45 Questions
What is the result of repeated episodes of necrosis in the liver?
Diffuse liver cell injury
What type of tissue builds up in the liver during fibrosis?
Non-functional connective tissue
What is the term for the process of breaking down collagen?
Fibrinolysis
What is the result of the accumulation of excessive scar tissue in the liver?
Cirrhosis
What stimulates immune cells to release cytokines and growth factors?
Necrosis of hepatocytes
What is the stage of liver disease characterized by the accumulation of fibrous tissue in the liver?
Fibrosis
What is the result of the replacement of healthy liver cells with scar tissue?
Cirrhosis
What is the term for the process of producing collagen, fibronectin, and proteoglycans?
Fibrogenesis
What is the stage of liver disease characterized by inflammation and steatosis?
Steatohepatitis
What is the primary cause of jaundice?
A problem in the production of bile pigment
What is the significance of a bilirubin level of 2mg/dl in relation to jaundice?
It is the level above which jaundice is likely to occur
What is the characteristic of liver disease in the stage of inflammation/steatosis/steatohepatitis?
The liver's ability to regenerate is still intact
What is the primary difference between acute and chronic jaundice?
The duration of the jaundice
What is the primary function of the canaliculi in relation to bilirubin?
To excrete bilirubin
What is the characteristic of liver disease in the stage of liver failure?
The liver's ability to regenerate is completely lost
What is the primary cause of unconjugated bilirubin in the blood?
A problem in the conjugation of bilirubin in the liver
What is the significance of the liver's functional reserve?
It allows the liver to function normally even with significant damage
What is the characteristic of chronic jaundice in relation to the bile ducts?
The bile ducts are blocked
What is the characteristic pattern of fibrosis in cirrhosis?
Interconnecting bands of scar tissue
What is the primary cause of acute liver failure?
Certain prescription medicines and viral infections
What is the difference between compensated and decompensated cirrhosis?
Compensated cirrhosis has no symptoms, while decompensated cirrhosis has severe symptoms
What is the term for the abnormal liver profile in cirrhosis?
Significantly abnormal liver profile
What is the characteristic of chronic liver failure?
It develops more slowly
What is the term for the disease characterized by an abnormal accumulation of iron in the liver?
Hemochromatosis
What is the term for the type of bilirubin that is not conjugated with glucuronic acid?
Unconjugated bilirubin
What is the term for the progressive and irreversible damage to the liver?
Cirrhosis
What is the primary cause of liver damage in cirrhosis?
Scarring
What is the primary cause of Varices in patients with cirrhosis?
Increased resistance to flow through the damaged liver
What is the most common complication of gallstones?
Cholecystitis
What is the primary function of the liver in relation to gut-derived toxins?
To remove gut-derived toxins from the bloodstream
What is the name of the enzyme that is often used as a marker for liver cell injury?
Alanine Aminotransferase (ALT)
What is the name of the condition characterized by the inability of the liver to metabolize oestrogen?
Gynecomastia
What is the name of the test used to measure the liver's ability to form clots?
Prothrombin Time (PT/INR)
What is the name of the condition characterized by the accumulation of fluid in the peritoneal cavity?
Ascites
What is the name of the virus often associated with Hepatocellular Carcinoma?
Hepatitis C
What is the name of the condition characterized by the dilation of veins in the oesophagus and stomach?
Varices
What is the main function of GGT in the body?
To act as a transport molecule for other molecules
Which enzyme is most sensitive in detecting obstructive jaundice, cholangitis, and cholecystitis?
GGT
In which of the following conditions is GGT blood level usually high?
When the liver is damaged
What is the normal range of alkaline phosphatase (ALK) in the blood?
20-70 U/L
Which of the following organs is NOT a significant source of GGT?
Brain
What is the main reason for the increase in liver AP levels?
Obstruction or infiltrative diseases
What is the purpose of 'fractionating' or 'isoenzyming' alkaline phosphatase?
To identify the source of the enzyme
What is the characteristic of GGT rise in cases of liver damage?
It persists longer than with other enzymes
Which of the following is a location where alkaline phosphatase is found?
Placenta
Study Notes
Liver Disease and Cirrhosis
- Cirrhosis is a form of chronic liver disease, characterized by a nodular architecture, compromising blood and bilirubin flow.
- There are two categories of cirrhosis: compensated (heavily scarred but still functional) and decompensated (extensively scarred, symptomatic, and significantly abnormal liver profile).
Liver Failure
- Acute liver failure: caused by certain medications, viral infections, and toxins; characterized by bruising, bleeding, and hepatic encephalopathy.
- Chronic liver failure: develops slowly, leading to bruising, bleeding, mental status alteration, and portal hypertension.
Portal Hypertension
- Increased pressure in the portal venous system due to liver damage, leading to varices, splenomegaly, and ascites.
- Varices: dilation of oesophageal and gastric veins, potentially leading to hematemesis and massive hemorrhage.
Hepatocellular Carcinoma
- Usually related to HBV and HCV, characterized by high levels of alpha-fetoprotein and grim prognosis.
- Features include pleomorphism, abnormal architecture, and high N/C ratio.
Gallstones and Cholecystitis
- Gallstones: formed in the gallbladder, usually with multiple stones, and often asymptomatic until they move.
- Complications of gallstones include cholecystitis, pancreatitis, perforation, and empyema of the gallbladder.
- Cholecystitis: most common major complication of gallstones, characterized by RUQ pain, nausea, and vomiting.
Liver Profile
- Liver enzymes: ALT, AST, alkaline phosphatase, GGT, and LDH.
- Tests of liver function: bilirubin, total protein, serum albumin, and bleeding profile (prothrombin time, APTT).
- GGT: concentrated in the liver, but also present in the gallbladder, spleen, pancreas, and kidney; elevated in cases of liver damage.
Jaundice
- Condition characterized by yellowish skin, eyes, and mucous membranes due to high bilirubin levels.
- Caused by problems in bilirubin production, including liver disease, fever, chills, abdominal pain, and flu-like symptoms.
- Types of bilirubin: unconjugated, conjugated, and canalicular.
Stages of Liver Disease
- Stage of inflammation/steatosis/steatohepatitis: reversible, early phase of liver injury, characterized by inflammation, fat accumulation, and steatosis.
- Stage of fibrosis: new injury leads to inflammation, steatosis, and steatohepatitis, eventually causing diffuse liver cell injury and fibrosis.
- Stage of cirrhosis: liver fibrosis becomes extensive, altering the liver architecture, and replacing healthy liver cells with scar tissue.
Test your knowledge of the clinical manifestations of chronic liver diseases and cirrhosis, including hepatic encephalopathy, portal hypertension, and varices. This quiz covers the complications of liver damage and their effects on the body. Brush up on your gastroenterology skills and see how well you can identify these life-threatening conditions.
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