Flashcards in Liver Disease Deck (23):
What types of disease is the liver vulnerable to?
What histological features are common to the liver?
Inflammation - (hepatitis) acute and chronic, granulomas
Degeneration - swelling and oedema of hepatocytes, accumulation of fat
Necrosis - significant insult, focal or massive
Regeneration - occurs unless disease
Fibrosis - (cirrhosis) as a result of inflammation followed by regeneration
What is cirrhosis?
Diffuse fibrosis with nodular regeneration
Small, firm and nodular liver
Nodules - macro (more than 0.3cm) or micro (less 0.3cm)
What can cirrhosis lead to?
Portal hypertension - obstruction of portal veins
How much liver needs to be lost for hepatic failure?
80 - 90%
Mortality 70 - 90%
What are the causes of cirrhosis?
Alcoholic liver disease
Primary biliary cirrhosis - autoimmune
Secondary biliary cirrhosis - obstuction
Metabolic disorders - Wilsons disease
Why does jaundice happen?
Retention of bilirubin which gets deposited in tissues
Unconjugated bilirubin from breakdown of Hb and myoglobin is insoluble and bound to albumin
In the liver it gets conjugated with glucuronic acid by bilirubin UGT to make it water soluble so it can be excreted in bile
When would you get unconjugated hyperbilirubinemia?
When 80% of serum is conjugated
Bilirubin overproduction - increased Hb breakdown
decreased hepatic uptake
impaired hepatic conjugation
When would you get conjugated hyperbilirubinemia?
When 50% of serum is conjugated
BILE DUCT OBSTRUCTION CAUSES:
reduced hepatic excretion of bile
Impaired extra hepatic flow
What is jaundice?
A yellow discolouration of skin or eyes
Describe the liver?
Largest organ in the body - weighs 1500g
Exocrine gland (produces bile) and has metabolic activity
Divided into lobules
What are other clinical features associated with jaundice?
Pale stools - loss of bile into the gut
Dark urine - increased secretion of conjugated bile pigments
Itching - increased bile acids in circulation
What are the two types of hepatitis?
What is acute hepatitis?
Active liver cell destruction or necrosis
Degeneration of hepatocytes with individual cell necrosis
Hep A and E = faeco oral
Hep B, C, D = blood and bodily fluid contact
Alcohol induced liver disease from excessive alcohol,leads to fatty changes in liver beause of oxidation of fatty acids
Leads to alcoholic hepatitis, fibrosis and cirrhosis
BILE DUCT OBSTRUCTION
What is Wilsons disease?
ATPase is defective in excreting copper into the bile
What is chronic hepatitis?
Persists more than 6 months
Caused by drugs, viruses, automimmune disease, inborn error of metabolism (Wilsons disease)
What are the two types of liver tumour?
Benign - adenoma, angioma, focal nodular, hyperplasia
Malignant - Primary = HCC, Secondary - metastasis
What is HCC?
Most common cancer in the world associated with chronic hepatitis induced by Hep B infection
Almost always occurs in a background of established cirrhosis
What is the prognosis for HCC?
Usually poor because only 10 - 20% HCC can be removed
Deadly within 3 - 6 months
What is the gall bladder?
Sac connected to the common bile duct via the cystic duct
Stores and concentrates bile
What are gallstones?
Very frequent crystallisations of bile substances
Cholesterol - obesity
Bile pigment - haemolysis
Mixed - most common
What are the complications with gallstones?
Obstruction can lead to distension, infection, obstructive jaundice, pancreatitis, carcinoma