Flashcards in EXAM #2: LIVER PATHOLOGY III Deck (45)
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1
Draw the liver acinus and label the zones. What zone of the liver (acinus) is usually affected by drug injury?
Zone 3
2
Why is the centrilobular region (center of the liver lobule, i.e. the central vein) or zone 3 the most affected by toxic drug effects?
- Drug biotransformation occurs in the mitochondria of the liver acinus/lobule
- Mitochondria require oxygen
- Zone 3 has the lowest oxygen content as it is farthest from the portal triad carrying incomin-oxygenated blood
3
What are the two types of drugs that cause liver injury?
1) Intrinsic
2) Idiosyncratic
4
What is an intrinsic drug reaction?
This is a predictable drug reaction that occurs in response to sufficient quantity of a hepatotoxic agent e.g. Tylenol
Note that this type of reaction is dose-dependent and acute.
5
What is an idiosyncratic drug reaction?
This is an unpredictable drug reaction that is dependent on the genetic susceptibility of the host.
Note that this type of reaction is dose-independent and has a variable (though commonly subacute) onset.
6
What is the morphology of the liver injury seen with Tetracycline?
Microsteatosis
This is the abnormal retention of lipids within a cell. Micro simply refers to the fact that the lipid filled vesicles that accumulate do NOT distort the nucleus.
7
What is the morphology of the liver injury seen with Methothrexate?
Macrosteatosis
This is the abnormal retention of lipids within a cell. Macro simply refers to the fact that the lipid filled vesicles that accumulate DO distort the nucleus.
8
What is the morphology of the liver injury seen with Acetaminophen?
Necrosis
*Note that this is the leading cause of drug-induced acute liver failure
9
What is the morphology of the liver injury seen with Isoniazid?
Hepatitis
10
What is the morphology of the liver injury seen with Halothane?
Hepatitis
11
What is the morphology of the liver injury seen with Amiodarone?
Fibrosis
12
What is the morphology of the liver injury seen with Steroids?
Cholestasis
13
What is the morphology of the liver injury seen with Erythromycin?
Cholestasis
14
How much chronic alcohol consumption is required to induce alcoholic liver disease?
Males= more than 80g/day (six drinks)
Females= more than 40 g/day (three drinks)
15
What is the first pathologic change in the progression toward alcoholic liver disease with simple exposure?
Steatosis i.e. fat accumulation in hepatocytes
16
What is the first pathologic change in the progression toward alcoholic liver disease with severe exposure (binge drinking)?
Hepatitis--results from chemical injury to hepatocytes
*Note that the toxic effects of alcohol on the liver are specifically mediated by the toxic metabolite, acetaldehyde
17
Is fatty change or steatosis of the liver in alcoholic liver disease reversible?
Yes
18
What are Mallory Bodies?
Damaged intermediate filaments, or "alcoholic hyalin" acute alcoholic hepatitis
19
What are the histologic markers of chronic alcoholic liver disease?
Necrosis and fibrosis
*Note that this is long-term, chronic alcohol induced liver damage
20
What are the morphologic markers of alcoholic cirrhosis?
Extensive fibrosis and regenerative nodules
21
What cell mediates the inflammatory process seen in alcoholic hepatitis?
Neurtophils
22
What stain is used to demonstrate fibrosis in alcoholic hepatitis?
Trichrome stain
23
What are the clinical manifestations of Alcoholic Steatohepatitis?
- Fever
- Leukocytosis
- Jaundice
- AST/ALT elevation
24
What ratio of AST: ALT is indicate of continued drinking?
2:1 or greater
25
List the most common causes of death in chronic alcoholism.
1) Hepatic coma
2) Massive GI hemorrhage
3) Infection
4) Hepatorenal Syndrome
26
What is the alternate name for Nonalcoholic Steatohepatitis? How can you tell this apart from alcohol-related liver disease?
Non-alcoholic fatty liver disease
- ALT will be higher than AST
- Patients commonly asymptomatic
27
What causes Nonalcoholic Steatophepatitis?
1) Insulin resistance/ metabolic syndrome
2) Drug hepatotoxicity
3) Pregnancy
28
What two drugs can induce Nonalcoholic Steatohepatits?
Tamoxifen
Nifedipine
29
What are the symptoms of hepatic vein outflow obstruction?
Ascites
Hepatomegaly
Abdominal pain
AST/ALT elevation
Jaundice
*Note that this is what is seen in Budd-Chiari Syndrome
30
