{"id":57,"date":"2019-02-27T22:15:24","date_gmt":"2019-02-27T22:15:24","guid":{"rendered":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/?p=57"},"modified":"2019-02-27T22:16:50","modified_gmt":"2019-02-27T22:16:50","slug":"notes-on-liver-diease","status":"publish","type":"post","link":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/2019\/02\/27\/notes-on-liver-diease\/","title":{"rendered":"Some Notes on Liver Disease"},"content":{"rendered":"

This was tricky for me to write as the subject is\u00a0 the closest to my heart! I\u00a0 really found it hard to leave so much out.<\/p>\n

 <\/p>\n

Acute hepatitis:<\/strong><\/p>\n

    \n
  1. Viruses<\/li>\n
  2. Drugs<\/li>\n<\/ol>\n

    \u00a0<\/strong><\/p>\n

    Chronic hepatitis (liver disease lasting more than 6 months) <\/strong><\/p>\n

      \n
    1. Viruses<\/li>\n
    2. Autoimmune<\/li>\n
    3. Drugs<\/li>\n<\/ol>\n

      \u00a0<\/strong><\/p>\n

      Pathological features of chronic hepatitis<\/strong><\/p>\n

      Grade<\/em> = inflammation (can be in 3 places: portal tracts, interface and lobular)<\/p>\n

      Stage<\/em> = fibrosis (portal tract expansion > bridging > cirrhosis)<\/p>\n

       <\/p>\n

      The commonest causes of cirrhosis are:<\/strong><\/p>\n

        \n
      1. viral hepatitis<\/li>\n
      2. alcoholic liver disease<\/li>\n
      3. non-alcoholic fatty liver disease<\/li>\n<\/ol>\n

        \u00a0<\/strong><\/p>\n

        Viral hepatitis<\/strong><\/p>\n

        There are 5 hepatitis viruses (all RNA except for HBV): A-E<\/p>\n

        A and E: spread by faecal oral route, cause only an acute hepatitis<\/p>\n

        B, C and D (which can only infect people who have HBV, as well): spread by blood etc., cause the full range of liver disease:<\/p>\n

          \n
        1. acute hepatitis<\/li>\n
        2. chronic hepatitis – scarring begins<\/li>\n
        3. cirrhosis – nodules of hepatocytes surrounded by scar tissue<\/li>\n<\/ol>\n

           <\/p>\n

          Alcoholic liver disease and non-alcoholic fatty disease<\/strong> (risk factors: obesity, diabetes) produce the same pathological changes:<\/p>\n

            \n
          1. fatty change<\/li>\n
          2. fatty liver hepatitis (alcoholic hepatitis \/ non-alcoholic steatohepatitis (NASH) respectively): ballooning, neutrophils and scarring<\/li>\n
          3. cirrhosis<\/li>\n<\/ol>\n

            NB These 3 stages often con-exist<\/p>\n

             <\/p>\n

            There are (many) other liver diseases which may \u00a0cause of cirrhosis:<\/strong><\/p>\n

              \n
            1. Autoimmune hepatitis<\/strong>: anti smooth muscle actin autoantibodies, plasma cells, associated with other AI diseases, response to steroids<\/li>\n
            2. Drug induced liver<\/strong> injury (DILI): \u201cany kind of liver disease can be caused by a drug\u2019<\/li>\n
            3. Haemochromatosis<\/strong> = genetic (AR) increased iron absorption<\/em> from the gut<\/li>\n<\/ol>\n

              deposited in the liver and many other organs (including the pancreas).<\/p>\n

                \n
              1. Wilson\u2019s disease<\/strong> = genetic (AR) decreased copper excretion (by hepatocytes into the bile duct).<\/li>\n
              2. Primary sclerosing cholangitis <\/strong>(PSC): sclerosis (= fibrosis) of the bile ducts leading to their loss. Associated with Ulcerative Colitis<\/li>\n
              3. Primary biliary cholangitis<\/strong> (PBC): inflammation (with granulomas) of the bile ducts leading to their loss<\/li>\n<\/ol>\n

                 <\/p>\n

                Complications of cirrhosis:<\/strong><\/p>\n

                  \n
                1. Portal hypertension with varices<\/li>\n
                2. Liver failure with hepatic encephalopathy,<\/li>\n
                3. Liver cell cancer (the same as hepatocellular carcinoma)<\/li>\n<\/ol>\n

                   <\/p>\n

                  Tumours of the liver:<\/strong><\/p>\n

                  The commonest are secondary tumours (many via the portal vein)<\/p>\n

                   <\/p>\n

                  Primary tumours<\/strong><\/p>\n

                    \n
                  1. Benign <\/em><\/li>\n
                  2. Bile duct adenomas<\/li>\n
                  3. Hepatic adenomas (associated with the contraceptive pill)<\/li>\n<\/ol>\n

                     <\/p>\n

                      \n
                    1. Malignant<\/em><\/li>\n
                    2. Liver cell carcinoma<\/li>\n<\/ol>\n

                      Most commonly associated with cirrhosis.<\/p>\n

                      Spread via the portal vein.<\/p>\n

                      Carry a poor prognosis.<\/p>\n

                       <\/p>\n

                        \n
                      1. Cholangiocarcinoma (an adenocarcinoma)<\/li>\n<\/ol>\n

                        Divided into intrahepatic and extra hepatic (including gall bladder)<\/p>\n

                        May be associated with ulcerative colitis and worm infections<\/p>\n

                        Spread to lymph nodes<\/p>\n

                        Carry a poor prognosis<\/p>\n

                         <\/p>\n

                         <\/p>\n","protected":false},"excerpt":{"rendered":"

                        This was tricky for me to write as the subject is\u00a0 the closest to my heart! I\u00a0 really found it hard to leave so much out.   Acute hepatitis: Viruses Drugs \u00a0 Chronic hepatitis (liver disease lasting more than 6 months) Viruses Autoimmune Drugs \u00a0 Pathological features of chronic hepatitis Grade = inflammation (can be […]<\/p>\n","protected":false},"author":1119,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[289779,290088],"tags":[],"class_list":["post-57","post","type-post","status-publish","format-standard","hentry","category-hepato-biliary-pathology","category-undergraduate-pathology"],"_links":{"self":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/57","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/users\/1119"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/comments?post=57"}],"version-history":[{"count":3,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/57\/revisions"}],"predecessor-version":[{"id":60,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/posts\/57\/revisions\/60"}],"wp:attachment":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/media?parent=57"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/categories?post=57"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/my-path\/wp-json\/wp\/v2\/tags?post=57"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}