Gastrointestinal, liver and renal pathology
Introduced| English | Meaning |
|---|---|
| cirrhosis | cirrhosis |
| portal hypertension | portal hypertension |
| ascites | ascites |
| jaundice/ˈdʒɔːndɪs/ | jaundice |
| hepatocellular | hepatocellular |
| cholestatic | cholestatic |
| nephritic syndrome | nephritic syndrome |
| nephrotic syndrome | nephrotic syndrome |
Vomiting blood from a vein in the throat
- A man with long-standing liver disease suddenly vomits blood. The bleeding comes from swollen veins in his oesophagus, a pressure problem that started in his liver.
- Liver and kidney diseases are patterns: one structure fails, and the effects spread through pressures and pores.
Cirrhosis
- Cirrhosis 肝硬化 is bridging fibrosis with regenerative nodules across the whole liver. Common causes are alcohol, hepatitis B and C, and fatty liver disease.
- Scar tissue blocks blood flow through the liver, and the liver cells that remain do less work.
Which pair defines cirrhosis?
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Scar and nodules across the whole liver.
Portal hypertension
- Blocked flow raises portal hypertension 门静脉高压. Blood finds escape routes: oesophageal varices, which can bleed, and swollen veins around the navel.
- The spleen enlarges and traps platelets, so platelets fall (sequestration, not marrow failure). Fluid leaks into the abdomen: ascites 腹水.
Low platelets in cirrhosis are mainly caused by marrow failure.
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The enlarged spleen traps them (sequestration).
Put the chain from liver scar to bleeding in order.
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Varices are escape routes for portal pressure.
Liver failure
- The failing liver cannot clear ammonia, which reaches the brain: hepatic encephalopathy, with confusion and a flapping tremor.
- It makes less albumin and fewer clotting factors (INR rises), and bilirubin builds up: jaundice 黄疸.
Match each finding in cirrhosis to its cause.
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Pressure causes the first two; failing liver cells cause the last two.
Reading the liver panel
- ALT and AST high with ALP near normal: a hepatocellular 肝细胞性 pattern, from liver cell injury (hepatitis).
- ALP high with near-normal transaminases: a cholestatic 胆汁淤积性 pattern, from blocked bile flow. Albumin and INR test synthetic function.
ALP is very high, ALT is near normal and the bile ducts are dilated. Which pattern is this?
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ALP points to blocked bile flow.
Nephritic or nephrotic
- Nephritic syndrome 肾炎综合征: inflammation tears the filter. Blood and red-cell casts in the urine, high blood pressure, low urine output, protein below 3.5 g/day.
- Nephrotic syndrome 肾病综合征: injured podocytes let albumin through. Protein at least 3.5 g/day, low blood albumin, oedema and high lipids.
Urine output is 1.5 L/day with 3 g/L of protein. How much protein is lost per day?
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1.5 × 3 = 4.5 g/day, above the 3.5 g/day nephrotic line.
Match each kidney finding to what it means.
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Casts point to nephritic; the other three are the nephrotic chain.
Worked example: three panels
- (Fictional, U/L) ALT 900, ALP normal: acute hepatitis. ALP 600, ALT mildly up, dilated bile ducts on scan: a stone blocking the bile duct.
- Albumin low and INR 2.0 with normal enzymes: a quiet, burnt-out cirrhotic liver that no longer makes enough protein.
Worked example: grading the proteinuria
- (Fictional) A child has frothy urine, puffy eyes and low albumin. Urine 1.2 L/day with 3.5 g/L protein = 4.2 g/day: nephrotic range.
- A teenager with cola-coloured urine, red-cell casts and high blood pressure two weeks after a sore throat: nephritic.
Three common slips
- Blaming low platelets in cirrhosis on the marrow. The enlarged spleen traps them.
- Reading "proteinuria" without a number. 3.5 g/day is the nephrotic line.
- Taking normal liver enzymes as a healthy liver. A burnt-out cirrhotic liver can have normal enzymes but low albumin and high INR.
Recap
- Cirrhosis = fibrosis + nodules → portal hypertension: varices, big spleen (low platelets), ascites.
- Failure: ammonia (encephalopathy), low albumin, high INR, jaundice. ALT/AST = injury, ALP = blocked bile, albumin/INR = synthesis.
- Nephritic: blood, casts, hypertension, protein below 3.5 g/day. Nephrotic: podocytes, at least 3.5 g/day, low albumin, oedema, lipids.