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Pathology II Exam II > Liver 1 > Flashcards

Flashcards in Liver 1 Deck (38):
1

In the classic hexagonal concept of the liver, what represents the center?

Central vein, surrounding is the portal triads

2

True or false, most liver diseases affect each lobule so even a small biopsy can tell you what is happening in the entire liver?

TRUE

3

What are the forms of intrahepatic biliary disease?

-primary biliary cirrhosis
- primary sclerosing cholangitis

4

What systemic viral infections cause hepatitis? [4]

CMV, EBV, HSV, Adenovirus

5

How high are the transaminases in acute liver damage? What can severe cases lead to?

->1000
- fulminant hepatic necrosis

6

What are the steps to cirrhosis in chronic diseases?

inflammation--> necrosis--> fibrosis

7

What is the most common cause of acute/fulminant hepatic necrosis in the US population?

acetaminophen

8

Does hepatitis A B or C have an acute/fulminant symptoms?

A and B and (sometime/rarely) C

Remember that A does not form chronic disease, but B and C do

9

Being itchy all over can be a sign of liver disease, but severe itchiness is very characteristic of what liver disease?

Primary biliary cirrhosis

10

With jaundice, what other color changes can we see (3)?

yellow mucous membranes, pale stool, dark urine

11

hemolysis and genetic problems with conjugation lead to what type of elevated bilirubin?

Unconjugated bilirubin

12

What leads to elevated levels of both unconjugated and conjugated bilirubin?

Liver damage- cirrhosis and hepatocellular carcinoma

13

Elevated outflow obstruction of bile leads to what type of elevated bilirubin?

conjugated bilirubin

14

What is the main thing the liver detoxifies?

ammonia from breakdown of protein in ingested food or blood

so elevated ammonia means the liver is failing

15

What are the two main biliary enzymes?

alk phos
GGT (gamma glutamyl transpeptidase)

16

When are alk phos or GGT elevated?

PBC
PSC
Adverse drugs
Obstruction of biliary tree

17

ALT and AST elevation occurs because of what basic thing in hepatocytes?

necrosis-(death and damage)

18

Review other important tests to measure besides ALT, AST, ALK phos, and GGT

Viral serologies
Autoimmune serologies
Glucose, HgbA1c, lipids
iron
ceruloplasmin
alpha1-antitrypsin

19

What biliary disease is related to AMA serology?

PBC

20

What biliary disease is UC anca associated with?

primary sclerosing cholangitis

21

What are the signs of acute disease with viral A, B or the occasional C?

malaise, fatigue, jaundice
>1000 transaminases
- lasts several weeks

22

What percentage of HBV goes on to chronic viral hepatitis?

less than 10%

23

What percentage of HCV goes on to chronic viral hepatitis?

75%

24

Is HBV or HCV often transmitted with sexual contact? what about vertical transmission?

1. HBV
2. HBV- very common in underprivileged countries

25

IS HCV and HBV fecal oral like hep A?

No- mostly parenteral

26

Is there a vaccine for hep C?

no

27

Is Hep C or Hep B more of a problem in US?

HEp C,

Hep B is a huge global problem

28

What is the histological hallmark for Hep C? Hep B?

1. rounded portal lymphoid aggregates
2. Ground glass hepatocytes

29

A high degree of numerous plasma cells and activity is strongly suggestive of?

Autoimmune hepatitis

30

What sex predominates autoimmune hepatitis?

female 70-75%

31

True or false- we see hypergammaglobulinemia in autoimmune hepatitis ?

True

32

Is ANA or ASMA more specific in autoimmune hepatitis?

ASMA

33

T-F- Hep A histology often mimics autoimmune hepatitis?

True- plasma cells prominent

34

True or false- hep A screen is only positive if IgG is present?

False- IgM

35

Why is an adverse drug reaction not found on our huge algorithm chart?

can mimic virtually anything, a mixed picture that doesn't fit with anything can often clue that a drug reaction is causing the damage

36

How do we recognize an adverse drug reaction?

temporal relationship
- when was the drug started
- when was the jaundice or abnormal test noted

37

when does acetaminophen toxicity occur?

hours to a few days. other idiosyncratic reactions can typically take 2 to 10 weeks (75% are less than 4 months)

38

T-F-- herbal reactions can account for liver injury?

True- so if they say no medications but started a new herb etc.

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