What is chronic liver disease?
Liver disease lasting longer than 6 months which leads to cirrhosis
What is the end-stage of chronic liver disease if untreated?
Cirrhosis
What hepatic cells become activated to start fibrosis?
Hepatic stellate cells
Lots of liver diseases are chronic.
What is the official definition of chronic liver disease?
A disease lasting > 6 months WHICH LEADS TO CIRRHOSIS
What is NAFLD?
Non-alcoholic fatty liver disease
Which diseases cause NAFLD?
Hypertension
Hyperlipidaemia
T2 diabetes
Obesity
NAFLD / NASH is a fatty liver in the (presence / absence) of other causes.
absence
What is NASH?
Non-alcoholic steatohepatitis
Fat in the liver AND inflammation
Triglycerides are stored in pockets away from the mitochondria of hepatocytes (NAFLD). What happens when these triglycerides are exposed to oxidative stress?
NASH
non-alcoholic steatohepatitis, i.e inflammation
How is NAFLD diagnosed?
Ultrasound / Liver biopsy if required
How is NAFLD treated?
Weight loss
Exercise
How is NASH diagnosed?
Liver biopsy
The end stage of NASH is ___.
cirrhosis
How is NASH treated?
Exercise and weight loss
Experimental drugs
What type of liver disease is primary biliary cholangitis?
Autoimmune
What tissue is affected by autoantibodies in PBC?
Biliary tree tissue
Who tends to get PBC?
Middle aged women
What are some symptoms of PBC?
Fatigue
Itch without rash
Xanthelasma / Xanthomas
How is PBC treated?
Ursodeoxycholic acid
PBC involves the immune system attacking the ___ ducts.
bile
What is radical treatment for PBC?
Liver transplant
Who tends to be affected by autoimmune hepatitis?
Young women
How would autoimmune hepatitis be described by a pathologist?
Chronic hepatitis with piecemeal necrosis and lobular involvement
What can trigger autoimmune hepatitis?
Viruses
Toxins
Drugs
How is autoimmune hepatitis treated?
Corticosteroids (prednisolone)
Immunosuppressors (azathioprine, steroid-sparer)
Eventually, those with autoimmune hepatitis will go on to develop ___.
cirrhosis
but 13-20% of patients have spontaneous resolution
What is primary sclerosing cholangitis?
Autoimmune disease of LARGE bile ducts
primary biliary cholangitis affects the small bile ducts
What IBD is associated with primary sclerosing cholangitis?
UC
What investigations are used to diagnose primary sclerosing cholangitis?
MRCP
ERCP
What is haemochromatosis?
Autosomal recessive disease of iron overload
Patients with haemochromatosis lay down iron in their skin. What sign is associated with this?
Bronzed skin
What are some complications of haemochromatosis?
Cirrhosis
Cardiomyopathy
Pancreatic failure
Bronze diabetics
Is Wilson’s disease autosomal dominant or recessive?
Autosomal recessive
Which copper-carrier loses its function in Wilson’s disease?
Ceruloplasmin
Which metal is deposited in the tissue in Wilson’s disease?
Copper
What are Kaiser Fleisher rings?
Rings of copper in the eyes
What is the liver outcome of untreated Wilson’s disease?
Cirrhosis
alpha 1 anti-trypsin deficiency is another example of a chronic liver disease
lung emphysema, cirrhosis
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What is Budd-Chiari syndrome?
Thrombosis of hepatic veins
blood can’t drain from the liver, causing cirrhosis
What are the symptoms of Budd-Chiari syndrome?
Jaundice
Tender hepatomegaly
Ascites
Which immunosuppressant is toxic to the liver and causes cirrhosis?
Methotrexate
What is cardiac cirrhosis?
Incompetent tricuspid valve causes backflow of blood to the liver
Liver can’t drain blood - cirrhosis