pathology of the liver and cirrhosis Flashcards
(29 cards)
what is the legal driving limit?
80mg/dl
what is the level of alcohol that puts a naive drinker at risk of death?
300mg/dl
what is the level of alcohol that puts a chronic drinker at risk of death?
> 350mg/dl
what are the 3 signs of chronic alcohol liver disease?
- fatty change
- hepatitis
- cirrhosis
what are the liver function tests (LFT’s)?
- bilirubin
- total protein
- albumin
- alanine transaminase (ALT)
- aspartate transaminase (AST)
- alkaline phosphatase (ALP)
- gamma glutamyl transferase (GGT)
- prothrombin time (PT)
what is shown on a haematological test if someone has iron deficiency anaemia?
decreased Hb and decreased MCV
what is shown on a haematological test if someone has folate ad B12 deficiency?
increased MCV
what is shown on a haematological test if someone has a clotting factor related abnormality?
raised INR
what is the pathogenesis of alcohol steatosis?
1) increased precursors for fat synthesis
2) reduced fat breakdown
3) reduced hepatic excretion of fat
4) fatty change of liver is reversible on abstention
what are the key features of acute hepatitis?
- may be associated with jaundice
- patient may be very unwell
- polymorphs/neutrophils in the liver
what are the key features of chronic hepatitis?
- if the patient does not abstain, there is a risk of progression to fibrosis and cirrhosis
- lymphocytes infiltrate in the liver
what is alcoholic cirrhosis?
irreversible end stage liver disease
what are the hallmarks or cirrhosis?
fibrosis/scarring and modularity
what does repeated inflammation and the healing process lead to in alcoholic cirrhosis?
regeneration of the hepatocytes into nodules separated by scar tissues
what size is a macro-nodule?
> 3mm
what size is a micro-nodule?
<3mm
what are the other causes of cirrhosis?
- alcohol
- viral hepatitis (B, C, D, E etc…)
- primary biliary cirrhosis
- primary haemochromatosis
- Wilson’s disease
- alpha-1-antitrypsin deficiency
- cryptogenic
what are the complications of cirrhosis?
- portal hypertension
- liver failure (jaundice, hypoproteinaemia, bleeding, hepatic encephalopathy)
- ascites
- hepatocallular carcinoma
what causes portal hypertension?
fibrosis
what happens with portal hypertension?
- blood flow through the liver is impeded
- blood finds an alternative route to the heart via the spleen and oesophagus leading to collateral circulation and an enlarged spleen and oesophageal varices
what is the triad of portal hypertension?
- cirrhosis
- oesophageal varices
- splenomegaly
what are the causes of bleeding in alcoholic patients?
- oesophageal varices
- peptic ulcer
- mallory weiss tear
- haemorrhagic gastritis
- reflux oesophatitis with ulceration
where does a Mallory Weiss tear occur?
oesophagi-gastric junction
when does a Mallory Weiss tear occur?
when the patient vomits and retches against a closed cardiac sphincter
