EXAM #2: LIVER PATHOLOGY III Flashcards Preview

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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

What are the symptoms of impaired intrahepatic blood flow?

Ascites
Esophageal varices
Hepatomegaly
AST/ALT elevation

*Note that this is what is seen in cirrhosis