Liver Cirrhosis

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1.    What has happened to the liver to reach such a pathological state?

       Pathological state: liver cirrhosis

       It is the end result of continued damage to liver cells (hepatocytes) due to a variety of causes.         Examples of these causes include alcoholism and hepatitis B and C.

2.    Describe the key histopathological features.

             Wholesale disruption of liver architecture

              Formation of nodules of regenerating hepatocyes separated by fibrous bands.

             Fibrous bands may connect portal areas.

3.    What are the main histopathological effects?

2 main effects:

a)      Disordered hepatocyte function leading to:

-       decreased production of plasma proteins resulting in oedema

-     decrease detoxification � toxic metabolites not removed efficiently, e.g. NH3 toxic in brain (encephalopathy)

-     jaundice

b)      Disturbance of blood flow through liver from portal veins to hepatic veins (vascular obstruction) � increased portal venous pressure (portal hypertension) � portal systemic anaestomosis open up � may result in large dilated thin walled veins e.g. Oesophageal varices � veins may rupture � cough out blood.

4.    The panel of liver function tests to assess the integrity of the patients� liver was performed.  Comment on the expected changes (normal, ↑ or ↓)

a) total bilirubin (conjugated and unconjugated)            ↑

b) ALT                                                               ↑

c) AST                                                              ↑

d) GGT                                                              ↑

e) ALP                                                              ↑

f) Total protein (albumin, globulin)                        ↓

g) Prothrombin time, APTT                            ↑

5.    State T or F

In the liver, cirrhosis

-          usually precedes fatty change       F (fatty change precedes cirrhosis)

-          is usually reversible after a period of       F (cirrhosis is an irreversible process)

abstinence from alcohol

-          is often evident on the gross specimen      T (can see the nodules)

never affects hepatic function             F (see 3 point a)

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Copyright � Joseph Ong 2003