General Liver Flashcards
What are the serum measurements for hepatocyte integrity?
- aspartate aminotransferase (AST)
- alanine aminotransferase (ALT)
- lactate dehydrogenase (LDH)
What are the tests that look for biliary excretory function?
- serum bilirubin
- urine bilirubin
- serum bile acids
What are the tests that look for damage to the bile canaliculus?
- Serum alkaline phosphatase **
- Serum gamma-glutamyl transpeptidase (GGT)
What are the tests that look for hepatocyte synthetic function?
- Serum albumin
- Coagulation factors (PT, PTT, fibrinogen, prothrombin, factors V, VII, IX and X)
- hepatocyte metabolism: serum ammonia, aminopyrine breath test
What are reversible changes in hepatocytes?
- steatosis: accumulation of fat in the liver
- cholestasis: accumulation of bilirubin in liver
What happens in hepatocyte necrosis?
- fluid flows into cell, cell swells and ruptures (lysis) when osmotic regulation is interrupted
- blebs form to carry off intracellular material to extracellular space
- macrophages cluster at sites of injury
When is hepatocyte necrosis the primary mode of death?
- in ischemic/hypoxic injury
- it’s also a big part of the response to oxidative stress
What happens during hepatocyte apoptosis?
- cell shrinks, nuclear chromatin condenses (pyknosis), fragments (karyorrhexis) and cell fragments into acidophilic apoptotic bodies
What are acidophil bodies?
- apoptotic hepatocytes; named due to deeply eosinophilic stain
What are Councilman bodies?
- the same thing as acidophil bodies, term is just specific to Yellow Fever
What is confluent necrosis?
- widespread parenchymal loss with severe zonal loss of hepatocytes
- may begin as zone of hepatocyte dropout around CENTRAL VEIN
- produces space filled with cellular debris, macrophages, and remnants of reticular meshwork
When would you see confluent necrosis in the liver?
- acute toxic injuries, ischemic injuries or viral/autoimmune hepatitis
What is bridging necrosis?
- bridging area is the zone that links central veins to portal tracts, or bridges portal tracts
- necrosis is vascular insult that leads to parenchymal extinction due to large areas of contiguous hepatocyte death
- collapse of supporting framework can occur, and cirrhosis may result
What happens in regeneration of the liver?
- the cells replicate mitotically even if adjacent cells have died
What is special about hepatocytes in regeneration?
- they are stem cell like, they can replicate even in settings of chronic injury
- stem cell replenishment isn’t a significant part of parenchymal repair!
