Goljan disorders circulatory, alcohol related liver disorder

Question 1

define prehepatic obstruction to blood flow

Answer 1

obstruction of blood flow to liver (hepatic artery, portal vein)

Question 2

What are mechanisms that cause prehepatic obstruction to blood flow?

Answer 2

hepatic artery thrombosis w/ infarction;

portal vein thrombosis

Question 3

How does hepatic artery thrombosis w/ infarction lead to prehepatic obstruction to blood flow?

Answer 3

liver infarction uncommon bc of dual blood supply => hepatic artery and portal vein tributaries normally empty blood into sinusoids

Question 4

What are the causes of hepatic artery thrombosis w/ infarction?

Answer 4

liver transplant rejection;

vasculitis due to PAN

Question 5

What are the causes of portal vein thrombosis?

Answer 5

pylephlebitis;
polycythemia vera;
hepatocellular CA

Question 6

How does pylephlebitis cause portal vein thrombosis?

Answer 6

most often due to acute appendicitis;

air in portal vein from bacterial gas

Question 7

how does hepatocellular Ca cause portal vein thrombosis?

Answer 7

tumor invasion into portal vein

Question 8

clinical findings of portal vein thrombosis

Answer 8

portal HTN, ascites, splenomegaly;

NO hepatomegaly

Question 9

What are the causes intrahepatic obstruction to sinusoidal blood flow?

Answer 9

cirrhosis;
centrilobular hemorrhagic necrosis;
peliosis hepatis;
sickle cell disease

Question 10

what are diseases that lead to intrahepatic obstruction to sinusoidal blood flow?

Answer 10

centrilobular hemorrhagic necrosis;

peliosis hepatis

Question 11

What is centrilobular hemorrhagic necrosis often due to?

Answer 11

LHF and RHF

Question 12

how does LHF lead to centrilobular hemorrhagic necrosis?

Answer 12

LHF decreases cardiac output causing hypoperfusion of liver

Question 13

How does hypoperfusion of liver from LHF decreased CO cause damage?

Answer 13

ischemic necrosis of hepatocytes located around central vein

Question 14

how does RHF lead to centrilobular hemorrhagic necrosis?

Answer 14

causes backup of systemic venous blood into ventral veins and sinusoids

Question 15

What does centrilobular hemorrhagic necrosis look like grossly?

Answer 15

enlarged liver w/ mottled red appearance=> nutmeg liver

Question 16

What causes nutmeg liver?

Answer 16

congestion of central veins and sinusoids;

necrosis of hepatocytes around central vein

Question 17

clinical findings in centrilobular hemorrhagic necrosis?

Answer 17

painful hepatomegaly w/ or w/o jaundice;
increased transaminases caused by ischemic necrosis;
may progress to cardiac cirrhosis (fibrosis around central veins)

Question 18

Tx of centrilobular hemorrhagic necrosis?

Answer 18

treat HF

Question 19

Define peliosis hepatis

Answer 19

sinusoidal dilation due to blood

Question 20

what causes peliosis hepatis

Answer 20

anabolic steroids;

Bartonella henselae causing bacillary angiomatosis (in AIDS)

Question 21

risks in peliosis hepatis

Answer 21

potential for intraperitoneal hemorrhage

Question 22

Define post-hepatic obstruction to blood flow

Answer 22

obstruction of blood flow out of the liver => hepatic vein

Question 23

What are the causes that lead to posthepatic obstruction to blood flow?

Answer 23

hepatic vein thrombosis;

veno-occlusive disease

Question 24

What are diseases assoc w/ posthepatic obstruction to blood flow?

Answer 24

hepatic vein thrombosis;

veno-occlusive disease

Question 25

what are the causes of hepatic vein thrombosis?

Answer 25

``` polycythemia vera (MC); hypercoag state (OCP, protein C/S def, anti-phospholipid syndrome); hepatocellular carcinoma (invades hepatic vein) ```

Question 26

Clinical findings in hepatic vein thrombosis

Answer 26

enlarged, painful liver; portal HTN, ascites, splenomegaly; high mortality

Question 27

lab findings in hepatic vein thrombosis

Answer 27

increased transaminases; | increased PT

Question 28

how is hepatic vein thrombosis diagnosed?

Answer 28

ultrasound w/ pulsed Doppler 1st-line test; | MRI

Question 29

Tx of hepatic vein thrombosis

Answer 29

anticoag Tx; in situ thrombolysis; stenting, various shunts

Question 30

Px of hepatic vein thrombosis

Answer 30

approx 75% mortality rate in 1st yr

Question 31

How does veno-occlusive disease cause posthepatic obstruction to blood flow?

Answer 31

complication of bone marrow transplantation => collagen develops around central veins

Question 32

define hematobilia

Answer 32

blood in bile in patients w/ trauma to liver

Question 33

How does alcohol cause liver disease?

Answer 33

``` fatty change (MC); alcoholic hepatitis ```

Question 34

Why does alcohol cause fatty liver change?

Answer 34

substrates of alcohol metabolism used to synthesize liver triglyceride

Question 35

clinical findings in fatty change of liver

Answer 35

tender hepatomegaly WITHOUT fever or neutrophilic leukocytosis

Question 36

Tx of fatty change of liver from alcohol

Answer 36

alcohol rehab

Question 37

pathogenesis of alcoholic hepatitis

Answer 37

genetic predisposition likely; ACETALDEHYDE damage to hepatocytes; stimulation of collagen synthesis around central vein (perivenular fibrosis)

Question 38

micro findings in alcoholic hepatitis

Answer 38

fatty change WITH neutrophil infiltration; Mallory bodies; perivenular fibrosis

Question 39

what are Mallory bodies?

Answer 39

damaged cytokeratin intermediate filaments in hepatocytes of alcoholic hepatitis

Question 40

clinical findings alcoholic hepatitis

Answer 40

painful hepatomegaly; fever, neutrophilic leukocytosis, ascites, hepatic encephalopathy; may progress to alcoholic cirrhosis

Question 41

lab findings of alcoholic hepatitis

Answer 41

``` absolute neutrophilic leukocytosis; AST > ALT; increased ALP and GGT (GGT disproportionately increase to ALP); thrombocytopenia in some; hypoglycemia in some ```

Question 42

Tx of alcoholic hepatitis

Answer 42

mandatory to stop alcohol intake; | corticosteroids may be helpful

Question 43

what can cause angiosarcoma in the liver?

Answer 43

vinyl chloride; arsenic; thorium dioxide (radioactive contrast)

Question 44

what can cause cholangiocarcinoma of the liver?

Answer 44

thorium dioxide

Question 45

what can cause hepatocellular carcinoma of liver?

Answer 45

vinyl chloride, alfatoxin (aspergillus mold)

Question 46

what can cause liver cell adenoma of liver?

Answer 46

oral contraceptive pills

Question 47

what are drugs/chemicals that can cause acute hepatitis?

Answer 47

isoniazid (toxic metabolite); halothane; acetaminophen; methyldopa

Question 48

what are drugs/chemicals that can cause cholestasis?

Answer 48

``` OCPs (estrogen interferes w/ intrahepatic bile secretion); anabolic steroids (same mechs as OCPs) ```

Question 49

what are drugs/chemicals that can cause fatty change of liver?

Answer 49

amiodarone (resembles alcoholic hepatitis, Mallory bodies, cirrhosis progression); methotrexate

Question 50

What drugs/chemicals can cause fibrosis of liver?

Answer 50

methotrexate; retinoic acid; amiodarone