Liver Flashcards

(40 cards)

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?

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
31
When do you do a fibroscan?
ALT, AST, GGT high Increased ALP Metabolic syndrome Hazardous/harmful alcohol risk
32
What does a fibroscan do?
Ferritin and liver elastography
33
What cells are antigen presenting in the liver?
Dendritic cells
34
What cells are found in hepatic sinusoids?
Kupffer cells, dendritic cells, T cells
35
What antibodies are found in autoimmune chronic hepatitis?
Type 1: Anti smooth muscle Ab Anti nuclear Ab Type 2: Anti-LKM antibodies
36
Treatment of autoimmune chronic hepatitis
Prednisolone
37
What antibodies are found in primary biliary cirrhosis?
Anti mitochondrial antibodies | Some antinuclear antibodies
38
How is primary biliary cirrhosis linked to environment?
Industry/mining Toxic waste N. aromaticovorans can induce AM Abs
39
How do you diagnose primary sclerosing cholangitis?
Radiology, autoantibody detection Linked with IBD MRCP/ERCP + biopsy
40
Treatment of primary sclerosing cholangitis?
Ursodeoxycholic acid