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Flashcards in Liver 2 Deck (40):
1

What are 4 histological features of acute steatohepatitis?

1. fat
2. ballooned hepatocytes
3. mallory bodies
4. acute inflammation (neutrophils)

2

What pattern of fibrosis do we see on trichome stain of alcoholic steatohepatitis damage?

spider web (sinusoidal)

3

What is the recommended drinks per day for men? women? what is the individual susceptibility for ETOH liver damage?

-2
-1
-1 in 6 heavy ETOH users

4

What is it called when there is just fatty change without inflammation or liver damage?

steatosis

5

What do mallory bodies look like?

pink, ropey material

6

T-f---damage from steatohepatitis first leads to portal fibrosis?

False, central vein

7

What is the AST:ALT ratio in steatohep.?

2:1

8

T_F-- Alk phos is often elevated out of proportion to GGT in steatohepatitis?

False- the other way around

9

Amyloidosis affecting the liver would look like what histologically?

waxy pink material filling the sub sinusoidal spaces

poor prognoses (in the case his alk phos was huge compared to the GGT even though AST:ALT was 2:1

10

NASH is related to what other metabolic issues?

insulin resistance and metabolic syndrome

11

What might explain cryptogenic cirrhosis?

NASH

12

What are the differences histologically between NASH and alcohol damage?

Similar but more fat and glycogenated nuclei and less inflammation, ballooning and mallory hyaline

13

What is the AST ALT ratio in NASH?

Usually ALT will be higher

14

Is NASH or alcoholic steatohepatitis related to macrocytic anemia?

alc. steatohep.

15

T-F---NASH usually has a high titre positive ANA?

False- low

16

What histo features do we see in acute heart failure? Chronic?

1. centrilobar congestion and necrosis
2. nutmeg liver

17

What is buds chiari syndrome?

obstruction of hepatic vein---associated with hypercoaguable state

18

Where do we see the fibrosis in chronic congestive heart failure?

centrilobar fibrosis leading to cirrhosis

19

what is the mottled color of nutmeg liver due to?

combination of congestion and pale fibrous tissue

20

In budd chiari what do we see histologically around the central vein?

marked congestion with surrounding sinusoidal congestion.

[hepatocytes get choked off and undergo necrosis

21

In budd chiari- do light pink areas or dark pink areas mean more necrosis?

light pink

22

T-F-- ferritin is an acute phase reactant?

True

23

In hemochromatosis, the liver is often first to accumulate…what follows?

pancreas-->diabetes
heart-->cardiomyopathy
joints-->arthralgia
pituitary-->infertile
thyroid-->hypothyroid
skin-->bronze

24

What gene is defective in hemochromatosis?

HFE Gene
usually homozygous C282Y (europeans)

25

T-F-- hemochromatosis liver disease is often found concurrently with HCV or alcohol which accelerates the fibrosis?

True

26

Is hemochromatosis a risk factor for developing hepatocellular carcinoma?

YEs

27

how do we treat hemochromatosis?

phlebotomy

28

is alpha-1 antitrypsin deficiency autosomal dominant?

no- recessive

29

what abnormal protease inhibitor alleles are associated with liver disease in alpha-1 antitrypsin deficiency?

Z and M

PIMM is wild type.

30

how do we visualize histologically alpha-1 antitrypsin deficiency?

PAS-D stain- globules are bright pink inside hepatocytes

31

is alpha-1 antitrypsin deficiency less treatable than hemochromatosis? is it a risk factor for hepatocellular carcinoma?

yes, yes

32

Is wilson's disease autosomal dominant?

No recessive

33

What is wilson's disease?

impaired copper excretion into bile and a failure to incorporate copper into ceruloplasmin

34

Where is copper accumulation highest?

liver, brian and eye.

also kidney

35

What is bland cholestasis?

only bile stasis is seen without other findings of liver damage

in his to you just see brown bile blobs in normal looking hepatocytes

36

can bland cholestasis lead to jaundice?

yes

37

what is the classic cause of bland cholestasis?

drugs--> oral contraceptives

(also gilbert's, pregnancy, post-operative and infection)

38

Does gilbert's syndrome lead to unconjugated or conjugated hyperbilirubinemia?

unconjugated

39

how does one become jaundiced when they have gilbert's syndrome?

illness
fasting/eating low calories
dehydration
menstruation
stress
lack of sleep
exercise

40

What is the most common cause of obstruction of extra hepatic duct? what are some others?

1.gallstone

2. tumor in bile duct, ampulla, head of pancreas, also congenital problems