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GI (Additional) > Mechanisms of Liver Disease 1 and 2 > Flashcards

Mechanisms of Liver Disease 1 and 2 Flashcards

1
Q

What reversible types of hepatocellular injury?

A

Ballooning degeneration
Steatosis
Cholestasis

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2
Q

What is ballooning degeneration? What is it indicative of?

A

Reversible hepatocellular injury

Depletion of cellular ATP with loss of volume control (influx of electrolytes and water)

It is present in many different causes of liver injury

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3
Q

What is steatosis?

A

Reversible hepatocellular injury

Accumulation of fat triglyceride droplets in hepatocytes

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4
Q

Differentiate between macrosteatosis and microsteatosis

A

Macrosteatosis - large droplets replacing the nucleus; more common, seen in numerous conditions

Microsteatosis - small droplets that do not replace the nucleus; more rare, seen in pregnancy, Reye’s syndrome

BOTH CAN BE PRESENT IN ONE PATIENT

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5
Q

What’s causing the damage in cholestasis? The bilirubin or bile salts?

A

BILE SALTS

Bilirubin just causes the yellow discoloration of the skin (jaundice)

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6
Q

What is kernicterus?

A

Severe complication of UNCONJUGATED hyperbilirubinemia

Free bilirubin crosses blood brain barrier and deposits in basal ganglia

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7
Q

What is “feathery degeneration” of hepatocytes and what is it indicative of?

A

Feathery degeneration is ballooning of hepatocytes caused by bile salt accumulation seen in cholestasis and its related disorders

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8
Q

What are the three key features seen in obstructive/mechanical cholestasis?

A

Portal expansion

Bile duct proliferation

Bile plugs

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9
Q

What are irreversible types of hepatocellular injury?

A

Necrosis

Apoptosis

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10
Q

What are the types of necrosis in hepatocellular injury

A

Cytolytic - IRREVERSIBLE ballooning of hepatocytes due to defective osmotic regulation –> cell swelling and death

Coagulative - architecture of dead tissue is preserved; results from ischemic damage

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11
Q

What is the difference between confluent necrosis and zonal necrosis?

A

Confluent = death of GROUPS of adjacent hepatocytes

Zonal = confluent necrosis that exhibits a zonal distribution in the lobule (Zone 3 vs Zone 1, etc.)

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12
Q

What lab tests are indicative of hepatocyte integrity?

A

AST, ALT, LDH

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13
Q

What lab tests are indicative of biliary function?

A

Bilirubin
Bile Acids
Cancalicular enzymes: GGT, alk phos

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14
Q

What cells in the liver cause fibrosis?

A

Stellate cells

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15
Q

What are the most common causes of ACUTE liver failure?

A

Viral hepatitis (worldwide)

Acetaminophen overdose (USA)

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16
Q

What are the most common causes of CHRONIC liver failure?

A

Chronic Hepatitis B and C

Non-alcoholic Fatty Liver Disease (NAFLD)

Alcoholic Liver Disease

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17
Q

What is the defining difference between acute and chronic hepatitis in terms of structural change?

A

Acute: changes are primarily within the lobule

Chronic: changes are primarily within the portal tract (fibrosis!)

18
Q

If you see chronic hepatitis on histology, what 4 things should be on the differential?

A

Chronic Viral Hepatitis

Autoimmune Hepatitis

Metabolic Diseases

Drugs

19
Q

Define the terminology used for describing chronic hepatitis

A

Limiting plate = hepatocytes at junction of portal tract and lobule

Interface activity (piecemeal necrosis) = inflammation and hepatocellular injury at limiting plate i.e. death of hepatocytes at the junction of portal tract and lobule

Grade = severity of portal and lobular inflammation and cellular injury

Stage = extent of fibrosis

20
Q

What are the five mechanisms of liver disease?

A

Steatosis

Iron Overload

Cholestatic Diseases

Vascular Diseases

Nodules and Tumors

21
Q

What are the main causes of steatosis?

A

Alcoholic liver disease

Non-alcoholic liver disease (NAFLD)

Ischemia

Inherited Disorders

22
Q

What are the key histologic features of alcoholic liver disease?

A

Steatosis with pericentral sinusoidal (“arachnoidal,” “chicken wire”) fibrosis

Mallory-Denk bodies (characteristic but not exclusively seen in alcoholic liver disease) - just eosinophilic looking hyaline in hepatocytes

23
Q

What zone is most affected in many of the causes of steatosis?

A

ZONE 3

24
Q

List the main inherited disorders that can cause steatosis?

A

Fatty Acid Oxidation Defect

Cystic Fibrosis

25
Q

What are the main causes of iron overload leading to liver disease?

A

Hereditary Hemochromatosis

Hemosiderosis (secondary hemochromatosis)

26
Q

What is the difference between Hereditary Hemochromatosis and Hemisiderosis?

A

Hereditary hemochromatosis is due to a genetic defect/inherited disorder

Hemochromatosis is iron accumulation due to iron overload, ineffective erythropoiesis, increased oral iron intake, chronic liver disease

27
Q

What is the main histologic difference between hereditary hemochromatosis and hemosiderosis?

A

HH - iron accumulation occurs in hepatocytes

Hemosiderosis - iron accumulation in Kupffer cells

28
Q

Is neonatal hemochromatosis a hereditary hemochromatosis or is it hemosiderosis?

A

It is a subset of hemosiderosis but it presents a lot like HH: does not have any mutations but fibrosis extends to other parts of the body (heart, lungs, etc.)

29
Q

What causes neonatal hemochromatosis?

A

in-utero alloimmune reaction of mother with formation of anti-liver antibodies that destroy the liver

30
Q

What are the main causes of INTRAHEPATIC cholestasis?

A

Primary biliary Cirrhosis (PBC)

Biel duct paucity (aka ductopenia)

31
Q

What are the main causes of EXTRAHEPATIC cholestasis?

A

Primary Sclerosing Cholangitis

Bile duct stones

Malignancy of head of pancreas

Strictures

Biliary atresia (neonatal)

32
Q

What is the histologic duct lesion in PBC vs. PSC?

A

PBC - inflammatory destruction of interlobular bile ducts +/- granulomas

PSC - “onion-skin” inflammation and fibrosis and on ERCP you’ll see BEADING

33
Q

What are the main serologic differences between PBC and PSC?

A

PBC = AMA+

PSC = ANCA+

34
Q

What are the characteristic histologic signs of extrahepatic/obstructive cholestatic disease?

A

Enlarged portal ducts

Bile duct proliferation

Bile plugging

35
Q

What is characteristic histology of inflow obstruction (hepatic infarction)

A

Coagulative type necrosis with a hyperemic rim

Super rare because you would need to occlude both the portal vein and the hepatic artery

36
Q

What is Budd-Chiari syndrome

A

Caused by outflow obstruction that spares caudate lobe of the liver

Hepatomegaly, ascites and liver dysfunction

Necrosis of Zone 3 (sometimes 2 but spares 1)

37
Q

What are benign tumors and tumor-like lesions of liver

A

Cysts

Mesenchymal tumors

Cholangiocellular

Hepatocellular

38
Q

What are the main types of benign cysts found in liver?

A

Echinococcal (major)

Simple cysts and polycystic liver disease

39
Q

What are the main types of benign mesenchymal tumors found in liver?

A

Adult: Hemangioma (common, benign)

Child: Infantile hemandioendothelioma (

40
Q

What are the main types of benign hepatocellular tumors of the liver?

A

Adenoma (highly associated with OCPs)

Focal nodular hyperplasia

41
Q

What is fibrolamellar carcinoma?

A

Type of hepatocellular carcinoma

Better outcome and occurs at younger age

GI (Additional) (9 decks)

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