice 
secondary biliary cirrhosis 
ascending cholangitis 
liver abscess
pancreatitis 
gallstone ileus

104 Theme 2 (22 decks)

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