Liver and diseases II 2024.PDF

Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Learning outcomes To understand the pathogenesis of cirrhosis To describe the pathology of liver tumour To show knowledge on alcoholic liver disease Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Cirrhosis A h...

Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Learning outcomes To understand the pathogenesis of cirrhosis To describe the pathology of liver tumour To show knowledge on alcoholic liver disease Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Cirrhosis A histological diagnosis End results of a variety of diseases causing chronic liver injury A diffuse and irreversible process Resulting from necrosis of liver cells followed by fibrosis and nodule formation Cirrhosis The end result of cirrhosis: Impairment of liver cell function Gross distortion of the liver architecture Portal vein hypertension Inefficient organ → liver failure Causes of cirrhosis: Viral, most common world-wide − HBV, HCV & others (Hep D) Alcohol, most common in the West Autoimmune hepatitis Wilson’s disease Other causes (e.g., drugs; non-alcohol fatty liver disease) Pathology of cirrhosis: Fibrosis Regeneration nodules micronodular macronodular mixed Normal liver Cirrhosis Clinical features of cirrhosis: Secondary to portal hypertension & liver cell failure Jaundice, fever, loss of body hair, spider angioma, scleral icterus, palmar erythema, gynaecomastia De-compensated: with severely impaired liver function & complications Compensated cirrhosis: without any of complications Spider angioma Scleral icterus Palmar erythema Gynaecomastia Complications Portal hypertension (variceal haemorrhage) Liver failure (portosystemic encephalopathy; hepatorenal syndrome) Hepatocellular carcinoma Others (e.g. ascites) Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Liver tumour The most common malignant liver tumours are metastatic, particularly those from the GI tract, breast or bronchus Primary liver tumours may be either benign or malignant Hepatocellular carcinoma (HCC) - hepatoma HCC HBV and HCV carriers - extremely high risk of developing HCC Cirrhosis, particularly due to viral hepatitis Others: – Aflatoxin, – Androgenic steroids etc – Contraceptive pill (weak association) Pathology HCC is a stepwise progression: cirrhosis → dysplastic nodules → tumours One mass lesion, or multiple masses within the liver Histological features: – Most common: liver cells cords lined by endothelial cells, thicker than normal – In well-differentiated tumour: neoplastic cells show features of normal hepatocytes – In poorly differentiated tumour: the cells are pleomorphic with giant cells Cords of tumour cells separated by sinusoidal spaces (lined by endothelial cells) Pleomorphic tumour, giant cells Clinical features: Signs/symptoms: weight loss, fever, anorexia, ascites & abdominal pain Cirrhosis + rapid development of above features→ likely HCC Cirrhosis + asymptomatic: identified by AFP & liver US Cirrhosis + a focal lesion in the liver → highly likely to be HCC Investigations: Serum AFP may  (in 2/3 patients) Ultrasound or CT scanning: large filling defects (90% cases) MRI or angiography: used when diagnostic doubt Biopsy: only performed when diagnostic doubt Cirrhosis & a liver mass d>2cm:HCC Management and Prognosis: Surgical resection or liver transplantation: occasionally possible Chemoembolisation in selected patients Chemotherapy & radiotherapy unhelpful Prognosis: survival often < 6month Liver and diseases II Cirrhosis Liver tumour Alcoholic liver disease Alcoholic liver disease The most common cause of chronic liver disease in the West More common in men, 4th and 5th decades, although also in 20s. Alcohol acts as hepatotoxin; also genetic predisposition and immune mechanisms Major pathological lesions − Alcoholic fatty liver − Alcoholic hepatitis − Alcoholic cirrhosis Alcoholic fatty liver The most common biopsy finding in alcoholic individuals Alcohol → fat → accumulation in hepatocytes (steatosis) Symptoms usually absent Hepatomegaly on examination Lab test: often normal; ↑MCV – heavy drinking; -GT usually elevated Fat disappears on cessation of alcohol intake but continued drinking → fibrosis and cirrhosis Alcoholic fatty liver: macroscopic steatosis Alcoholic hepatitis Pathology: Liver cell necrosis, infiltration of polymophonuclear leucocytes, Mallory body May progress to cirrhosis, particularly continued alcohol consumption Presentation: a broad spectrum asymptomatic to very ill with hepatic failure Investigations: leucocytosis with elevated bilirubin and transferases ( AST and ALT < 500IU/L); albumin↓, prothrombin time prolonged Treatment: Supportive and adequate nutritional intake Corticosteroids - of benefit in severe disease Alcoholic hepatitis: left: necrotic hepatocyte & inflammatory cell, Mallory body right: Eosinophilic Mallory bodies in hepatocytes, surrounded by fibrous tissue Alcoholic cirrhosis Final stage of liver disease from alcohol abuse Destruction and fibrosis, with regenerating nodules producing a classic micronodular cirrhosis Patients may be asymptomatic, although often with one of the complications of cirrhosis and signs of chronic liver disease Investigation as for cirrhosis in general Management: directed at the complications of cirrhosis, advise patients to stop drinking for life Abstinence improves the 5-year survival rate Cirrhotic (micronodular) liver: Top: External surface studded with regeneration nodules Bottom: histology - regeneration nodules surrounded by connective tissue Which of the following statements is NOT true about cirrhosis? a) Cirrhosis is a histological diagnosis b) It is the end results of a variety of chronic liver diseases c) It is a localised and irreversible process d) There is fibrosis and distortion of normal structure e) Portal vein hypertension is a complication Which of the following statements is correct regarding alcoholic liver disease? a) It is the most common cause of chronic liver disease in the West b) It is more common in men but also occurs in women c) Alcohol acts as hepatotoxin d) Alcoholic fatty liver and alcoholic cirrhosis are major pathological lesions e) All of the above