Class: Liver path Flashcards
(135 cards)
Portal triad is made up of?
bile duct, Portal vein, hepatic artery
How are lobular and acinar liver units different by what is at their center?
lobular: Portal vein at center
acinus: Central vein at center
acinus/lobule which is structural which is functional
lobule = structure acinus = functional
In a liver bx, what ix poorest px:
- focal necrosis
- fatty degeneration
- lymphocytic infiltration
- Bridging fibrosis
- Single cell necrosis
bridging fibrosis
What is the mildest form of injury in the liver?
Hydropic degeneration or swelling
WHat organelles does Hydropic degeneration affect and what is the pathogenesis of injury?
lack of adequate energy supply (ATP) inhibits the activity of the ATP-pump that maintains water homeostasis across the cell membrane . This leads to intracellular water retention (swelling).
The next step in hepatocellular injury after hydropic degeneration is due to a further inability to do what? and results in an increased level of one thing and a decrease in another?
inability to produce ATP–>
increased Triglycerides
decreased lipoprotein synthesis
WHt is the result of fatty degeneration (aka fatty metamorphosis) is a progression from one pathilogical state to another. Nme those 2 states
retained lipids (from lack of lipoprotein synth) are packaged into vesicals: early = microvesicular steatosis later/chronic = macrovesicular steatosis
What are 3 etiologies of microvesicular steatosis
Reye’s syndrome (inborn error of ASA mtb)
Pregnancy
tetracycline
What are 3 etiologies of macrovesicular steatosis?
Alcohol
Diabets
Obesity
Which can be life threatening via hepatic failure, micro- or macrovesicular steatosis?
micro
WHat is the pathogenesis of steatohepatitis
in macrovesicular steatosis, some cells rupture and die –> inflammatory reaction = steatohepatitis
What are the 4 types of hepatocellular necrosis and the progession from mild to severe
- single cell necrosis
- Focal necrosis
- zonal necrosis (zones 1-3)
- diffuse necrosis (submassive and massive)
what zone of the acinus is the first to be affected by ischemia?
zone 3
what zone of the acinus is the first to be affected by viral hepatitis and ingested toxins
ZOne 1
what zone of the acinus is the first to be affected by Yellow fever
Zone II
healing by secondary intention (scar formation) occurs in the case of what two types of injury to the liver?
Extensive acute necrosis as well as chronic (repetitive) injury
healing by secondary intention (scar formation) involves activation of what cell types?
stellate cell, kupfer cells
in cirrhosis: Fibrosis is mediated by what cytokine/cell
Transforming Growth Factor-beta (TGF-β) acting on stellate cells
What is the morphological hallmark of end-stage liver disease/cirrhosis.
bridging fibrosis and nodular regeneration
How is chronic hepatits defined? as evidenced by elevated what?
necroinflammatory dz of liver lasting >6 months
as evidenced by high ALT (and others)
two ddx of cirrhotic liver? and what are they in terms of fibrosis and nodules?
chronic hepatic fibrosis (fibrosis wothout nodules)
partial nodular transformation (nodules without fibrosis)
What antigen is used to dx HBV?
HBVsAg
Presence of what 2 markers in blood indicate that you are infectious with HBV?
HBeAg (need an envelope to infect)
HBV DNA