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Gastrointestinal > Liver pathology > Flashcards

Liver pathology Flashcards

1
Q

What is the definition of acute liver disease?

A

Any insult causing damage to a previously healthy liver, over a duration of less than 6 months

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2
Q

What is acute liver failure defined as?

A

Encephalopathy and prolonged coagulation

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3
Q

How might acute liver disease present clinically?

A 
Jaundice
Lethargy
Nausea
Anorexia
Pain
Itch
Arthralgia (joint pain)
Abnormal LFTs
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4
Q

What are ten causes of acute liver disease?

A 
Viral (hepatitis, EBV etc.)
Drugs (ask about paracetamol)
Shock liver
Cholangitis
Alcohol
Malignancy
Chronic liver disease
Budd Chiari
Acute fatty liver of pregnancy
Cholestasis of pregnancy
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5
Q

What is shock liver?

A

Hepatic ischaemia

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6
Q

What investigations should be done in acute liver disease?

A 
History
Examination
LFT's 
Prothrombin time
Ultrasound
Virology
Liver biopsy (rarely)
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7
Q

What treatment can be given to soothe itch associated with liver disease?

A

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

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8
Q

What antibiotics might cause liver disease?

A

Co-amoxiclav
Flucloxacillin
NSAIDs

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9
Q

Which self-bought drugs do patients often talk about in history for liver disease?

A

“Fat burners”

“Protein powders”

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10
Q

What is the definition of fulminant hepatic failure?

A

Jaundice and encephalopathy in a patient with a previously normal liver

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11
Q

What are some of the complications of fulminant hepatic failure?

A 
Encephalopathy
Hypoglycaemia
Coagulopathy
Circulatory failure
Renal failure
Infection
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12
Q

Where are the anastomoses between the portal system and the systemic venous system?

A

Oesophageal & gastric venous plexus (base of oesophagus)
Umbilical vein
Retroperitoneal collateral vessels
Haemorrhoidal venous plexus (rectum)

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13
Q

What may happen to the anastomoses between the systemic and portal venous systems in portal hypertension?

A

Dilatation
May become varicosed
Rupture

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14
Q

What defines portal hypertension?

A

Portal vein pressure above the normal range of 5 to 8 mm Hg

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15
Q

What are some prehepatic causes of portal hypertension?

A

Portal vein thrombosis

Occlusion secondary to congenital portal venous abnormalities

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16
Q

What are some intrahepatic causes of portal hypertension?

A

Distortion of liver architecture:
Presinusoidal: schistosomiasis, non-cirrhotic portal hypertension
Postsinusoidal: cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis

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17
Q

What is Budd-Chiari syndrome?

A

A condition caused by occlusion of the hepatic veins

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18
Q

What are some of the signs and symptoms in Budd-Chiari syndrome?

A 
Jaundice
Right upper quadrant pain
Hepatomegaly
Ascites
Elevated liver enzymes
19
Q

What are the three commonest causes of liver cirrhosis?

A

Alcohol
Hepatitis C
Non-alcoholic fatty liver disease

20
Q

What is compensated cirrhosis?

A

Cirrhosis of the liver with an otherwise clinically normal patient - may be an incidental finding

21
Q

What is decompensated cirrhosis?

A

Liver failure

22
Q

What are some of the signs of compensated liver cirrhosis?

A 
Spider naevi
Palmar erythema
Clubbing
Gynaecomastia
Hepatomegaly
Splenomegaly
23
Q

What are some of the signs of decompensated liver cirrhosis?

A

Jaundice
Ascites
Encephalopathy
Bruising

24
Q

What is encephalopathy?

A

Brain injury arising from advanced cirrhosis of the liver

25
Q

In patients with excess alcohol intake, what vitamin supplementation is necessary?

A

Vitamin B supplements - thiamine

26
Q

What are two common complications of vitamin deficiency associated with liver cirrhosis?

A

Osteoporosis

Osteomalacia

27
Q

How is ascites treated?

A

Improvement of underlying liver disease
Treatment of infection, if any
Reduce salt intake
Diuretics - preferably spironolactone, add loop in recurrent ascites

28
Q

What is a transjugular intrahepatic portosystemic shunt?

A

An artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein

29
Q

What is spontaneous bacterial peritonitis?

A

The development of peritonitis (infection in the abdominal cavity) despite the absence of an obvious source for the infection
Can be a translocated bacterial infection of ascites

30
Q

How is the diagnosis of spontaneous bacterial peritonitis made?

A

Aspiration of fluid

Neutrophil count >250 cells/mm3

31
Q

What treatment is given in spontaneous bacterial peritonitis?

A

Antibiotics and albumin infusion

32
Q

What is non-alcoholic fatty liver disease?

A

Fatty liver or steatohepatitis in the absence of another cause

33
Q

What is the “two-hit” theory of NAFLD?

A

First hit - excessive fat accumulation

Second hit - oxidative stress, pro-inflammatory cytokine release e.g. TNF-alpha, ischaemia-reperfusion injury

34
Q

What antibodies can be found in the blood in autoimmune hepatitis?

A

Antinuclear antibodies
Anti-smooth muscle antibodies
Raised IgG

35
Q

What is primary biliary cirrhosis?

A

An autoimmune disease of the liver marked by the slow progressive destruction of the small bile ducts of the liver

36
Q

What antibodies are present in the blood in primary biliary cirrhosis?

A

Anti-mitochondrial antibodies

Raised IgM

37
Q

What is liver failure?

A

Inadequate synthesis of albumin, clotting factors and glucose and inadequate metabolism and elimination of endogenous products e.g. bilirubin, nitrogenous waste, hormones etc.

38
Q

What are some of the causes of hepatomegaly?

A

CRAM & FAIL

Cancer
Right heart failure
Alcoholic liver disease
Myeloproliferative diseases

Fatty liver
Amyloidosis
Iron - haemochromatosis
Lymphoma & leukaemia

39
Q

Why might right heart failure cause hepatomegaly?

A

The IVC has no valves - backlog of pressure from right heart will extend to liver

40
Q

What is haemochromatosis?

A

An issue with iron metabolism & secretion leading to build up in the body
Can be congenital

41
Q

What are some of the signs of haemochromatosis?

A 
Skin discolouration
Diabetes
Joint involvement (e.g. arthritis)
Pituitary - sexual dysfunction
Heart failure
42
Q

How is haemochromatosis treated?

A

Removal of a pint of blood every week until ferratin falls below 100
Then - remove 3/4 units a year

43
Q

What three markers in blood characterise autoimmune hepatitis?

A

Increased IgG
Antibodies against liver specific and non-liver specific proteins
Infiltration of: monocytes, macrophages, lymphocytes, plasma cells, macrophages and mast cells

44
Q

What antibodies may be present in autoimmune hepatitis?

A

Anti-smooth muscle antibodies

Anti-nuclear antibodies

Gastrointestinal (17 decks)

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