Pathology of the liver

Question 1

What is the pathogenesis of liver disease?

Answer 1

Insult to hepatocytes…viral, dug, toxinn, antibody
Grading…degree of inflammation
Staging….degree of fibrosis
Cirrhosis

Question 2

What can cause an acute onset of jaundice?

Answer 2

Viruses
Alcohol
Drugs
Bile duct obstruction

Question 3

How does acetoaminophen toxicity affect the liver?

Answer 3

Confluent necrosis produces massive acute necoriss and liver failure

Question 4

What are the consequences of acute liver failure?

Answer 4

Complete recovery
Chronic liver disease
Death from liver failure

Question 5

What is jaundice?

Answer 5

Yellowing of the skin and/or sclera due to bilirubin

Question 6

What are the different types of jaundice?

Answer 6

Pre-hepatic
Hepatic
Post-hepatic
Conjugated or unconjugated

Question 7

What causes pre-hepatic jaundice?

Answer 7

Haemolysis of all causes, too much haem to break down in the liver
Haemolytic anaemia
Unconjugated bilirubin

Question 8

What causes hepatic jaundice?

Answer 8

Acute liver failure (virus, drugs, alcohol) 
Alcoholic hepatitis
Cirrhosis
Bile duct loss (atresia, PBC, PSC) 
Pregnancy

Question 9

What causes post-hepatic jaundice?

Answer 9

Congenital biliary atresia
Gallstones block CBD
Stricture of CBD
Tumours (Ca head of pancreas)

Question 10

What is cirrhosis?

Answer 10

Fibrous bands separarting regenrative nodules altering the hepatic microvasculature causing loss of hepatic function

Question 11

What can cause cirrhosis?

Answer 11

Alcohol
Hep B and C
Iron overload (haemochromatosis) 
Autoimmune liver disease 
Gallstones

Question 12

What are the complications of cirrhosis?

Answer 12

Portal hypertension
Ascites
Liver failure

Question 13

What are the clinical signs of portal hypertesion?

Answer 13

Oesophageal varices
Caput medusa
Haemorrhoids

Question 14

Why does ascites occur in cirrhosis?

Answer 14

Accumulation of fluid within the abdo cavity as the liver is no longer making albumin which is a protein in the plasma that draws fluid back into the circulation and without it the fluid sits in the extracellular space

Question 15

What is the pathogeneiss of alcoholic liver disease?

Answer 15

When alcohol is drank, there is an increased peripheral release of fatty acids and increased synthesis of fatty aids and triglycerides within the liver cells. Acetaldehyde is a product of alcohol metabolism and is resposible for hepatocyte injury

Question 16

What will occur after 2/3 days of heavy drinking?

Answer 16

Fatty liver - reversible

Question 17

What will occur aftern 4-6 weeks of heavy drinking?

Answer 17

Acute alcoholic hepatitis - reversible

Question 18

What will occur after mnths/yrs of heavy drinking?

Answer 18

Fibrosis - irreversible

Question 19

What will occur after years of heavy drinking?

Answer 19

Cirrhosis - irreversible

Question 20

What is the name for when hepatocytes become fatty?

Answer 20

Steatosis

Question 21

What are the differential diagnosis of fatty liver?

Answer 21

NASH
Pregnancy
Drugs
Nutritional
Diabetes
HCV

Question 22

What are the histological changes in alcoholic hepatitis?

Answer 22

Hepatocyte necorsis
Neutrophils
Mallory bodies
Pericellular fibrosis

Question 23

What is the outcome of alcoholic liver disease?

Answer 23

Cirrhosis
Portal hypertesion 
Malnutrition 
HCC
Social disintegration

Question 24

Who does NASH affect?

Answer 24

Diabeteics
Obese people
People with hyperlipidaemia

Question 25

What are the causes of viral hepatitis?

Answer 25

``` Hep A Hep B Hep C Hep E Delta agent EB virus Yellow fever virus Herpers simplex virus Cytomegalovirus ```

Question 26

What will chronic viral hepatitis involve?

Answer 26

Inflammation of the portal triad Interface hepatitis - piecemeal necorsis Lobular inflammation Fibrosis

Question 27

What is the outcome of hep B?

Answer 27

``` Fulminant acute infection Chronic hepatitis Cirrhosis Hepatocellualr carcinoma Assymptomatic ```

Question 28

What is the outcome of hep C?

Answer 28

Chronic hepatitis | Cirrhosis

Question 29

What are the autoimmune diseases that can cause chronic hepatitis?

Answer 29

Primary biliary cirrhosis Autoimmune hepatitis Primary sclerosing cholangitis

Question 30

Who is likely to get primary biliary cirrhosis?

Answer 30

Females

Question 31

What can you see on biopsy of primary biliary cirrhosis?

Answer 31

Granulomas and bile duct loss

Question 32

What does primary biliary cirrhosis look like histologically?

Answer 32

Portal inflammation | Destruction of the bile ducts in PBC which does not happen in chronic hepatitis of other causes

Question 33

What does a granuloma look like histologically?

Answer 33

A collection of histocytes with surroinding lymphocytes

Question 34

What colour is the liver in PBC?

Answer 34

Green

Question 35

Who is likely to be affected by autoimmune hepatitis?

Answer 35

Commoner in younger females

Question 36

What oes autoimmune hepatitis look like histologically?

Answer 36

Chronic hepatitis pattern Numerous plasma cells Autoantibodies to smooth muslce, nuclear or LKM, raise IgG

Question 37

What is primary sclerosing cholangitis?

Answer 37

Chronic inflammatory process affecting intra and extra hepatic bile ducts

Question 38

What does primary sclerosing cholangitis lead to?

Answer 38

Periductal fibrosis, duct destruction, jaundice and fibrosis

Question 39

What other disease is primary sclerosing cholangitis associated with?

Answer 39

Ulcerative colitis

Question 40

Who s linke to be affected by primary sclerosing cholangitis?

Answer 40

Males

Question 41

What does primary sclerosing cholangitis look like histologically?

Answer 41

Periductal onion skinning fibrosis

Question 42

What are the 3 most common storage disorders?

Answer 42

Haemochromatosis Wilson's disease Alpha-1-antirypsin deficiency

Question 43

Who will get primary haemochromatosis?

Answer 43

Genetic condition | Increased absorption of iron from the intestine and abnormal iron metabolism

Question 44

Who will get secondary haemochromatosis?

Answer 44

Iron overload from diet Transfusions Iron therapy

Question 45

What can primary haemochromatosis lead to?

Answer 45

Deposited in portal connective tissue and stimulates fibrosis Cirrhosis if not treated Predidposes to cacrinoma Can cause diabtetes, cardiac failure and impotence

Question 46

What is wilson's disease?

Answer 46

Inherited autosomal recessive disorder of copper metabolism

Question 47

Where does copper accumulate?

Answer 47

In the liver and brain (basal ganglia)

Question 48

What can wilson's disease cause?

Answer 48

Chronic hepatitis and neurological deterioration

Question 49

What is alpha-1-antitypsin deficiency?

Answer 49

Inherited autosomal recessive disorder of production of an enzyme inhibitor

Question 50

What can alpha-1-antripysin deficiency cause?

Answer 50

Emphysema and cirrhosis

Question 51

What are the primary tumours of the liver?

Answer 51

Hepatocellular adenoma | Hepatocellular carcinoma

Question 52

Where are common metastases to the liver from?

Answer 52

Colon, pancreas, stomach, breast, lung and other

Question 53

Who is hepatocellular adenoma likely to affect?

Answer 53

Women on the contraceptive pill

Question 54

What is hepatocellular carcinoma associated with?

Answer 54

HBV HCV Cirrhosis

Question 55

What does HCC usually present with?

Answer 55

Mass, pain and obstruction