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Flashcards in Liver Deck (40)
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1

How much is taken in a liver biopsy?

1/50000th of the total liver volume

2

Why would you biopsy the liver?

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

3

Name 5 diseases of the liver

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

4

What cells activate fibrosis?

Stellate cells (they contain vitamin A)

5

What does chronic hepatitis involve architecturally?

Portal tract inflammation
Interface hepatits
Lobular inflammation
Acidophil bodies
Fibrosis and cirrhosis

6

What does biliary disease involve architecturally?

Portal tract inflammation and expansion
Bile duct damage and loss
Granulomas

7

How do you treat genetic haemoatochromatosis?

Venesection

8

What does paracetamol do to the liver?

Causes necrosis

9

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

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

10

What do contraceptive steroids do to the liver?

Hepatic vein thrombosis

11

Nitrofurantoin and etretinate do to the liver?

Cause chronic hepatits

12

What does allopurinol do to the liver?

Cause granulomas

13

What do antineoplastic agents do to the liver?

Veno-occlusive disease

14

What would decompensation in liver disease look like?

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

15

What causes ascites in liver disease?

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

16

Why is jaundice seen in liver disease?

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

17

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

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

18

Why do people with liver failure get more infections?

Unable to produce acute phase proteins

19

Why do people with liver failure experience hypoglycaemia?

Liver unable to store glycogen and fat

20

Pathogenesis of encephalopathy

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

21

What is involved a liver screen?

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

22

Management of ascites?

Na and water restriction
Diuretics
Treat precipitants

23

Encephalopathy treatment?

Modify microbiota (lactulose, rifaxamin, probiotics)
Laxatives
Nutrition

24

What marker is raised in fatty liver disease?

ALT

25

What is seen in the architecture of steatohepatitis?

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

26

What causes oxidative stress in alcoholic hepatitis?

CCl4-> free radicals
Ethanol-> Cytp450 and diet -> oxidant stress

27

What are the major cytokines involved in alcoholic hepatitis?

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

28

What causes fatty liver to turn into alcoholic hepatitis?

A Babson event-> activated macrophage-> TNF

29

What could a Babson event be?

Massive boozing spree
Intercurrent infection
Endotoxin
Alcohol withdrawl

30

Treatment of alcoholic hepatitis?

Alcohol abstinence
Prednisolone
Pentoxyfyllene