Hepatic Pathology Flashcards
(34 cards)
Liver failure
-deficiency in metabolic or synthetic capacity of the
-acute =quick onset
-chronic=slow onset
-many causes
Acute Liver Failure
-rare
-rapid necrosis of hepatic tissue (7-28 day) (without pre-existing disease)
- Coagulopathy and encephalopathy
-toxicity common cause
Acetaminophen (paracetamol toxicity)
-Inhibits COX in brain
-modulate endogenous cannabinoid system
-liver metabolism - half life 4hrs
-overdose in self harm 235 deaths in 2020
-NAPQI build up (metabolite)
Hepatic Encephalopathy
-altered consciousness due to liver failure
-acute and chronic liver failure
(40% of chronic)
-nitrogenous waste products cause
(ammonia)
-astrocytes increased osmotic pressure
- G-aminobutyric acid, less neurone energy
Chronic Liver Failure Causes
-over 6 months
Alcoholism.
Viral hepatitis.
Haemochromatosis.
Wilson’s disease.
Autoimmune disease
Chronic Liver Disease Classes of Symptoms
Chronic liver disease associated.
Decompensation.
Cause.
Viral Hepatitis
-virus has strains, A, B, C, D and E
-IV = C, D, B
-Faecal oral= A, E
- mucous membranes= B and D
Hepatitis A
-45% have Abs against
-contaminated food and water
-4-6 week incubation
-faecal shedding in 2 weeks before onset of symptoms
Hepatitis C
-Parenteral transmission (40% IV drug users)
-2% of world infected
-sRNA
-7 genotypes, no.1 70% of cases
Pathology of liver destruction by Hepatitis
-Viral infection of hepatocytes results in necrosis.
-Kupfter hyperplasia
-mononuclear cells in liber =fibrosis
(Cytotoxic T cells, NK cells)
Ledipasvir (drug)
-inhibits HCV protein NS5A
RNA binding protein.
Sub-cellular localization of HCV.
Modulates host cell interferon response
100% cure rate when used with nucleoside analogues= sofosbuvir, ribavirin
Vaccine
-HepB vaccine 2 months of age dose.
-HepA for travelling to high risk countries
-Inactivated virus vaccines
-HepC no simple vaccine
Clinical Course of Viral Hepatitis
-prodromal phase (in 2 weeks)
-icteric phase (2-8 weeks)
-recovery phase (in 8 weeks)
chronic hepatitis if persists= viral antigen and abnormal liver functions
Portal Hypertension
-usually 3mmHg, hypertension above 10mmHg
-cirrhosis impeding blood flow
classes: intrahepatic, post hepatic and prehepatic
Symptoms associated with chronic liver disease
Nail clubbing.
Anaemia.
Caput medusae.
Testicular atrophy.
Spider nevi.
Jaundice.
Ascites.
Oedema.
Bruising
Ascites
-Accumulation of fluid in the peritoneal cavity
-complication of portal hypertension
[Increased capillary hydrostatic and hepatic sinusoidal pressure, decreased oncotic]
-hypovolaemia, RAAS activation
-Transudate, fluid increase, hepatic portal vein pressure increase
-Exudate= inflammation
Peritonitis
-inflammation of peritoneum
-emergency
-common in ascites (Spontaneous bacterial peritonitis)
-host defences compromised= bacteraemia (complement)
-gram negatives (E.coli, K. pneumoniae)
Paracentesis
-sample fluid in peritoneal cavity
-remove fluid too
Diuretics
-salt reduction in diets and potassium sparing diuretics can reduce fluid build up
-furosemide (Na K Cl cotransporter inhibitor, loop diuretic)
-vasopressin receptor 2-antagonists
Hepatorenal Syndrome
-renal failure from liver failure (co -morbidity of ascites
-Arterial dilation in the splanchnic vasculature main cause (systemic hypotension, renal hypotension and reduced GFR)
-Compensation can occur due to limited renal vasoconstriction (angiotensin clearance poor)
Chronic Liver disease neuropathy
-caused by alcohol
Chronic Liver disease Kayser-Fleshier Rings
-Caused by Wilson’s
Dupuytren’s Contracture
-alcohol
-genetics, Viking’s disease, WNT mutations
-Age= fibrotic response to fatty tissue damage, circulatory damage, changes in prostaglandin production
Liver carcinoma Rates
-5700 new cases, 5091 deaths
-under 40 only 25% survive 5 years
-over 80 only 5% survive 5 years
