Diseases of the Liver and Biliary Tract Flashcards by Kristi Wojtowicz

What are the 5 functions of the liver?

Carbohydrate metabolism
Fat metabolism
Protein metabolism
Bile synthesis
Detoxification

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Necrosis of the liver where the injury is largely confined to a particular zone of the liver lobule.

Zonal necrosis

-This is an umbrella term, there is more specific names depending on the location

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Necrosis around the terminal hepatic vein.

Centrilobular necrosis

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Necrosis next to portal tract.

Piecemeal necrosis

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Necrosis across the lobule

Bridging necrosis

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What are apoptotic lesion called on the liver? How are they different from necrosis?

Councilman bodies

apoptotic are more isolated, maybe just one cell
apoptotic appear eosinophilic
necrosis has clumps and clusters of cells

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What is serious fibrosis classified as?

Cirrhosis

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What is cirrhosis caused by?

Repeated bouts of inflammation, cell damage, diffuse fibrosis

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What does cirrhosis lead to, possible consequences?

Portal hypertension- can lead to esophageal varices which can lead to vomiting of blood and bleeding of esophagus
Impaired liver function
Increased chance of liver cancer from the dysplastic cells
Metabolic consequences of ascites, edema, bleeding, and jaundice

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What is the number 1 aetiology of cirrhosis?

Drugs and toxins

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What are some other aetiologies of cirrhosis?

Infections- Hep B, Hep C
Metabolic disease
Autoimmune disease
Biliary obstruction
Vascular

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How is cirrhosis “identified”?

Loss of normal liver architecture

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When is cirrhosis classified as micro nodular? Macronodular? Any other classifications?

Micronodular: less than 3mm nodules
Macronodular: greater than 3mm nodules
Mixed is another possibility

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What is jaundice caused by?

Elevated serum bilirubin. It is a manifestation of improper function of the liver.

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What is pre hepatic hemolytic jaundice?

Caused by unconjugated bilirubin buildup

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What is hepatic jaundice?

Caused partially by conjugated and partially unconjugated bilirubin buildup

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What is post hepatic obstructive jaundice?

Caused by conjugated bilirubin buildup

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What is the problem with excess bilirubin?

Toxic. Will produce excessive collagen that can lead to formation of fibroids.

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What enzyme is lacking in unconjugated hereditary hyperbilirubinemia diseases?

UDP glucuronyltransferase (UGT1A1)

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What unconjugated hereditary hyperbilirubinemia disease is fatal due to kernicterus (bilirubin deposited in brain) during the neonatal period?

Crigler-Najjar Syndrome Type 1

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What unconjugated hereditary hyperbilirubinemia disease is less severe that Crigler-Najjar Syndrome Type 1 and why?

Crigler- Najjar Syndrome Type 2, there is some enzyme present but the activity is still severely reduced.

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What unconjugated hereditary hyperbilirubinemia disease is mild with 30% reduced activity?

Gilbert Syndrome

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What conjugated hereditary hyperbilirubinemia disease results from a defect in the canalicular membrane of hepatocytes?

Dubin Johnson

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What conjugated hereditary hyperbilirubinemia disease results from multiple defects in hepatocellular uptake and excretion of bilirubin?

Rotor Syndrome

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Is Crigler-Najjar Syndrome a conjugated or unconjugated disease?

Unconjugated

What are the 2 conjugated hereditary hyperbilirubinemia diseases?

Dubin Johnson | Rotor Syndrome

What are the 3 unconjugated hereditary hyperbilirubinemia diseases?

Crigler-Najjar Syndrome Type 1 and Type 2 | Gilbert Syndrome

What colour is urine in severe jaundice?

Dark urine

What is the stool like in severe jaundice?

Pale stool | fat in the feces (steatorrhea)

What is portal hypertension? What can result?

Increased blood pressure in the portal system. | Varicose veins can result, especially in the esophagus (esophageal varices)

Is infarction possible in the liver?

Yes, it is rare though due to the dual blood supply

What is nutmeg liver a manifestation of?

Congestive heart failure- mainly right sided

How can excess iron be caused metabolically?

Metabolic defect - excess iron absorption OR - abnormal iron storage regulation

What is excess iron called?

Hemochromatosis

What are the results of genetic hemochromatosis?

Liver: cirrhosis, risk of CA Pancrease: fibrosis Heart: cardiomyopathy Skin: pigmenation

What disease is a manifestation of copper overload?

Wilson's Disease | -mutation is Cu-transport ATPase

What are the results of Wilson's disease?

Liver: chronic hepatitis, cirrhosis Brain: psychiatric disorders Eyes: Kayser-Fleisher rings on cornea

Is Wilson's disease autosomal dominant or recessive?

Autosomal recessive

What is a diagnostic sign of copper overload? **

Kayser-Fleisher rings = copper deposits in the eye **

What are the 3 benign liver tumours discussed?

Hepatic adenoma Bile duct adenoma Hemangioma

Who does hepatic adenoma occur most often in and why?

Women of childbearing age. Role of estrogen.

How do cells look in hepatic adenoma?

Cells resemble normal hepatocytes with minor variation. Nodules can become large.

What is a hemangioma?

Benign neoplasm of blood vessels. Sometimes called a harmatoma which is an excessive proliferation of tissue native to that area.

What should hemangioma not get confused with? How can you differentiate?

Not be be confused with a hematoma which has extra blood out of the vessation. Use a test called a DIASCOPY, apply pressure with a glass slide if the area blanches it is a hemangioma. In a hematoma it will not blanch because the blood is outside the vessel.

What is hepatocellular carcinoma? Who is it more common in gender wise?

Cancer of hepatocytes | More common in men

What are risk factors of hepatocellular carcinoma?

Hepatitis carriers (B or C) Any liver cirrhosis Aflatoxins/Mycotoxins - toxins produced by a deep fungal infection called Aspergillus

What is another malignant tumour possible in the liver that is even less common than hepatocellular carcinoma?

Angiosarcoma- rare malignancy of blood vessels

What are risk factors for angiosarcoma?

Thorotrast contrast medium Arsenic Anabolic steroids Vinyl chloride

What are the most common organ tumours to metastasize to the liver?

Lung Breast Colon Stomach

What is biliary cirrhosis? What are the types?

Blockage of bile ducts that drain bile from the liver. Can be intrahepatic or extra hepatic. Primary and secondary.

What is primary biliary cirrhosis caused by?

Autoimmune | scarring, cirrhosis, liver failure, granulomatous destruction of intrahepatic ducts

What is secondary biliary cirrhosis caused by?

Obstruction and malignancy | Obstruction of extra hepatic biliary tree, gallstones, malignancy of pancreas

What disease involves the intra-hepatic bile ducts?

Primary biliary cirrhosis

What disease involves the extra-hepatic bile ducts?

Secondary biliary cirrhosis

What disease involves the intra and extra-hepatic bile ducts?

Sclerosing Cholangitis

Which of the 3 bile duct disease carries an increased risk of developing bile duct carcinoma?

Sclerosing Cholangitis

Which of the 3 bile duct disease is more common in females?

Primary Biliary Cirrhosis

Which of the 3 bile duct disease is more common in males?

Sclerosing Cholangitis

Which of the 3 bile duct diseases in associated with ulcerative colitis?

Sclerosing Cholangitis

What is Sclerosing Cholangitis?

Chronic sclerosis of intra and extra hepatic bile ducts

What is common between primary biliary cirrhosis and sclerosing cholangitis?

Both disease result in identical end-stage changes in the liver with cirrhosis

What is carcinoma of the bile duct called?

Cholangiocarcinoma

What are the risk factors for cholangiocarcinoma?

Sclerosing cholangitis

What is acute cholecystitis?

Acute inflammation of gallbladder

Where is acute cholecystitis felt?

Right upper quadrant, sometimes the pain is on and off

What is the most common reason for acute cholecystitis?

Usually due to gallstones

What can happen in acute cholecystitis?

May perforate | -biliary peritonitis

What is chronic cholecystitis?

Chronic gallbladder inflammation

What is the most common cause for chronic cholecystitis?

Gallstones

What can happen in chronic cholecystitis?

Wall thickened May calcify- "Porcelain gallbladder" May frill with mucus- "Mucocele"

What is cholelithiasis?

Stone formation in the gallbladder- formation of gallstones

Patients at highest risk for cholelithiasis? **

``` Fair Fat Female Fertile ** ```

What are cholesterol stones from? What colour?

Not enough bile salts to keep cholesterol in solution | Appear multiple and yellow in color

What are pigmented stones? What colour?

Calcium salts of unconjugated bilirubin | Appear black or brown

What is carcinoma of gallbladder associated with 90% o the time?

Gallstones

What gender is carcinoma of gallbladder much more common in?

Females

Diseases of the Liver and Biliary Tract Flashcards

(76 cards)