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Questions and Answers
What is the most common cause of portal hypertension?
What is the most common cause of portal hypertension?
Which condition is associated with non-cirrhotic portal hypertension?
Which condition is associated with non-cirrhotic portal hypertension?
What is a significant physiological change in the case of portal hypertension secondary to cirrhosis?
What is a significant physiological change in the case of portal hypertension secondary to cirrhosis?
Which of the following is NOT classified as a cause of pre-hepatic portal hypertension?
Which of the following is NOT classified as a cause of pre-hepatic portal hypertension?
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Which response to phenobarbital is generally observed in cases of moderately to severely decreased UDP-GT activity?
Which response to phenobarbital is generally observed in cases of moderately to severely decreased UDP-GT activity?
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What is the primary vascular supply to the liver?
What is the primary vascular supply to the liver?
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What is a clinical consequence of portal hypertension related to the lower oesophagus?
What is a clinical consequence of portal hypertension related to the lower oesophagus?
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Which route for liver biopsy is considered safer and avoids certain risks?
Which route for liver biopsy is considered safer and avoids certain risks?
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What does the term 'caput medusae' refer to in the context of liver pathology?
What does the term 'caput medusae' refer to in the context of liver pathology?
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In liver histology, what is the central structure of the centrilobular region?
In liver histology, what is the central structure of the centrilobular region?
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Which symptom is NOT commonly associated with impaired liver function?
Which symptom is NOT commonly associated with impaired liver function?
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What is the role of macrophages in bilirubin metabolism?
What is the role of macrophages in bilirubin metabolism?
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Which of the following is a potential risk of a percutaneous liver biopsy?
Which of the following is a potential risk of a percutaneous liver biopsy?
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What is the primary location of the liver in relation to the rib cage?
What is the primary location of the liver in relation to the rib cage?
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Which of the following is a consequence of impaired protein synthesis in the liver?
Which of the following is a consequence of impaired protein synthesis in the liver?
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What is the incubation period for Hepatitis A virus (HAV)?
What is the incubation period for Hepatitis A virus (HAV)?
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Which of the following viruses is associated with parenteral transmission?
Which of the following viruses is associated with parenteral transmission?
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What defines a fatty liver in terms of steatosis percentage?
What defines a fatty liver in terms of steatosis percentage?
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Which condition is characterized by both steatosis and ballooning degeneration of liver cells?
Which condition is characterized by both steatosis and ballooning degeneration of liver cells?
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What is the most common cause of chronic hepatitis in Hong Kong?
What is the most common cause of chronic hepatitis in Hong Kong?
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Which of the following is NOT associated with metabolic syndrome?
Which of the following is NOT associated with metabolic syndrome?
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What is the primary treatment recommendation for individuals with alcoholic liver disease?
What is the primary treatment recommendation for individuals with alcoholic liver disease?
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Which statement about the epidemiology of NAFLD is true?
Which statement about the epidemiology of NAFLD is true?
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What is the primary purpose of a transjugular intrahepatic portosystemic shunt (TIPS)?
What is the primary purpose of a transjugular intrahepatic portosystemic shunt (TIPS)?
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What physiological process is triggered by variceal bleeding leading to protein degradation?
What physiological process is triggered by variceal bleeding leading to protein degradation?
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Cirrhosis involves the formation of what type of tissue structure?
Cirrhosis involves the formation of what type of tissue structure?
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Which classification of cirrhosis is commonly associated with viral hepatitis?
Which classification of cirrhosis is commonly associated with viral hepatitis?
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What is the current understanding of the reversibility of cirrhosis?
What is the current understanding of the reversibility of cirrhosis?
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What type of renal failure is characterized as pre-renal?
What type of renal failure is characterized as pre-renal?
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What effect does cirrhosis have on hepatocyte regeneration?
What effect does cirrhosis have on hepatocyte regeneration?
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Which of these is an incorrect statement about cirrhosis?
Which of these is an incorrect statement about cirrhosis?
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What is the typical sex ratio for Primary Biliary Cholangitis (PBC)?
What is the typical sex ratio for Primary Biliary Cholangitis (PBC)?
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Which of the following antibodies is associated with Primary Sclerosing Cholangitis (PSC)?
Which of the following antibodies is associated with Primary Sclerosing Cholangitis (PSC)?
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At what age does Primary Biliary Cholangitis typically onset?
At what age does Primary Biliary Cholangitis typically onset?
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What histological finding is indicative of Primary Biliary Cholangitis?
What histological finding is indicative of Primary Biliary Cholangitis?
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Which condition is commonly associated with Primary Biliary Cholangitis?
Which condition is commonly associated with Primary Biliary Cholangitis?
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What is the main diagnostic procedure for identifying Primary Sclerosing Cholangitis?
What is the main diagnostic procedure for identifying Primary Sclerosing Cholangitis?
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How do the age demographics differ between Primary Biliary Cholangitis and Primary Sclerosing Cholangitis?
How do the age demographics differ between Primary Biliary Cholangitis and Primary Sclerosing Cholangitis?
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What is a common biochemical finding in Primary Biliary Cholangitis?
What is a common biochemical finding in Primary Biliary Cholangitis?
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Which of the following diseases shows a 'beads on string' appearance on imaging?
Which of the following diseases shows a 'beads on string' appearance on imaging?
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Which of the following is a feature that distinguishes Primary Biliary Cholangitis from Primary Sclerosing Cholangitis?
Which of the following is a feature that distinguishes Primary Biliary Cholangitis from Primary Sclerosing Cholangitis?
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Which symptom is associated with impaired oestrogen metabolism?
Which symptom is associated with impaired oestrogen metabolism?
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What complication can arise from liver failure?
What complication can arise from liver failure?
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What type of bilirubin increase is seen in pre-hepatic jaundice?
What type of bilirubin increase is seen in pre-hepatic jaundice?
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Which imaging or laboratory results would be most useful to diagnose intrahepatic cholestasis?
Which imaging or laboratory results would be most useful to diagnose intrahepatic cholestasis?
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What condition is characterized by tea-colored urine and pale stool?
What condition is characterized by tea-colored urine and pale stool?
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What is the bilirubin level threshold for clinically detectable hepatic jaundice?
What is the bilirubin level threshold for clinically detectable hepatic jaundice?
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What is a common cause of post-hepatic jaundice?
What is a common cause of post-hepatic jaundice?
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Which syndrome is associated with a mutation in UGT1A1 gene?
Which syndrome is associated with a mutation in UGT1A1 gene?
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Which condition can lead to the presentation of caput medusae?
Which condition can lead to the presentation of caput medusae?
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How does cholestasis affect bilirubin levels in intrahepatic conditions?
How does cholestasis affect bilirubin levels in intrahepatic conditions?
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What type of jaundice occurs when there is inadequate uptake and conjugation of bilirubin?
What type of jaundice occurs when there is inadequate uptake and conjugation of bilirubin?
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What is the result of ineffective erythropoiesis in relation to bilirubin levels?
What is the result of ineffective erythropoiesis in relation to bilirubin levels?
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What typically defines the clinical presentation of Crigler-Najjar type I?
What typically defines the clinical presentation of Crigler-Najjar type I?
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What is the underlying issue in Gilbert's syndrome?
What is the underlying issue in Gilbert's syndrome?
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Study Notes
ACP-L21 & 22 HBP Pathology
-
Liver Anatomy & Physiology:
- Heaviest visceral organ, ~1500g
- Located between the 5th right intercostal space and below the costal margin, at the mid-clavicular line
- Composed of 2 lobes and 8 segments
- Covered by Glisson's capsule
- Vascular supply: 75% portal vein, 25% hepatic artery
- Contains 6 portosystemic anastomoses (HUS1)
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Liver Location and Drainage:
- Location: Lower oesophagus, umbilicus, left gastric vein, (portal),anal canal, inferior/middle rectal vein, and superior rectal vein.
- Superficial epigastric vein and para-umbilical vein are also associated with the systemic drainage.
- Portal drainage occurs via the portal vein.
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Consequences of portal hypertension:
- Oesophageal varices
- Haemorrhoids
- Caput medusae
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Liver Histology:
- Hexagonal structure (theoretical)
- Centrilobular region: Contains central vein
- Periportal region: Characterized by portal tracts, containing portal vein, hepatic artery, and bile duct
- Trabeculae: 1-2 cells thick
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Bilirubin Metabolism:
- Bilirubin is produced from the breakdown of hemoglobin.
- Unconjugated bilirubin (lipid-soluble) is transported in the blood bound to albumin.
- The liver conjugates bilirubin, making it water-soluble, for excretion in bile.
- Conjugated bilirubin is excreted into the bile, then the small and large intestine, where it is converted to urobilinogen.
- Urobilinogen is then transformed into urobilin, which imparts the characteristic color to urine.
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Liver Biopsy:
- Indications: Diagnosing liver masses with inconclusive imaging results (30-60%) or staging known parenchymal liver disease.
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Routes:
- Percutaneous (risk of tumor seeding, bleeding, and organ puncture)
- Transjugular (safer, via IJV→SVC→IVC)
- Open wedge (laparoscopy).
Stigmata of Chronic Liver Disease
- General: Impaired liver function, protein synthesis, biliary excretion, and waste metabolism. Associated symptoms such as malaise, fatigue, anorexia, weight loss, RUQ pain.
- Jaundice: Yellowing of the sclera; characterized by different types of bilirubin (conjugated, unconjugated).
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Portal Hypertension: Increased pressure in the portal venous system
- Pre-hepatic: Thrombosis, stenosis, or compression of the portal vein
- Hepatic: Cirrhosis, schistosomiasis, or granulomatous diseases
- Post-hepatic: Right heart failure, tricuspid regurgitation or inferior vena cava (IVC) or hepatic vein thrombosis
- Ascites: Excessive fluid in the peritoneal cavity. Symptoms include sodium retention, water retention, reduced systemic/local vasodilators to increased local vasoconstrictors, dilutional hyponatremia
- Hepatorenal syndrome: Pre-renal failure due to intense renal vasoconstriction; influenced by RAAS and SNS
- Hepatic encephalopathy: Hyperammonemia due to decreased functional hepatocytes.
Cirrhosis
- Definition: Diffuse process of regenerative nodules surrounded by bridging fibrous septa.
- Types: Macro-nodular and micro-nodular.
- Child-Pugh scoring system: A clinical and laboratory parameter to assess and monitor the severity of cirrhosis.
Infectious Liver Disease
-
Viral Hepatitis (HAV, HBV, HCV, HDV, HEV) causes of infectious hepatitis.
- Features: transmission routes, incubation periods, risk of chronic hepatitis, and HCC.
- Acute Hepatitis: Viral infection duration <6 months, outcome can be remission or progression
- Chronic Hepatitis: Viral infection ≥6 months
- Non-viral Hepatitis: Infectious hepatitis caused by bacteria or parasites
Alcoholic Liver Disease
- Etiology and Epidemiology: Related to significant/excessive alcoholic beverages intake .
- Classification:
- Steatosis (Fatty Liver): Fat accumulation in the liver (5% or more)
- Steatohepatitis (ASH): Steatosis + inflammation, and liver damage
Non-alcoholic Fatty Liver Disease (NAFLD)
- Definition: Accumulation of fat in the liver in the absence of significant alcohol consumption.
- Epidemiology: Common, often associated with metabolic syndrome (obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low HDL-C).
- Manifestations: Usually asymptomatic, but can progress to NASH (nonalcoholic steatohepatitis) and cirrhosis if left untreated.
Drug-induced Liver Injury (DILI)
- Definition: Liver damage/injury caused by medications.
Metabolic Liver Diseases
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Inherited disorders: Genetic mutations affecting the way iron and copper are managed in the body (e.g. HFE haemochromatosis, Wilson's disease).
- HFE haemochromatosis: An iron overload disease, characterized by elevated transferrin saturation, increased serum ferritin and/or hepatic iron index
- Wilson's Disease: Copper accumulation in the liver or other organs; characterized by low serum ceruloplasmin, and high urine copper levels.
Malignant HBP Tumours
- Epidemiology / Risk Factors: HCC (Hepatocellular Carcinoma), associated with cirrhosis, chronic hepatitis B/C, aflatoxin B1, alcohol, NAFLD.
- Pathology: Varying cell structure and architecture
Pancreatic Disease
- Acute pancreatitis: Inflammation of the pancreas, often caused by gallstones or alcohol abuse.
- Chronic pancreatitis: Ongoing inflammation/damage of the pancreas, often causing pancreatic insufficiency.
- Pancreatic cancer: Malignant tumour of the pancreas, frequently in head of pancreas.
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Description
This quiz covers the essential aspects of liver anatomy, physiology, location, and drainage, highlighting the consequences of portal hypertension. Additionally, it delves into the histological features of the liver, focusing on its structural organization. Test your knowledge on liver pathology and its clinical implications.
