Chempath 4: LIVER disease CPC

Question 1

how are hepatocytes arranged

Answer 1

a trabeculae with sinusoids between them

Question 2

what 3 vessels make up the portal triad

Answer 2

hepatic artery
bile duct
portal vein

Question 3

describe the arrangement of endothelial cells in the liver

Answer 3

discontinuous
spaces between the hepatocytes and the endothelium of the sinusoids
so all blood comes into contact with all the liver enzymes
space = space of disse

Question 4

describe the zones in between the portal tract and central vein

Answer 4

zone 1 - closest to the portal tract - highest oxygen concentration
zone 3 - most susceptible to hypogea, most metabolically active cells

Question 5

how can fractions of bilirubin be measured

Answer 5

van den Bergh reaction (amount of conjugated bilirubin in blood)
add methanol - total bilirubin
difference = unconjugated bilirubin

Question 6

how does phototherapy work

Answer 6

converts bilirubin into lumirubin and photobilirubin

Question 7

what is Gilberts syndrome

Answer 7

AR
worsened by fasting
phenobarbital can reduce bilirubin levels
UDP glucuronyl transferase activity reduced to 30%
no bilirubinuria (bound tight to albumin)

Question 8

what is a negative uribilinogen suggestive of

Answer 8

biliary obstruction

should always be in the urine of normal people

Question 9

what is the best marker of liver function

Answer 9

PT
normal 12-14 s
extrinsic pw - I,II,V,VII,X

Question 10

what is a marker of the livers synthetic function

Answer 10

albumin

Question 11

when are ALP levels highest

Answer 11

biliary obstruction

Question 12

describe key histological features in hepatitis

Answer 12

lots of cells containing fat
cells containing mallory hyaline (inclusion in cytoplasm of liver cells)
neutrophil polymorphs
alcoholic hepatitis –> balloon cells containing mallory hyaline
bile accumulation in the liver - blocked flow

• liver cell damage, inflammation, fibrosis, fatty change, mega mitochondria

Question 13

what might a collages stain show in hepatitis

Answer 13

pattern of collagen around liver cells

cirrhosis

Question 14

DD in fatty liver disease

Answer 14

NASH
alcoholic hepatitis
malnourishment (kwashiorkor)

Question 15

how does the liver regenerate after alcohol

Answer 15

produces lots of nodules

disorganised regeneration - rise in portal pressure

Question 16

list features of chronic alcoholic liver disease

Answer 16

palmar erythema
spider nave
gynaecomastia (liver fails to break down estradiol)
dupuytrens contractures

Question 17

features of portal hypertension

Answer 17

caput medusae
splenomegaly 
scrotal oedema 
shifting dullness 
visible veins, ascites, splenomegaly 

later - flapping tremor (asterisks) = hepatic encephalopathy

Question 18

how is liver failure defined

Answer 18

failed synthetic function
failed clotting factor and albumin production
failed clearance of bilirubin
failed clearance of ammonia ( –> encephalopathy)

Question 19

list sites of porto-systemic anastamoses

Answer 19

oesophageal varices
rectal varices
umbilical vein reanalysing
spleen-renal shunt

Question 20

what are scratch marks a sign of

Answer 20

obstructive jaundice
only post-hepatic causes of jaundice make you itchy (gallstones, pancreatic cancer)
because of bile salts and bile acids

Question 21

what is courvoisiers law

Answer 21

if the gallbladder is palpable in a jaundiced patient, the cause is unlikely to be gallstones
(gallstones are painful)