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DEMS: Unit 1 > Liver Disease > Flashcards

Flashcards in Liver Disease Deck (41):
1

Clinical indications of cytoplasmic accumulation of material

  • accumulation ==> cell damage and death
  • Fat – Steatosis
  • Bile – Cholestasis
  • Iron – Hemosiderosis
  • Copper – Wilson’s Disease/cholestasis
  • Viral particles – Viral hepatitis

2

Pathologic findings in hepatocyte death

  • balooning degeneration = 
    • hepatocyte swelling
    • clumping of organelles and keratin filaments
    • clearing of cytoplasm
  • necrosis & apoptosis
    • decreaseing cells size
    • increased eosinophilia @ cytoplasm
    • small dark nucleus

3

Ballooning degeneration indicates...

steatohepatitis

4

necrosis/apoptosis @ confluent zone 3 indicates...

  • wide spread ischemia

5

acidophils @ interface zone indicate...

  • acidophils = single necrotic/apoptotic cell w/in liver parenchyma
  • DDx:
    • autoimmune hepatitis
    • viral hepatitis

6

Neutrophils indicate...

steatohepatitis

7

Eosinophils indicate...

drug reaction

8

Plasma cells indicate...

autoimmune hepatitis

9

Portal based inflammation indicates...

biliary disease

10

Interface inflammation indicates...

  • autoimmune hepatitis
  • viral hepatitis

11

Zone 3 inflammation indicates...

  • autoimmune hepatitis
  • acute cellular rejection (transplant pts)

12

Pathologic findings of cholestasis

  • cholestasis = bile accumulation @ hepatic parenchyma
    • obstructive vs. non-obstructive causes
  • ==> ballooning degeneration

13

Pathologic findings of bile ductular reaction

  • obstructive outflow ==> bile build up @ canilliculi of zone 1 hepatocytes
  • hepatocytes ==metaplasia==> ~bile duct cells
    • ==> bile duct-like structures @ interface zone + PMNs + edema

14

Progressive fibrosis ==>

cirrhosis

15

Clinicopathologic patterns in Acute Hepatitis

  • Clinical
    • new onset sx lasting < 6 mo.
    • labs = evelated AST & ALT
  • Causes
    • acute viral
    • autoimmune
    • adverse drug rxn
    • indiopathic
  • Pathology
    • marked lobular disarray
    • inflammation
    • numerous single necrotic hepatocytes
    • no significant fibrosis

16

Clinicopathologic patterns in Chronic Hepatitis

  • Clinical
    • hepatic injury/inflammation > 6 mo.
  • Causes
    • viral, autoimmune, drug rxn, idiopathic
  • Pathologic
    • less lobular disarray and inflammation
    • rare single necrotic hepatocytes
    • slow progression of fibrosis

17

Scales used to assess severity of chronic hepatitis

  • GRADE = assessment of necroinflammatory activity
    • = ~current liver damage
  • STAGE = degree of fibrosis
    • = ~cumulative injury over time
  • both scales use 0-4 scale

18

Cirrhosis characteristics

  • end stage of chronic liver disease
  • pathologic findings
    • fibrous septa
    • distortion of architecture
    • regeneration nodules
  • clinical/laboratory findings
    • portal HTN
    • poor synthetic fxn
  • ==> increased risk for hepatocellular carcinoma

19

Characteristics of cholestatic liver disease

  • acute or chronic jaundice 
  • laboratory findings
    • elevated alkaline phosphatase
    • elevated GGT (gamma glutamyl transpeptidase)
    • elevated bilirubin
  • obstructive vs. nonobstructive causes
  • pathologic
    • interface ductular rxn + edema + PMNs

20

Viral Hepatitis: types of virus

  • Hep A = ssRNA
  • Hep B = dsDNA
  • Hep C = ssRNA
  • Hep D = ssRNA
  • Hep E = ssRNA

21

Viral Hepatitis: Routes of transmission

  • Hep A = fecal-oral
  • Hep B
    • parenteral
    • sexual contact
    • perinatal
  • Hep C
    • parenteral
      • IV drugs, intranasal cocaine = risks
  • Hep D = parenteral
  • Hep E = fecal-oral

22

Viral Hepatitis: risk for chronicity

  • Hep A = never
  • Hep B = 10%
  • Hep C = 80%
  • Hep D = rare
  • Hep E = never

23

Hep A: Serology/Dx

  • detected by serum IgM (and sometimes IgG) specific antibodies

24

Hep B: Serology/Dx

  • HBsAg (antigen)
  • antibody (IgM or IgG) HBcAg
    • IgM = acute/initial infection
    • IgG = ~chronic/indicates past infection

25

Hep C: Serology/Dx

  • PCR for HCV RNA
  • ELISA for antibody to HCV

26

HCV: presentation/histology

  • rarely presents as acute hepatitis
  • histo
    • interface and lobular necroinflammatory activity
    • progressive fibrosis
    • nodular lymphocytic aggregates @ portal areas

27

HBV: presentation/histology

  • histology
    • ground glass hepatocytes = viral particles @ cytplasm
    • sanded nuclei = viral particles @ nucleus
    •  

28

Non-hepatotropic viruses that infect the liver

  • HSV
  • CMV
  • adenovirus

29

Presentation of autoimmune hepatitis

  • lab tests
    • high AST, ALT
    • normal ALP
    • positive autoantibody (ANA, ASMA)
  • histology
    • interface and centrolobular necrainflammation 
    • hepatocyte necrosis
    • prominent plasma cells

30

Clinical Presentation of Primary biliary cirrhosis (PBC) vs. Primary Sclerosing Cholangitis (PSC)

  • PBC = autoimmune destruction of intrahepatic bile ducts
    • insidious
    • pruritis
    • jaundice (later)
    • females
    • liver fxn = high ALP, GGT, & bilirubin
    • positive AMA; elevated IgM
  • PSC = idiopathic ==> inflammation and fibrosis of (mostly) extrahepatic bile ducts
    • liver fxn = high ALP, GGT, bilirubin 
    • no other signs/symptoms
      • progression ==> fatigue, pruritis, jaundice
    • males
    • strong association w/ulcerative colitis

31

Pathologic Presentation of Primary biliary cirrhosis (PBC) vs. Primary Sclerosing Cholangitis (PSC)

  • PBC
    • plasma cell rich inflammation @ portal areas
    • lymphocytic cholangitis
    • bile duct destruction
      • ==> duct loss (ductopenia)
  • PSC
    • beading of extra- (and intra-) hepatic bile ducts 
    • lymphocytic periductular inflammation
    • progressive fibrosis ==> onion skin fibrosis

32

Characteristics of drug-induced liver injury

  • varied presentations 
  • varied histology
    • necrosis, cholestatis, acute hepatitis, etc.
  • most common cause = acetominophen

33

Histologic findings of steatohepatitis

  • non-alcoholic steatohepatitis (NASH) vs. alcoholic steatohepatitis
  • triad =
    • steatosis
    • lobular inflammation
    • ballooning degeneration
  • alcoholic SH
    • mallory hyaline
    • prominent PMNs
  • chronic changes
    • chicken-wire fibrosis (=sinusoidal pattern)
    • secondary micronodular fibrosis

34

Clinical presentation of alcoholic steatohepatitis

  • Hx = alcohol
  • Labs
    • AST: ALT = 2(+) : 1
    • normal ALP
    • high GGT

35

Presentation of Hemochromatosis

  • genetic disorder (Auto Rec.)
  • males > females
  • pathophsyiology = abnormal regulation of iron absorption ==> excess/deposition of iron
  • clinical
    • liver disease
    • diabetes
    • heart failure
  • histology
    • iron deposition @ hepatocytes
      • initially @ periportal region
    • ==> hepatic injury & fibrosis

36

Presentation of Wilson's disease

  • genetic (auto rec) dz of copper overload
  • clinical
    • neuro sx
    • Kayser-Fleischer rings on opthalm exam
  • histology
    • copper accumulation @ hepatocytes
    • steatosis or acute/chronic hepatits-like changes possible

37

Presentation of Alpha-1-Antitrypsin

  • genetic (auto rec) of decreased production of protease inhibitor (that limits tissue damage)
  • clinical
    • mostly ==> emphysema
    • liver disease (10%)
  • histology
    • intracytoplasmic acculumulation of PAS positive hyaline globules
    • progressive fibrosis

38

Presentation/characteristics of hepatocellular carcinoma

  • most common primary malignant tumor of liver
  • exclusively in pts w/ chronic liver disease and cirrhotic liver
  • prognosis
    • size
    • macroscopic & microscopic vascular invasion
    • focality
    • invasion

39

Common benign liver tumors + characteristics

  • hemangioma
    • most common
    • vascular spaces
    • ==> vague GI sx
    • well-circumscribed
  • focal nodular hyperplasia (FH)
    • hyperplastic parenchyma due to vascular anomaly
    • histo = central stellate scar, ductular rxn
  • hepatocellular adenoma
    • proliferation of benign hepatocytes
    • assoc. w/OCPs
    • risk of rupture
    • well-circumscribed

40

Characteristics of hepatocellular carcinoma

  • Hepatocellular carcinoma (HCC)
    • patients have cirrhotic/chronic liver dz.
    • Distinct mass in a cirrhotic liver
    • May have green-yellow color (bile)
    • Thickened hepatic plates
    • Endothelialization of sinusoids
    • No true portal areas

41

Characteristics of cholangiocarcinoma

  • May be intra- or extrahepatic
  • PSC is a major risk factor
  • Usually presents at an advance stage
  • Densely fibrotic mass in the hilar region with infiltrative edges
  • Tan-white in color
  • Invasive gland forming tumor with abundant desmoplastic response