Flashcards in Liver Injury Deck (58):
in hepatitis, injury is to what? how is the inflammatory response?
Sensitive Hepatocytes damages
inflammation is variable
When Jaundiced, what is liver ALT levels?
super high in the 1000s
what causes high ALT?
hepatocyte membrane damage
enlarged liver causes jaundice how?
swelling of hepatocytes obstruct bile flow
In hepatic lobules, there are zones, which ones are most vulnerable?
Zone 3 to toxins and ischemia
When do you get Mallory bodies?
when do you get zonal coagulative necrosis?
acute viral hep A+B causes lobular ____
disarray and apoptosis
paracetomol toxicity causes?
zonal coagulative necrosis
alcoholic hepatitis you see what histologically?
in lobular disarray what happens? 3 things
neutrophils in acute viral hepatitis?
what is a Councilman body?
hepatocyte undergoing apoptosis
What else can cause zonal coagulative necrosis besides paracetomol? 3 others
what is the toxic metabolite that directly injures hepatocyte? causes what?
causes depletion of glutathione
tell tale sign of coagulative necrosis histologically?
hepatocyte undergoing apoptosis is called?
where do you normally get the most severe appearance of coagulative necrosis of hepatocytes histologically?
Zone 2 sometimes
inflammation with paracetemol toxicity?
Four dead giveaways of alcoholic hepatitis?
Why are there neutrophils in alcoholic hepatitis and not other kinds of hepatitis?
Mallory bodies attracting them
describe a Mallory body:
'c' shaped collapse of hepatocyte cytoskeleton
in a ballooned hepatocyte
Damage in alcoholic hepatitis more likely in zone?
What is around the central vein in alcoholic hepatitis?
Cholestasis histologically see?
yellow brown dots in dilated biliary canaliculi
chronic liver disease is one or several diseases? causes what hallmark feature?
is chronic liver disease always symptomatic?
Nope, need to look at liver tests etc.
definition of chronic liver disease?
raised ALT for >6 months
what is most common cause of chronic liver disease?
chronic hep B and C
chronic hepatitis is background for two things:
what is a hallmark feature of acute and chronic viral hepatitis?
what happens to portal tracts in chronic hepatitis C? 3 things
1. lymphocytes infiltration
2. germinal centre formation
3. interface hepatitis
What is periportal inflammation known as? how to assess it?
use grading system to measure extent of fibrosis
what is the major reason for cell death in chronic hepatitis?
what are the margins like in interface hepatitis?
hallmark feature in chronic hepatitis?
What kind of collagen and scar tissue deposition do you get in chronic hepatitis?
Septal Fibrosis >cirrhosis>irreversible damage
what is an important progression marker in septal fibrosis?
bridging fibrosis between portal tracts
do you get lobular disarray in chronic viral hepatitis?
Fibrosis in acute viral hepatitis?
What is a increasingly important DDx for abonormal liver function tests?
Non-alcoholic fatty liver disease (NAFLD)
Two kinds of Non-alcoholic fatty liver disease?
with or without
2. steatohepatitis/fibrosis (NASH)
What is NASH?
What is steatosis?
just fat in the liver
What is steatosis with steatohepatitis
fat with inflammation AND fibrosis
causes of Non-alcoholic fatty liver disease (NAFLD)? 5 things
2 types of steatosis are? describe epidemiology
macrovesicular/large droplet (very common)
microvesicular/small droplet (very rare)
How big are the macrovesicular steatosis?
larger than background hepatocytes
what causes macrovesicular steatosis? 2 reasons
increased triglyceride synthesis
can you tell from histology whether macrovesicular steatosis is from alcohol or NAFLD?
Nope. need clinical info
Can you get steatohepatitis without steatosis?
No, steatohepatitis needs steatosis first
macrovesicular steatosis alone has risk of fibrosis?
when do you increase risk of fibrosis with macrovesicular steatosis?
if have inflammation and hepatocyte injury
hallmark feature of steatohepatitis?
hepatocellular ballooning degeneration
Where else does hepatocellular ballooning degeneration happen besides steatohepatitis? how to distinguish?
need to correlate clinical findings
non-alcoholic steatohepatitis features? 5 main
large fat droplets
mallory bodies (severe)
What kind of fibrosis in non-alcoholic steatohepatitis? as opposed to chronic hepatitis?
pericellular fibrosis vs. septal fibrosis