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Liver Disease Flashcards

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1
Q

What separates the 2 main lobes of the liver

A

The falciform ligament

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2
Q

How many segments is the liver split into

A

8

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3
Q

What supplies blood to the liver

A 
Hepatic artery (oxygenated blood)
Hepatic portal vein (nutrients)
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4
Q

What connects the gall bladder to the common hepatic duct

A

cystic duct

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5
Q

What cells make up the liver and how are they arranged

A

Hepatocytes
Sheets of hepatocytes are separated by sinusoids
Hepatic tissue can be arranged into lobules - hexagons

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6
Q

What is found in the centre and corners of each lobule

A

Central vein located at the centre

Portal tract at the corner of each lobule

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7
Q

What is the portal tract made up of

A

Hepatic artery
Portal vein
Bile duct

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8
Q

What functional units are found in hepatic tissue and where are they found

A

Acini are functional units of hepatic tissue found between 2 central veins

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9
Q

Where are the 3 zones of acini found in hepatic tissue

A

Zone 1 = closest to portal tract
Zone 3 = closest to central vein
Zone 2 = found between the 2 other zones

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10
Q

What is the metabolic function of the liver

A

Detoxification and breakdown of toxins, hormones and drugs

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11
Q

What are the synthetic functions of the liver

A
  • Bile (emulsification of fat)
  • Protein (production and activation)
  • Carbohydrate (gluconeogenesis)
  • Lipid (cholesterol, triglycerides)
  • Red blood cells (in foetal liver)
  • Clotting factors
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12
Q

What responses does the liver have to injury

A
  • Hepatocyte degeneration and intracellular accumulation
  • Hepatocyte necrosis and apoptosis
  • Inflammation
  • Regeneration
  • Fibrosis
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13
Q

What symptoms are associated with liver injury

A
  • Jaundice
  • Oedema
  • Ascites
  • Cerebral dysfunction
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14
Q

What is jaundice cause by and what does it look like

A

Increased serum bilirubin and bilirubin deposition in tissues and causes discolouration of skin and sclera

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15
Q

What is ascites

A

Accumulation of fluid in the abdominal cavity

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16
Q

Describe how bilirubin is formed

A
  • Hb in RBCs is released
  • Heme from Hb is oxygenised by Heme Oxygenase
  • This forms Biliverdin
  • Biliverdin is reduced to unconjugated bilirubin by biliverdin reductase
  • Unconjugated bilirubin gains a glucuronate to form conjugated bilirubin
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17
Q

What are the 3 site classifications of jaundice and what does each mean

A

Prehepatic - takes place before the bilirubin reach the liver
Intrahepatic - Takes place within the liver
Post-hepatic - takes place after the bilirubin leaves the liver

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18
Q

What are the prehepatic causes of jaundice

A

Excess bilirubin production:

  • haemolytic anaemia
  • Internal bleeding
  • Ineffective erythropoiesis
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19
Q

What are the intrahepatic causes of jaundice

A

Impaired conjugation
Impaired excretion
Reduced Uptake

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20
Q

What can cause impaired conjugation in intrahepatic jaundice

A
  • Physiological jaundice in newborns/ can occur in breast feeding
  • Diffuse hepatocellular disease
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21
Q

What can cause impaired excretion in intrahepatic jaundice

A
  • Intrahepatic bile duct disease

- Drugs

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22
Q

What can cause reduced uptakes in intrahepatic jaundice

A

drugs

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23
Q

What is the mechanism of postheaptic of jaundice

A

Extrahepatic biliary obstruction

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24
Q

What can cause extra hepatic biliary obstruction and cause post hepatic jaundice

A

Gallstones
Pancreatic cancer
Extrahapetic biliary atresia
Biliary strictures

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25
What can cause hepatic oedema/ascites
Portal hypertension - high blood pressure in the portal venous system Hypoalbuminaemia - low level of albumin in the circulation
26
How can cerebral dysfunction occur with liver injury and what symptoms are associated with it
- Increased production of ammonia in liver injury - Ammonia disrupts neurotransmission - Symptoms include disturbance in consciousness, rigidity, hyper-reflexia, asterixis
27
What is hepatitis
Inflammation of the liver following injury, can be acute or chronic
28
Name some causes of hepatitis
Viral Alcohol Drugs/toxins Autoimmune
29
How is Hepatitis A spread and is it chronic or acute
Faecal-oral spread | not chronic
30
How is Hepatitis B spread and is it chronic or acute and how can it progress
Parenteral spread Chronic in 5-10% Can progress to chronic hepatitis and hepatocellular carcinoma
31
How is Hepatitis C spread and is it chronic or acute and how can it progress
Parenteral spread Chronic in 5-10% Can progress to chronic hepatitis and hepatocellular carcinoma
32
When does hepatitis D tend to occur
Tends to occur as a co infection with hepatitis B = fulminant disease
33
What can super infection of hepatitis D cause
Chronic progressive hepatitis
34
How is hepatitis E spread and is it chronic
Spread via water droplets and not chronic
35
What are the symptoms of acute hepatitis
- Mostly non-specific symptoms initially, like nausea, vomiting and pain - Specific symptoms = profound loss of appetite, dark urine and jaundice - Some progress to acute liver failure
36
Describe the macroscopy of acute hepatitis
Mild hepatomegaly | Congestion
37
Describe the microscopy of acute hepatitis
- Scattered foci of lobular necrosis and inflammation - Apoptotic bodies (councilman bodies) - Hepatocyte ballooning and necrosis - Disruption of architecture (lobular disarray) - Inflammation of portal tracts
38
How long do symptoms have to show for before you can diagnose chronic hepatitis
>6 months
39
What are the causes of chronic hepatitis
- Hepatitis B or B + D - Hepatitis C - Autoimmune Hepatitis - Drug-induced hepatitis
40
What 3 histological features of chronic hepatitis can be seen
Inflammation (predominantly lymphocytic) Hepatocyte necrosis Fibrosis
41
Where can you see inflammation histologically in chronic hepatitis
Portal tracts Periportal interface hepatitis (piecemeal necrosis) Lobular
42
What is periportal interface hepatitis
Inflammation within the lobular boundaries
43
What types of necrosis can you see histologically in chronic hepatitis and describe them
- Bridging necrosis - portal tract to central vein or portal tract to portal tract - Confluent necrosis - larger area necrosis
44
What is fibrosis and what can it result in
This is the replacing of the liver tissue for scar tissue and can eventually cause cirrhosis
45
What is cirrhosis
Cirrhosis is irreversible end stag liver disease that disrupts the vascular architecture and blood flow of the liver
46
Name some of the causes of cirrhosis
- Alcohol - Viral hepatitis (B,C and D) - Autoimmune hepatitis - Primary and secondary biliary cirrhosis - Metabolic causes e.g. haemochromatosis, Wilson's disease, Alpha-1-antitrypsin deficiency - Drugs - Idiopathic - Venous outflow obstruction
47
What complications can cirrhosis cause
Hepatic failure Portal hypertension Hepatic encephalopathy Oesophageal varices - obstructed portal veins
48
Describe the mechanism of how cirrhosis causes hepatic encephalopathy
- Portal blood bypasses liver | - Toxic or metabolic effect on the brain
49
Describe the mechanisms by which portal hypertension can cause ascites
``` High intrasinusoidal pressure Leakage from hepatic lymphatics Hypoalbuminaemia Na+ Water Retention ```
50
What are ascites
Build up of fluid in the abdomen
51
Portal hypertension results in what
Ascites Portal systemic venous shunts Splenomegaly (congestive)
52
Describe the effects of portal systemic venous shunts
- Oesophagus: varices - Rectum: haemorrhoids - Falciform ligament - Anterior abdominal wall
53
What problems come about as a result of hepatic failure
- Jaundice - Hypoalbuminaemia - Coagulopathy - DIC - disseminated intravascular coagulation - Raised serum area - Hepatorenal syndrome - Gynaecomastia, spider nave - Encephalopathy
54
What are the 3 stages of Alcoholic liver disease
1. Alcoholic Steatosis 2. Alcoholic Hepatitis 3. Alcoholic Cirrhosis
55
What happens in alcoholic steatosis
- Fatty change in the liver = soft yellow liver | - Fibrosis
56
What happens alcoholic hepatitis
- Fatty cahnge - Fibrosis - Hepatocyte necrosis - Inflammation - Iron deposition - Mallory's hyaline (protein) deposition
57
What are benign primary liver tumours called
Liver cell adenoma
58
What kinds of malignant primary liver tumour can you get
- Hepatocellular carcinoma - Cholangiocarcinoma - Angiosarcoma - Hepatoblastoma (mainly children)
59
Describe the morphology of secondary liver tumours
- Hepatomegaly | - Typically multiple nodules; rarely a solitary nodule
60
When do hepatocellular carcinomas often develop
In a cirrhotic liver
61
List the aetiologies (factors) of hepatocellular carcinomas
- Hep B virus - Hep C virus - Haemochromatosis - Aflatoxin - Alcohol, age, gender
62
Describe the clinical features of hepatocellular carcinomas
- Abdominal pain - Weight loss - Hepatomegaly - Raised serum alpha-feto protein (also seen in cirrhosis, yolk sac tumours) - Metastases occur later: lungs - Survival <6 months usually - Death due to cachexia, varices, encephalopathy
63
Describe the macroscopy of hepatocellular carcinoma
Hepatomegaly - 1. univocal mass: yellow/white, soft, haemorrhage, necrotic 2. Multifocal 3. Diffusely infiltrative
64
Describe the microscopy of hepatocellular carcinoma
- Well differentiated tumours resemble normal liver trabeculae - Poorly differentiated tumours may mimic metastases

FHHD (21 decks)

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