{"id":57,"date":"2019-02-27T22:15:24","date_gmt":"2019-02-27T22:15:24","guid":{"rendered":"https:\/\/blogs.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.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"],"yoast_head":"\nSome Notes on Liver Disease - My Path<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.imperial.ac.uk\/my-path\/2019\/02\/27\/notes-on-liver-diease\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Some Notes on Liver Disease - My Path\" \/>\n<meta property=\"og:description\" content=\"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 […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.imperial.ac.uk\/my-path\/2019\/02\/27\/notes-on-liver-diease\/\" \/>\n<meta property=\"og:site_name\" content=\"My Path\" \/>\n<meta property=\"article:published_time\" content=\"2019-02-27T22:15:24+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-02-27T22:16:50+00:00\" \/>\n<meta name=\"author\" content=\"Robert Goldin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Robert Goldin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/\"},\"author\":{\"name\":\"Robert Goldin\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/#\\\/schema\\\/person\\\/ae3686a35ddfab70a9ba176d3e643902\"},\"headline\":\"Some Notes on Liver Disease\",\"datePublished\":\"2019-02-27T22:15:24+00:00\",\"dateModified\":\"2019-02-27T22:16:50+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/\"},\"wordCount\":405,\"commentCount\":0,\"articleSection\":[\"Hepato-biliary Pathology\",\"Undergraduate Pathology\"],\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/\",\"url\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/\",\"name\":\"Some Notes on Liver Disease - My Path\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/#website\"},\"datePublished\":\"2019-02-27T22:15:24+00:00\",\"dateModified\":\"2019-02-27T22:16:50+00:00\",\"author\":{\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/#\\\/schema\\\/person\\\/ae3686a35ddfab70a9ba176d3e643902\"},\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/2019\\\/02\\\/27\\\/notes-on-liver-diease\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Some Notes on Liver Disease\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/#website\",\"url\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/\",\"name\":\"My Path\",\"description\":\"Rob Goldin\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-GB\"},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.imperial.ac.uk\\\/my-path\\\/#\\\/schema\\\/person\\\/ae3686a35ddfab70a9ba176d3e643902\",\"name\":\"Robert Goldin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/cbb08e649da7c1060a5cde6321602b89e9e6b9d3b9cebc668c47e2676cf28207?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/cbb08e649da7c1060a5cde6321602b89e9e6b9d3b9cebc668c47e2676cf28207?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/cbb08e649da7c1060a5cde6321602b89e9e6b9d3b9cebc668c47e2676cf28207?s=96&d=mm&r=g\",\"caption\":\"Robert Goldin\"},\"description\":\"I am a histopathologist based at Imperial but work one day a week in Oxford. 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