Flashcards in Liver Part 2 Deck (53):
1
What are some conditions other than hep B,C,D that can lead to chronic hepatitis?
Chronic alcoholism
Wilson's disease
alpha-1 antitrypsin def
drugs and other hepatoxins
autoimmune diseases
2
What is hist of chronic hep B?
ground glass appearance
- hazy because lots of antigen
3
Which hep virus is most likely to cause fulminant liver?
Hep B
4
What happens to liver in fulminant hepatitis?
shrinks, stained with bile, soft consistency, wrinkled appearance
5
What is number one cause of fulminant liver?
acetaminophen
6
What happens with alcohol and acetaminophen?
impaired hepatic metabolism of methionine -> decreased glutathion -> cyt p 450 increases breakdown of alcohol and increases conversion of acetaminophen to toxic metabolites (especially NAPQI)
7
what does cytochrome p-450 do?
produces reactive oxygen species that react with cellular proteins, damage membranes and alter hepatocellular function
8
What are three forms of liver disease caused by chronic alcohol consumption?
- hepatic steatosis
- alcoholic hepatitis
- cirrhosis
9
hepatic steatosis
accumulation of lipid droplets
no inflammation
reversible
large, fatty liver
10
alcoholic hepatitis
hepatocyte swelling and necrosis
ballooning necrosis
mild deposition of hemosiderin
mallory bodies
11
when are mallory bodies present?
alcoholic hepatitis
12
mallory bodies
hepatocytes accumulate keratin
13
where else do you see mallory bodies?
alcoholic hepatitis
NASH
primary biliary cirrhosis
Wilsons disease
hepatocellular tumors
14
alcoholic cirrhosis
- final and irreversible form of alcoholic liver disease
- shrunken, non-fatty, brownish green liver
- fibrous bands and lumpy bumpy appearance
- scar tissue
15
can cirrhosis develop without previous evidence of steatosis or alcoholic hep?
yes
16
alcoholic hepatitis
appears acutely
weight loss, anorexia, upper abd pain
hyperbilirubinemia
elevated alkaline phosphatase
neutrophilic leukocytosis
17
labs for alcoholic hep
AST 2 or more times higher than ALT because alcohol use has decreased vitamin absorption and damaged brush border
18
what are clinical symptoms of liver disease
jaundice
echymosis
gynecomasticy
yellow buccal mucosa
bright red tongue
spider something (nevi?)
19
top 5 causes death due to end stage alcoholic liver disease?
1. hepatic coma
2. massive GI bleed
3. concurrent infection
4. hepatorenal syndrom
5. hepatocellular carcinoma
20
cirrhosis
portal HTN
caput medusae
21
risk factors for steatosis?
genetic
diet
obesity
dyslipedemia
metabolic syndrome
22
iron in pancreas leads to what?
bronze diabetes
23
Wilsons
copper
keyser-flasure rings around iris
24
NAFLD lab work
elevated ALT and AST
AST not elevated more than ALT
GGT elevated prior to ALT and AST
25
NAFLD accounts for what % of cases of chronic hepatitis of unknown cause?
70%
26
NASH (non alcoholic steato hepatitis)
intermediate form of liver damage
- mallory bodies
- ballooning degeneration and apoptosis
- sinusoidal fibrosis
27
hemochromatosis
excess iron in liver and pancreas
28
primary hemochromatosis
genetic defect
29
secondary hemochromatosis
excessive administration of iron (transfusions)
30
Wilsons disease
autosomal recessive
copper in liver, brain, eyes
hepatocyte necrosis
kayser-fleishcer rings
31
90-95% of plasma copper is what?
ceruloplasmin
32
alpha-1 antitrypsin deficiency
autosomal recessive
abnormally low serum levels of a1antitrypsin
liver and lung repair cannot happen
33
microscopic changes of alpha 1 antitrypsin def?
presence of round or oval globular inclusions
hepatocytes larger and lose shape
acid-schiff PAS positive stain
34
What disease is more likely to occur in adults and children with AAT?
adults: lung disease and emphysema
children: liver disease
35
why is cirrhosis likely to develop with AAT?
genetic mutation with substitution of lysine residue in place of glutamine during enzyme synthesis makes proteins non-functional
36
what would you think if there was an unexplained change at base of lunge seen on an X-ray?
AAT
37
primary biliary cirrhosis
autoimmune
t-cell mediated destruction of bile ducts in liver
liver disease starts around small bile ducts
bile duct clogged or destroyed = fibrosis
whole architecture changed
38
what is hist feature of primary biliary cirrhosis?
granulomatous destruction of medium sized intrahepatic bile ducts
39
how do you test for primary biliary cirrhosis?
anti mitochondrial ab test
40
signs of PBC?
xanthelasmas (soft nodules)
xanthomas (deposition on eyelid)
fatigue
pruritis
jaundice
41
complications of PBC?
cirrhosis
portal HTN
end stage = hepatic encephalopathy and hepatic coma
42
what extra hepatic autoimmune disorder is PBC associated with?
RA
Sjogrens
43
primary sclerosing cholangitis
bile ducts initially become inflamed and over time become fibroses and scarred
segmental stricture and dilations of bile ducts
beaded appearance with barium
44
what is primary sclerosing cholangitis associated with?
UC
70% of pt with PSC have UC
45
hist of sclerosing cholangitis?
onion skin
fibrous tissue
46
workup for PSC?
elevated alkaline phosphatase
47
what is there an increased risk of developing with PSC?
cholangiocarcinoma
48
hist of degeneration?
ballooning
49
eosin body formed after apoptosis?
councilman body
50
lipid accumulation in hepatocytes without inflammation
steatosis
51
hazy cell with ground glass appearance found in what?
hep B
52
alcoholic hep from keratin?
mallory body
53