Lecture 10 - Liver and biliary system pathology Flashcards
(35 cards)
Liver functions
Stores:
- Glycogen
- Vitamins
- Copper
- Iron
Synthesises:
- Glucose
- Protein e.g. albumin
- Bile
- Lipids and cholesterol
- Coagulation factors
Metabolism:
- Bilirubin
- Ammonia
- Alcohol
- Carbohydrates and lipids
Detoxifies drugs
Liver cirrhosis
Due to chronic liver injury and inflammation causing fibrosis and hepatocyte necrosis e.g.
- Alcholoic liver disease
- Fatty liver
- HBV
- Autoimmune hepatitis
Resulting in nodules
Irreversible
Impaired liver function and structure
Alcoholic liver disease
- Increased deposition of triglycerides (weeks)
- Alcoholic hepatitis (years)
- Cirrhosis (years) - end stage and irreversible
Steatosis
Abnormal retention of lipids within an organ
Microvascular change in alcoholic disease
Steatohepatitis Pericentral fibrosis - blue streaks Neutrophil infiltration Cirrhosis Hepatocyte ballooning
Macrovascular change in alcoholic disease
Liver appears: yellow enlarged - hepatomegaly soft greasy tender
- Jaundice
- RUQ pain
Cirrhosis - shrinks liver
Non alcoholic fatty liver disease
NAFLD
Alcoholic liver disease without alcohol
Inflammation - non - alcoholic steatohepatitis (NASH)
NAFLD risk factors
Obesity
Diabetes
Metabolic syndrome - dyslipidaemia
Hereditary haemochromatosis
Increased absorption of iron from the small intestines and excess deposition
Autosomal recessive
Increased ferritin
Risk of developing hepatocellular carcinoma
Wilson’s disease
Abnormal copper metabolism
- reduced secretion of copper from biliary sytem therefore accumulation in tissues
Autosomal recessive
Low caeruloplasmin
Caeruloplasmin
Enzyme that aids secretion of copper in blood
Primary biliary cirrhosis
+ve anti mitochondrial antibody
Primary sclerosing cholangitis
-ve +ve anti mitochondrial antibody
Markers for autoimmune hepatitis
Anti-nuclear antibody
Anti smooth muscle antibody
Portal hypertension
- Fibrotic liver doesn’t expand
- Compresses veins entering the liver from the portal venous system
- Backflow
- Build up of blood in the portal venous system
increases hydrostatic pressure in the portal venous system
- Ascites
- Splenomegaly - build up of pressure in the splenic circulation
- Oesophageal, umbilical and anorectal varices
Oesophageal varices
Haematemesis if ruptured
Anorectal varices
Painless as above pectinate line
Rarely bleed
Umbilical varices
Uncommon
Caput medusa
Foetal ligamentum teres links the liver to the umbilicus
Hepatorenal syndrome
Development of AKI in the presense of cirrhosis
- Portal hypertension
- Arterial vasodilation (splanchnic) - decrease BP
- RAAS activated
- Renal artery vasoconstriction decreasing GFR
What are gall stones made from?
Cholesterol
Bile pigments e.g. bilirubin
Gall stones on Xray
Radiolucent - dont show up on Xrays
Renal calculi do show up
Do ultrasound
Risk factors for gall stones
Diet and lifestyle - overweight Middle aged Female Pregnancy Pre-existing liver disease
Gall stones symptoms
RUQ pain
Colicky pain - on and off
Pain after eating - CCK
NO INFLAMMATION
Temporary obstruction of a gallstone usually in the cystic duct
Complications of gallstones
Acute cholecystitis
Acute ascending cholangitis
Acute pancreatitis
