Liver and Biliary Disease

Question 1

How much does the liver weight?

Answer 1

1500g

Question 2

What is the blood supply to the liver?

Answer 2

Portal vein.

Hepatic artery.

Question 3

What are the cells of the liver? (6)

Answer 3

Hepatocytes. 
Bile ducts. 
Blood vessels. 
Endothelial cells. 
Kupffer cells. 
Stellate cells.

Question 4

What is the normal structure of the liver based on?

Answer 4

Based on the blood supply to the liver.

Question 5

What leads to stellate cell activation?

Answer 5

Liver injury - i.e. loss of hepatocyte microvilli.

Question 6

What do stellate cells do once activated? (3)

Answer 6

Deposition of scar matrix.
Loss of fenstrae.
Activate Kupffer cells.

Question 7

What is the definition of cirrhosis? (4)

Answer 7

Whole liver involved.
Fibrosis.
Nodules of regenerating hepatocytes.
Distortion of liver vascular architechture: intra and extra hepatic (e..g gastro-oesophageal) shunting of blood.

Question 8

What are the two ways in which cirrhosis is classified?

Answer 8

According to nodule size (micronodular or macronodular)

According to aetiology (alcohol/insulin resistance, viral hepatitis)

Question 9

What are the complications of cirrhosis? (3)

Answer 9

Portal hypertension.
Hepatic encephalopathy.
Liver cell cancer.

Question 10

Is cirrhosis reversible?

Answer 10

It can be.

Question 11

What are the two primary causes of acute hepatitis?

Answer 11

Viruses.

Drugs.

Question 12

What is the histological finding in acute hepatitis

Answer 12

Spotty necrosis.

Question 13

What are the three primary causes of chronic hepatitis?

Answer 13

Viral hepatitis.
Drugs.
Auto-immune.

Question 14

How is grade defined in chronic hepatitis?

Answer 14

Severity of inflammation.

Question 15

How is stage defined in chronic hepatitis?

Answer 15

Severity of fibrosis.

Question 16

What is the histological finding in interface hepatitis?

Answer 16

Piecemeal necrosis.

Question 17

What percentage of people clear hepatitis C infection?

Answer 17

15-30% of people

Question 18

What are the symptoms of chronic hepatitis C infection? (6)

Answer 18

Fatigue.
Upper right quadrant discomfort.
Transient loss of appetite.

Itching.
Depression.
Impaired memory.

Question 19

What are some extrahepatic complications of chronic hepatitis C infection? (3)

Answer 19

Cryoglobuinaemia.
Glomerulonephritis.
Keratoconjunctivitis sicca.

Question 20

What are some symptoms of hepatic insufficiency due to hepatitis C infection? (3)

Answer 20

Ascites.
Oesophageal varices.
Hepatic encephalopathy.

Question 21

What is the average time to development of HCC due to chronic hepatitis C infection?

Answer 21

10-50 years.

Question 22

What are the options for early stage HCC treatment? (3)

Answer 22

OLT
Surgery
Percutaneous ablation.

Question 23

What should be considered to treat intermediate HCC?

Answer 23

TACE

Question 24

What is done in terminal HCC?

Answer 24

Institute a supportive program.

Question 25

What are the three types of alcoholic liver disease?

Answer 25

Fatty liver. Alcoholic hepatitis. Cirrhosis.

Question 26

What is NAFLD/NASH?

Answer 26

Non-alcholic fatty liver disease. | Non-alcoholic steatohepatitis.

Question 27

What is NAFLD/NASH due to?

Answer 27

Due to insulin resistance associated with raised BMI and diabetes.

Question 28

How do you tell apart ALD and NAFLD?

Answer 28

Cannot do so histologically - reliant on the history.

Question 29

What is primary biliary cirrhosis.

Answer 29

Bile duct loss associated with chronic inflammation (with granulomas)

Question 30

What can be found in primary biliary cirrhosis.

Answer 30

Anti-mitochondrial antibodies.

Question 31

What is primary sclerosing cholangitis

Answer 31

Periductal bile duct fibrosis leading to loss of architechture.

Question 32

What is primary sclerosing cholangitis associated with?

Answer 32

Ulcerative colitis

Question 33

What risk is associated with primary sclerosing cholangitis

Answer 33

Increased risk of cholangiocarcinoma

Question 34

What is the investigation of choice for primary sclerosing cholangitis

Answer 34

ERCP

Question 35

What is haemochromatosis

Answer 35

Genetically determined increased gut iron absorption

Question 36

What gene is responsible for haemochromatosis

Answer 36

Chromosome 6

Question 37

What is the pathological process in haemochoromatosis

Answer 37

Parenchymal damage to organs secondary to iron deposition (bronzed diabetes)

Question 38

What is haemosiderosis

Answer 38

Accumulation of iron in macrophages

Question 39

What is the treatment for haemosiderosis

Answer 39

Blood transfusion

Question 40

What is Wilson's disease

Answer 40

Accumulation of copper due to failure of excretion by hepatocytes

Question 41

What gene is responsible for Wilson's disease

Answer 41

Chromosome 13

Question 42

Where does copper primarily accumulate in Wilson's disease (2)

Answer 42

Liver and CNS (hepato-lenticular degeneration)

Question 43

What stain is used to detect Wilson's

Answer 43

Rhodanine stain

Question 44

What condition are Kayser-Fleischer rings seen in?

Answer 44

Wilson's disease. They are golden-brown pigment deposits in descemet's membrane in the peripheral of the iris.

Question 45

What are the ophthalmoligic manifestations of Wilson's disease? (2)

Answer 45

Kayser-Fleischer rings. | Sunflower cataracts.

Question 46

What is autoimmune hepatitis

Answer 46

Interface hepatitis with plasma cells

Question 47

What are the biochemical markers of autoimmune hepatitis?

Answer 47

Anti-smooth muscle actin antibodies

Question 48

What is the primary treatment for autoimmune hepatitis?

Answer 48

Steroids.

Question 49

What is alpha-1-antitrypsin deficiency

Answer 49

Failure to secrete alpha-1-antitrypsin leading to intra-cytoplasmic inclusions and hepatitis/cirrhosis.

Question 50

What is drug-related injury of the liver

Answer 50

Any kind of liver disease can be caused by a drug

Question 51

What drug can cause hepatic toxicity

Answer 51

Paracetamol (acataminiphen)

Question 52

What are some causes of hepatic granulomas? (4)

Answer 52

Primary biliary cirrhosis. Drugs. TB. Sarcoid.

Question 53

What are some benign liver tumours (3)

Answer 53

Liver cell adenoma Bile duct adenoma Haemangioma

Question 54

What are some causes of malignant liver tumours (2)

Answer 54

Secondary tumours. | Primary tumours.

Question 55

What is a common cancer than metastases to the liver.

Answer 55

Pancreatic cancer.

Question 56

What are some primary malignant liver tumours (4)

Answer 56

Hepatocellular carcinoma Hepatoblastima Cholangiocarcinoma Haemangiosarcoma

Question 57

What is HCC associated with

Answer 57

Cirrhosis (especially in the West)

Question 58

What is cholangiocarcinoma associated with (3)

Answer 58

Primary biliary cirrhosis. Worm infections. Cirrhosis.

Question 59

Where can cholangiocarcinoma arise from (2)

Answer 59

``` Intrahepatic ducts. Extrahepatic ducts (including gallbladder). ```