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Jason's GI Block > Liver Injury > Flashcards

Flashcards in Liver Injury Deck (58):
1

in hepatitis, injury is to what? how is the inflammatory response?

Sensitive Hepatocytes damages
inflammation is variable

2

When Jaundiced, what is liver ALT levels?

super high in the 1000s

3

what causes high ALT?

hepatocyte membrane damage

4

enlarged liver causes jaundice how?

swelling of hepatocytes obstruct bile flow

5

In hepatic lobules, there are zones, which ones are most vulnerable?

Zone 3 to toxins and ischemia

6

When do you get Mallory bodies?

alcoholic hepatitis

7

when do you get zonal coagulative necrosis?

paracetomol toxicity

8

acute viral hep A+B causes lobular ____

disarray and apoptosis

9

paracetomol toxicity causes?

zonal coagulative necrosis

10

alcoholic hepatitis you see what histologically?

Mallory bodies

11

in lobular disarray what happens? 3 things

hepatocyte swelling
sinusoids compressed
lymphocytes surround

12

neutrophils in acute viral hepatitis?

Nope

13

what is a Councilman body?

hepatocyte undergoing apoptosis

14

What else can cause zonal coagulative necrosis besides paracetomol? 3 others

toxic mushrooms
carbon tetrachloride
ischemia

15

what is the toxic metabolite that directly injures hepatocyte? causes what?

NAPQI
causes depletion of glutathione

16

tell tale sign of coagulative necrosis histologically?

no nucleus
ghost outline

17

hepatocyte undergoing apoptosis is called?

Councilman body

18

where do you normally get the most severe appearance of coagulative necrosis of hepatocytes histologically?

Zone 3
Zone 2 sometimes

19

inflammation with paracetemol toxicity?

Nope

20

Four dead giveaways of alcoholic hepatitis?

Mallory bodies
Neutrophils
Fat vacuoles
ballooned hepatocytes

21

Why are there neutrophils in alcoholic hepatitis and not other kinds of hepatitis?

Mallory bodies attracting them

22

describe a Mallory body:

'c' shaped collapse of hepatocyte cytoskeleton

in a ballooned hepatocyte

23

Damage in alcoholic hepatitis more likely in zone?

3

24

What is around the central vein in alcoholic hepatitis?

fibrous tissue

25

Cholestasis histologically see?

yellow brown dots in dilated biliary canaliculi

26

chronic liver disease is one or several diseases? causes what hallmark feature?

several diseases
causes scarring

27

is chronic liver disease always symptomatic?

Nope, need to look at liver tests etc.

28

definition of chronic liver disease?

raised ALT for >6 months

29

what is most common cause of chronic liver disease?

chronic hep B and C

30

chronic hepatitis is background for two things:

cirrhosis
hepatocellular carcinoma

31

what is a hallmark feature of acute and chronic viral hepatitis?

APOPTOSIS

32

what happens to portal tracts in chronic hepatitis C? 3 things

1. lymphocytes infiltration
2. germinal centre formation
3. interface hepatitis

33

What is periportal inflammation known as? how to assess it?

interface hepatitis
use grading system to measure extent of fibrosis

34

what is the major reason for cell death in chronic hepatitis?

apoptosis

35

what are the margins like in interface hepatitis?

irregular

36

hallmark feature in chronic hepatitis?

interface hepatitis

37

What kind of collagen and scar tissue deposition do you get in chronic hepatitis?

fibrous septa
Septal Fibrosis >cirrhosis>irreversible damage

38

what is an important progression marker in septal fibrosis?

bridging fibrosis between portal tracts

39

do you get lobular disarray in chronic viral hepatitis?

usually not

40

Fibrosis in acute viral hepatitis?

Nope.

41

What is a increasingly important DDx for abonormal liver function tests?

Non-alcoholic fatty liver disease (NAFLD)

42

Two kinds of Non-alcoholic fatty liver disease?

1. steatosis
with or without
2. steatohepatitis/fibrosis (NASH)

43

What is NASH?

non-alcoholic steatohepatitis

44

What is steatosis?

just fat in the liver
fatty liver

45

What is steatosis with steatohepatitis

fat with inflammation AND fibrosis

46

causes of Non-alcoholic fatty liver disease (NAFLD)? 5 things

Obesity
diabetes
Metabolic syndrom
drugs
GI surgery

47

2 types of steatosis are? describe epidemiology

macrovesicular/large droplet (very common)
microvesicular/small droplet (very rare)

48

How big are the macrovesicular steatosis?

larger than background hepatocytes

49

what causes macrovesicular steatosis? 2 reasons

increased triglyceride synthesis
decreased excretion

50

can you tell from histology whether macrovesicular steatosis is from alcohol or NAFLD?

Nope. need clinical info

51

Can you get steatohepatitis without steatosis?

No, steatohepatitis needs steatosis first

52

macrovesicular steatosis alone has risk of fibrosis?

Nope.

53

when do you increase risk of fibrosis with macrovesicular steatosis?

if have inflammation and hepatocyte injury

54

hallmark feature of steatohepatitis?

hepatocellular ballooning degeneration

55

Where else does hepatocellular ballooning degeneration happen besides steatohepatitis? how to distinguish?

alcoholic hepatitis
need to correlate clinical findings

56

non-alcoholic steatohepatitis features? 5 main

large fat droplets
inflammation
hepatocellular ballooning
mallory bodies (severe)
fibrosis

57

What kind of fibrosis in non-alcoholic steatohepatitis? as opposed to chronic hepatitis?

pericellular fibrosis vs. septal fibrosis

58

ASH vs NASH? distinction?

Alcoholic steatohepatitis vs. non-alcoholic steatohepatitis
distinction if clinical