What are some risk factors for NASH?
What do you screen for when cirrhosis is found?
T/F Macrovescicular steatosis predisposes one to a high risk of cirrhosis
False, steatohepatitis is required for a high risk
What makes the nodules present in cirrhosis green?
What histopathology is typical of acute viral hepatitis?
Lobular disarray - cell swelling, disordered plates, irregular sinusoids
What attracts neutrophils in alcoholic hepatitis?
What diseases lead to cirrhosis?
All of the chronic liver diseases
- Chronic hepatitis
- Alcoholic liver disease
- Chronic billary obstruction
- Metabolic disease
What do all diseases that lead to cirrhosis have in common?
Apoptosis and inflammation of hepatocytes
When is hepatic carcinoma in cirrhosis seen the most?
When there is underlying Hep B, C, alcoholic liver disease or haemachromatosis
What is the pathogenesis of portal hypertension due to cirrhosis?
Constriction of portal arteries and veins in response to increased blood flow
Hepatic vein direct compressed by fibrous bands
Loss of small vessels due to scar tissue
Shunts of hepatic arteries into portal veins
What is hepatic encephalopathy caused by?
Accumulation of ammonia in the brain
What other organs get cirrhosis?
None, cirrhosis is a term used purely for the liver
How do you differentiation ASH and NASH?
What is a councilman body?
A hepatocyte undergoing apoptosis
What is septa fibrosis the precursor for?
What is the greatest cause of portal hypertension?
Is hepatocellular ballooning due to water or lipid accumulation?
What are the 4 feature of alcoholic hepatitis?
What is the meaning of interface hepatitis?
Describe the pathogenesis of cirrhosis
Chronic inflammation > Stellate cells act. into myofibroblast phenotype > Activated by cytokines from Kupffer cells > Produce collagen
What is a postsinusoidal cause of portal hypertension?
Thrombosis of hepatic veins
What are mallory bodies?
Collapsed cytoskeleton due to alcohol damage
What is macrovescicular steatosis caused by?
Increase synthesis of triglycerides or
Decrease in secretion of triglycerides
What are the three site of anastomosis where varices can occur in portal hypertension
Which zone of hepatic lobules is most sensitive to toxic and ischaemic damage?
What are the clinical signs of chronic liver disease?
Abdominal wall collaterals
Where does apoptosis and inflammation occur in the liver during chronic hepatitis?
Portal and periportal (ie in and around the portal triad)
What is more severe NASH or alcoholic steatohepatitis?
T/F Acute hepatitis usually involves the whole liver
How is interface hepatitis graded?
By the degree with which lymphocytes are escaping the portal tract
What is the hallmark feature of steatohepatitis?
Hepatocellular ballooning degeneration
What the most common causes of chronic hepatitis?
Hep B and C
What is the main immune cells present in viral hepatitis?
What is histologically in chronic hepatitis?
T/F Neutrophils are present in viral hepatitis?
False, mainly T cells
What are the causes of chronic hepatitis?
Hep B, C and autoimmune hepatitis
What does vascular remodelling do the progression of cirrhosis?
Causes areas of local ischaemia > accelerates cirrhosis, particularly important in late stage development
What are the cells that contribute to cirrhosis pathogenesis?
What are the three complications of cirrhosis?
Parenchymal liver failure
What is the liver damaged by with paracetamol use?
The toxic metabolite of paracetamol NAPQI directly injures hepatocytes and causes the depletion glutathione
What is the most important enzyme for acute hepatitis in liver functions tests?
ALT (alanine transaminase)
T/F NAFLD is only in adults
False, children too
How do you measure portal vein pressure?
What is the primary form of cell death in acute viral hepatitis?
T/F There is an inflammatory response in paracetamol induced liver damage
What is the pressure values in portal hypertension?
Portal pressure >8mmHg or
Pressure gradient from portal to hepatic veins of >5mmHg
What is the hallmark feature of chronic and acute hepatitis?
What is cryptogenic cirrhosis?
A previously used terms for cirrhosis with an idiopathic cause - now replaced by NAFLD
What syndromes come under the umbrella of chronic liver disease?
Alcohol liver disease
Metabolic disease eg Haemochromatosis
Chronic obstruction of bile duct
What is NASH?
What is the definition of chronic hepatitis?
Raised serum aminotransferase for >6 months
What can happen to the central vein in alcoholic hepatitis?
What are some things that can be done to help diagnose the cause of cirrhosis?
Hep B and C screening
BIle duct obstruction
What are fibrous septa?
Bands of collagenous fibrosis radiating out from portal triads
What type of damage does paracetamol do to the liver?
What is steatohepatitis?
Macrovescicular steatosis with accompanying inflammation and hepatocyte injury
How does the pattern of fibrosis in NASH and ASH differ from that in chronic hepatitis?
It is pericellular cf to intertriad
What type of steatosis is most common?
Macrovescicular (large droplet) cf to microvescicular (small)
What infiltrate is present in viral hepatitis?
Describe the anatomy of cirrhosed liver
Nodules of regenerating tissue surrounded by bands of scar tissue
How does alcoholic acute hepatitis present?
Right upper quadrant tenderness
What is the mortality rate of acute alcohol hepatitis?
20-30% > increases to 50% if surgery is performed
What is a pre-sinusoidal cause of portal hypertension?
Portal vein thrombosis
What is a varix?
Dilated segment of a vein