EXAM #2: LIVER PATHOLOGY III Flashcards Preview

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Flashcards in EXAM #2: LIVER PATHOLOGY III Deck (45):
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

31

What are the symptoms of impaired blood inflow to the liver?

Esophageal varices
Splenomegaly
Intestinal congestion

*Note that this is what is seen in hepatic artery compromise or portal vein obstruction.

32

What are the common etiologies of liver infarct?

This is rare b/c of the livers dual blood supply, but when it does happen it is caused by:
1) Liver transplant
2) Chemoembolism
3) Polyarteritis nodosa
4) Surgery

33

What causes ischemic hepatitis/ shock liver/ hypoxic hepatitis??

- Left sided heart failure
- Heart surgery
- Shock

34

What are the manifestations of ischemic hepatitis?

- Centrilobular coagulative necrosis
- ASt/ALT elevation
- Jaundice

35

What are the extrahepatic etiologies of Portal Vein Thrombosis?

1) Abdominal infection
2) Hypercoaguability
3) Surgery

36

What are the intrahepatic etiologies of Portal Vein Thrombosis?

1) Cirrhosis
2) Malignancy e.g. HCC
3) Stasis
4) Pregnancy
5) Idiopathic

37

What are the clinical manifestations of portal vein thrombosis?

1) Abdominal pain
2) Portal HTN
- Esophageal varices
- Splenomegaly
- Ascites
3) Bowel Infarction

38

What are the etiologies of Hepatic Vein Obstruction?

- Cardiac related
1) Venous congestion
2) Centrolobular hemorrhage
3) Cardiac sclerosis
- Budd-Chiari Sydrome

39

What causes Hepatic Passive Congestion?

- Right heart failure
- Constrictive pericarditis
- Congenital heart disease

40

What is Budd-Chiari Syndrome?

Thrombosis of the hepatic vein or IVC--prevents the liver from draining

41

What are the etiologies of Budd-Chiari Syndrome?

1) HCC
2) Abdominal cancer
3) Myeloproliferative disorder
4) PNH
5) Hypercoagulability
6) Pregnancy
7) Contraceptives

42

What are the clinical features of acute Budd-Chiari Syndrome?

- Abdominal pain
- Hepatomegaly
- Ascites
- Jaundice
- Liver failure

43

What are the clinical features of chronic Budd-Chiari Syndrome?

- Portal HTN
- Cirrhosis
- Obliterative Hepatocavopathy

44

What is an Obliterative Hepatocavopathy?

IVC obstruction at its hepatic portion

*Note that this is endemic in Nepal and is suspected to have an infectious etiology

45

What is Veno-Occlusive Disease of the liver?

Complication following bone marrow transplant or ingestion of plant alkaloids (Jamaican)
- Vasculitis causes sinusoid obstruction