wk 6 5 pathology of liver 1/2

Question 1

microanatomy can be divided into 3 structures

Answer 1

1 - periportal
2- mid acinar
3 - pericental
(used to describe the patterns of liver injury)

Question 2

‘grading’ is a degree of……

‘staging’ is a degree of….

Answer 2

.. inflammation

…fibrosis

Question 3

acute causes of jaundice 4

Answer 3

virus
alcohol
drugs
bile duct obstruction

Question 4

acetoaminophen toxicity is seen in suicide of paracetamol consumption, what happens to liver

Answer 4

confluent necrossis

acute liver failure

Question 5

how can jaundice be classified

Answer 5

pre-hepatic (uncomplicated)
hepatic
post-hepatic (complicated)

Question 6

3 ways pre-hepatic jaundice can occur (too much haem)

Answer 6

haemolysis (incr in RBC breakdown = incr in bilirubin production)
haemolytic anaemias
unconjugated bilirubin ]

Question 7

5 ways hepatic jaundice can occur

death of liver cells

Answer 7

acute liver failure
alcoholic hepatitis
cirrhossi 
bile duct loss
pregnancy

Question 8

4 ways post-hepatic jaundice (bile cannot escape into bowel)

Answer 8

conginetal biliary atresia
gallstonesblock
stricutres of CB Duct
Tumours (head of pancrea)

Question 9

t/f cirrhosis iss reversible

Answer 9

true

Question 10

define cirrhosis

Answer 10

bands of fibrosis separated by regenerative nodules of hepatocytes

Question 11

if cirrhosis is said to be ‘micronodular’ this indicates

Answer 11

alcoholism

Question 12

6 common causes of cirrhosis

Answer 12

alcohol 
viral disease
iron overload
autoimmune
obstructive liver disease

Question 13

histologically cirrhosis is

Answer 13

nodules of hepatocytes separatyed by fibrotic bands

Question 14

main complication of cirrhosis

Answer 14

portal hypertension - porto-caval anastimoses

lead to oesophageal varices, caput medusa, haemorrhoids

Question 15

sites of porto-caval anastimoses

Answer 15

around rectum, paraumbilical and oesophagus

Question 16

clinical features of chronic liver disease

Answer 16

oedema
ascites
haematemesis 
spider naevi 
gnaecomastia
purpura and bleeding
infection
coma

Question 17

duration of drinking to turn liver into fatty liver? into hepatitis? into fibrotic? into cirrhotic?

Answer 17

2-3days (reversible)

4-6weeks (reversible)

mths-years

years

Question 18

how does the liver look histologically after 2 days

Answer 18

steatosis

lighter shade, more holes (fat vacuoles)

Question 19

other than alcohol, give 6 examples how a fatty liver can be produced

Answer 19

NASH 
pregnaancy
drugs
nutritional
diabetes (type 2 2nd commonest cause) 
HCV (type 3)

Question 20

4 features of alcoholic hepatitis in heavy drinkin (wks - months)

Answer 20

hepatocyte necrosis
neutrophils
mallory bodies
pericellular fibrossi

Question 21

t/f collagen found in alcoholic fibrosis

Answer 21

true

this separates cells from blood supply - leading to death

Question 22

t/f metabolic syndrome can produce the same pathology of alcoholic hepatitis

Answer 22

true

non-alcoholic steatohepatitis (NASH)

Question 23

commonest cause of liver cancer

Answer 23

NASH

Question 24

Hep A - E are the common causes of virla hepatitis, what are some rare causes

Answer 24

ebstein-barr virus
yellow fever
herpes

Question 25

which of the commonest viral hepatitis is spread via faecal-oral

Answer 25

Hep A and E

Question 26

5 likely outcomes of Hep B infection

Answer 26

``` death chronic hepatitis cirrhosis hepatocellular carcinoma assymptomatic ```

Question 27

6 causes of chronic hepatitis

Answer 27

``` Hep B Hep C PBC PSC Autoimmune Drug induced ` ```

Question 28

what is seen histologically in PBC

Answer 28

chronic portal inlfammation/ bile inflammation portal = bile = biliary granuloma around duct

Question 29

outline the steps to cirrhosis if the patient has PBC

Answer 29

untreated leads to bile duct loss cholestasis inflammation - fibrosis cirrhosis

Question 30

PSC is chronic inflammatory process affecting intra hepatic bile ducts alone t/f

Answer 30

false intra and extra hepatic bile ducts

Question 31

which inflammatory disease is PSC related to

Answer 31

UC

Question 32

PSC or PBC has an increased risk of malignancy in bile ducts and colon

Answer 32

PSC

Question 33

what is used to test for haemochromatosis

Answer 33

perls stain

Question 34

treatment of haemochromatosis

Answer 34

venesection

Question 35

wilsons disease is due to an inherited autosomal recessive disorder of copper metabolism, where does it accumulate? serology would show low levels of.....

Answer 35

liver and brain low serum caeruloplasmin

Question 36

what does alpha-1-1antitrypsin defiency cause

Answer 36

emphysema and cirrhosis

Question 37

how does alpha-1-antitrypsin cause emphsysema

Answer 37

used to protect against elastase neutrophils (similar protection for hepatocytes)

Question 38

hepatocellular adenoma are usually tumours which are benign, assymptomatic and found in women, however what can cause complications

Answer 38

enlargen - rupture or bleed

Question 39

hepatocellular carcinoma is associated with 3

Answer 39

Hep B Hep C Cirrhosis

Question 40

t/f multifocal hepatocellular carcinomas are common due to the circulation in liver

Answer 40

false | completely bawed yourself rory