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SBOMs > Liver > Flashcards

Liver Flashcards

1
Q

How much is taken in a liver biopsy?

A

1/50000th of the total liver volume

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2
Q

Why would you biopsy the liver?

A

Confirm presence/nature of neoplasm
Exclude underlying liver disease
Exclude secondary process
Staging

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3
Q

Name 5 diseases of the liver

A 
Steatohepatits
Chronic hepatitis (viral/autoimmune/drugs)
Biliary disease
Iron overload (haematochromatosis)
Metabolic disease
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4
Q

What cells activate fibrosis?

A

Stellate cells (they contain vitamin A)

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5
Q

What does chronic hepatitis involve architecturally?

A 
Portal tract inflammation
Interface hepatits
Lobular inflammation
Acidophil bodies
Fibrosis and cirrhosis
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6
Q

What does biliary disease involve architecturally?

A

Portal tract inflammation and expansion
Bile duct damage and loss
Granulomas

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7
Q

How do you treat genetic haemoatochromatosis?

A

Venesection

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8
Q

What does paracetamol do to the liver?

A

Causes necrosis

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9
Q

What do steroids, flucloxicillin and erythromycin do to the liver?

A 
Cause cholestasis (bland w/steroids)
Cause cholangiolytic cholestasis (w/fluclox and eryth)
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10
Q

What do contraceptive steroids do to the liver?

A

Hepatic vein thrombosis

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11
Q

Nitrofurantoin and etretinate do to the liver?

A

Cause chronic hepatits

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12
Q

What does allopurinol do to the liver?

A

Cause granulomas

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13
Q

What do antineoplastic agents do to the liver?

A

Veno-occlusive disease

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14
Q

What would decompensation in liver disease look like?

A 
Bleeding
Jaundice
Ascites
Encephlopathy
(due to sepsis, GI bleed, volume depletion)
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15
Q

What causes ascites in liver disease?

A 
Portal hypertension
-> hyperspelnism and varices
-> less blood in circulation
-> RAAS
Fluid imbalance = ascites
Also, hypoalbuminaemia due to liver failure= ascites
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16
Q

Why is jaundice seen in liver disease?

A 
Lack of functioning hepatocytes
Conjugated and unconjugated bilirubin increases
Decreased urobilinogen
Dark urin
ALT and AST and ALP raised
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17
Q

What clotting factors aren’t able to be made in liver failure?

A

1, 2, 5, 7, 9, 10, 12, 13

18
Q

Why do people with liver failure get more infections?

A

Unable to produce acute phase proteins

19
Q

Why do people with liver failure experience hypoglycaemia?

A

Liver unable to store glycogen and fat

20
Q

Pathogenesis of encephalopathy

A 
Liver fails to detoxify and excrete
Ammonia increases 
Brain converts ammonia to glutamine
Osmotic imbalance and cerebral oedema
= dorwsiness, confusion, coma
21
Q

What is involved a liver screen?

A

Viral hepatitis serology
Autoantibodies
Immunoglobulins
Cholesterol, TGs, ferritin, Alpha-1 antitripsin

22
Q

Management of ascites?

A

Na and water restriction
Diuretics
Treat precipitants

23
Q

Encephalopathy treatment?

A

Modify microbiota (lactulose, rifaxamin, probiotics)
Laxatives
Nutrition

24
Q

What marker is raised in fatty liver disease?

A

ALT

25
Q

What is seen in the architecture of steatohepatitis?

A

Ballooning degeneration
Mallory’s hyaline
Pericellular and perisinusoidal fibrosis
Neutrophil infiltration

26
Q

What causes oxidative stress in alcoholic hepatitis?

A

CCl4-> free radicals

Ethanol-> Cytp450 and diet -> oxidant stress

27
Q

What are the major cytokines involved in alcoholic hepatitis?

A

IL-8 (attracts neutrophils)
TNF-alpha
NFKB (attracts IL-8)

28
Q

What causes fatty liver to turn into alcoholic hepatitis?

A

A Babson event-> activated macrophage-> TNF

29
Q

What could a Babson event be?

A

Massive boozing spree
Intercurrent infection
Endotoxin
Alcohol withdrawl

30
Q

Treatment of alcoholic hepatitis?

A

Alcohol abstinence
Prednisolone
Pentoxyfyllene

31
Q

When do you do a fibroscan?

A

ALT, AST, GGT high
Increased ALP
Metabolic syndrome
Hazardous/harmful alcohol risk

32
Q

What does a fibroscan do?

A

Ferritin and liver elastography

33
Q

What cells are antigen presenting in the liver?

A

Dendritic cells

34
Q

What cells are found in hepatic sinusoids?

A

Kupffer cells, dendritic cells, T cells

35
Q

What antibodies are found in autoimmune chronic hepatitis?

A

Type 1: Anti smooth muscle Ab
Anti nuclear Ab
Type 2: Anti-LKM antibodies

36
Q

Treatment of autoimmune chronic hepatitis

A

Prednisolone

37
Q

What antibodies are found in primary biliary cirrhosis?

A

Anti mitochondrial antibodies

Some antinuclear antibodies

38
Q

How is primary biliary cirrhosis linked to environment?

A

Industry/mining
Toxic waste
N. aromaticovorans can induce AM Abs

39
Q

How do you diagnose primary sclerosing cholangitis?

A

Radiology, autoantibody detection
Linked with IBD
MRCP/ERCP + biopsy

40
Q

Treatment of primary sclerosing cholangitis?

A

Ursodeoxycholic acid

SBOMs (18 decks)

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