Liver Failure and Hepatic Injury

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common origin of liver cancer in the country discussed?

Hepatocellular adenomas associated with oral contraceptive use

Cholangiocarcinoma from parasitic liver fluke infection

Primary liver malignancy due to cirrhosis

Metastatic disease from the gastrointestinal tract (correct)

Which condition is strongly associated with an increased risk of developing hepatocellular carcinoma?

Infection by liver flukes

Cirrhosis (correct)

Ingestion of contaminated food

Use of anabolic steroids

In viral hepatitis, where do lymphocytes initially accumulate?

In the portal triad (correct)

Around the central veins

Within the liver parenchyma

In the Space of Disse

What is the primary limitation to liver regeneration after significant tissue loss?

Interference by fibrosis Signup and view all the answers

Which of the following best describes the typical histology of hepatocellular carcinoma?

Similar to a normal liver, but lacking the characteristic lobular architecture Signup and view all the answers

A patient is diagnosed with a 'hepatoma'; which condition is the most likely diagnosis, assuming no further specification?

Benign hepatocellular adenoma Signup and view all the answers

Which type of collagen is predominantly found in the Space of Disse?

Type IV collagen Signup and view all the answers

What is a known association of cholangiocarcinoma, as mentioned in the text provided?

Parasitic liver fluke infection Signup and view all the answers

What role do perisinusoidal stellate cells play in liver fibrosis?

They are stimulated by Kupffer cells to produce types II and III collagen. Signup and view all the answers

Why can patients with cirrhosis develop jaundice and/or hepatic failure, even with little change in liver weight?

Due to the blockage of bile outflow and disrupted blood flow from fibrosis. Signup and view all the answers

What is the primary cause of hepatic encephalopathy?

Build-up of toxic levels of blood ammonia. Signup and view all the answers

Which of the following is NOT a recognized class of causes for liver failure?

Chronic kidney disease with nephritis. Signup and view all the answers

Steatosis in the liver is characterized by the accumulation of:

Triglyceride droplets. Signup and view all the answers

What is the term for fatty liver change where small droplets don't displace the nucleus?

Microvesicular fatty change. Signup and view all the answers

Which cellular change in the liver involves cell swelling and bursting?

Lytic necrosis. Signup and view all the answers

What term describes necrosis that spans from one inflamed portal tract to another in the liver?

Bridging necrosis. Signup and view all the answers

Which of the following can cause both microvesicular and macrovesicular fatty changes in the liver?

Alcoholic liver disease. Signup and view all the answers

Which cells are responsible for engulfing necrotic and apoptotic hepatocytes in the liver?

Kupffer cells. Signup and view all the answers

What is the most frequent cause of liver cirrhosis?

Alcoholic liver disease Signup and view all the answers

Which type of hepatitis is LEAST associated with the development of cirrhosis?

Hepatitis A Signup and view all the answers

A patient with right-sided heart failure develops portal hypertension. What type of portal hypertension is this?

Post-hepatic Signup and view all the answers

What is the primary mechanism behind the tissue damage in hemochromatosis?

Excessive iron deposition Signup and view all the answers

A patient with a history of multiple blood transfusions shows signs of liver disease and a bronze discoloration of the skin. Which of the following conditions is most likely to be the cause?

Hemosiderosis Signup and view all the answers

What is a common way that Hepatitis A is transmitted?

Via the fecal-oral route Signup and view all the answers

Besides cirrhosis, which of the following is a potential consequence of chronic infection with hepatitis B or C?

Increased risk of liver cancer Signup and view all the answers

What is the appearance of the liver tissue associated with post-hepatic portal hypertension?

Nutmeg pattern Signup and view all the answers

Study Notes

Liver Failure

The liver detoxifies ammonia, a byproduct of protein metabolism.
Insufficient or damaged liver tissue leads to toxic ammonia levels, causing hepatic encephalopathy.
Impaired cognition, asterixis, decreasing consciousness, coma and death can result.
Three main categories of liver failure causes:
- Massive hepatic necrosis (often drug-induced, like acetaminophen, halothane, or carbon tetrachloride; also includes hepatitis A and B)
- Chronic liver disease with cirrhosis (alcoholic liver disease, hepatitis B&C)
- Hepatic dysfunction without overt necrosis (Reye syndrome, tetracycline toxicity, acute fatty liver of pregnancy).

Cellular Hepatic Injury

Liver cells can swell (accumulate fluid) causing steatosis (fatty change).
Microvesicular fatty change: small, non-displacing droplets (e.g., pregnancy, valproic acid).
Macrovesicular fatty change: large droplets (e.g., obesity, diabetes, hepatitis C, alcoholic liver disease).

Other Liver Damage

Necrosis: Liver cell death (lytic or chronic passive congestion, seen in certain drug reactions, toxins). Hepatocytes can be engulfed by Kupffer cells.
Inflammation (hepatitis): Can be acute or chronic, sometimes preceded by hepatocyte damage, common is viral hepatitis, involving lymphocytes and the parenchyma, and can lead to fulminant hepatitis.
Regeneration: Liver cells can regenerate. Fibrosis can interrupt this.
Fibrosis: Chronic inflammation or toxic insult causes fibrosis, making the liver divide into nodules (cirrhosis). Collagen deposition is irreversible.
Portal tracts: Type II & III collagen; space of Disse has type IV collagen. Cirrhosis involves bridging the portal, and central veins. Stellate cells create myofibers for constriction, impacting blood flow and bile.

Cirrhosis Causes

Alcoholic liver disease; 60%–70%
Viral hepatitis; 10%
Biliary diseases; 5%–10%
Primary hemochromatosis; 5%
Wilson disease; Rare
α1-antitrypsin deficiency; Rare
Cryptogenic cirrhosis; 10%–15%

Liver Tumors

Metastatic disease: Commonest liver cancer, originating from the GI tract via portal vein.
Primary liver cancer: Hepatocellular carcinoma (HCC), which is associated with cirrhosis.
Hepatocellular adenomas: Benign, often associated with oral contraceptives ('hepatoma' without modifier usually refers to this type)
Cholangiocarcinoma: Rare tumors of small intrahepatic bile ducts, possibly linked to parasitic liver fluke infections.

Hepatitis

Three main types: A, B, and C.
A: Fecal-oral, acute, non-persistent, does not cause cirrhosis or cancer.
B & C: Persistent infection risk, can lead to cirrhosis, liver cancer. Have acute and chronic hepatitis phases.

Hemosiderosis/Hemochromatosis

Iron overload (from blood transfusions, or a genetic condition).
Deposits in tissues, can lead to liver cirrhosis.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the critical concepts of liver failure and cellular hepatic injury. This quiz covers the causes of liver failure, symptoms of hepatic encephalopathy, and details on steatosis and types of fatty changes in liver cells. Test your knowledge on liver health and associated conditions.