Liver

Question 1

How much is taken in a liver biopsy?

Answer 1

1/50000th of the total liver volume

Question 2

Why would you biopsy the liver?

Answer 2

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

Question 3

Name 5 diseases of the liver

Answer 3

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

Question 4

What cells activate fibrosis?

Answer 4

Stellate cells (they contain vitamin A)

Question 5

What does chronic hepatitis involve architecturally?

Answer 5

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

Question 6

What does biliary disease involve architecturally?

Answer 6

Portal tract inflammation and expansion
Bile duct damage and loss
Granulomas

Question 7

How do you treat genetic haemoatochromatosis?

Answer 7

Venesection

Question 8

What does paracetamol do to the liver?

Answer 8

Causes necrosis

Question 9

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

Answer 9

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

Question 10

What do contraceptive steroids do to the liver?

Answer 10

Hepatic vein thrombosis

Question 11

Nitrofurantoin and etretinate do to the liver?

Answer 11

Cause chronic hepatits

Question 12

What does allopurinol do to the liver?

Answer 12

Cause granulomas

Question 13

What do antineoplastic agents do to the liver?

Answer 13

Veno-occlusive disease

Question 14

What would decompensation in liver disease look like?

Answer 14

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

Question 15

What causes ascites in liver disease?

Answer 15

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

Question 16

Why is jaundice seen in liver disease?

Answer 16

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

Question 17

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

Answer 17

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

Question 18

Why do people with liver failure get more infections?

Answer 18

Unable to produce acute phase proteins

Question 19

Why do people with liver failure experience hypoglycaemia?

Answer 19

Liver unable to store glycogen and fat

Question 20

Pathogenesis of encephalopathy

Answer 20

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

Question 21

What is involved a liver screen?

Answer 21

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

Question 22

Management of ascites?

Answer 22

Na and water restriction
Diuretics
Treat precipitants

Question 23

Encephalopathy treatment?

Answer 23

Modify microbiota (lactulose, rifaxamin, probiotics)
Laxatives
Nutrition

Question 24

What marker is raised in fatty liver disease?

Answer 24

ALT

Question 25

What is seen in the architecture of steatohepatitis?

Answer 25

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

Question 26

What causes oxidative stress in alcoholic hepatitis?

Answer 26

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

Question 27

What are the major cytokines involved in alcoholic hepatitis?

Answer 27

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

Question 28

What causes fatty liver to turn into alcoholic hepatitis?

Answer 28

A Babson event-> activated macrophage-> TNF

Question 29

What could a Babson event be?

Answer 29

Massive boozing spree Intercurrent infection Endotoxin Alcohol withdrawl

Question 30

Treatment of alcoholic hepatitis?

Answer 30

Alcohol abstinence Prednisolone Pentoxyfyllene

Question 31

When do you do a fibroscan?

Answer 31

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

Question 32

What does a fibroscan do?

Answer 32

Ferritin and liver elastography

Question 33

What cells are antigen presenting in the liver?

Answer 33

Dendritic cells

Question 34

What cells are found in hepatic sinusoids?

Answer 34

Kupffer cells, dendritic cells, T cells

Question 35

What antibodies are found in autoimmune chronic hepatitis?

Answer 35

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

Question 36

Treatment of autoimmune chronic hepatitis

Answer 36

Prednisolone

Question 37

What antibodies are found in primary biliary cirrhosis?

Answer 37

Anti mitochondrial antibodies | Some antinuclear antibodies

Question 38

How is primary biliary cirrhosis linked to environment?

Answer 38

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

Question 39

How do you diagnose primary sclerosing cholangitis?

Answer 39

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

Question 40

Treatment of primary sclerosing cholangitis?

Answer 40

Ursodeoxycholic acid