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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

kupfer cells stained brown found in?

hemachromatosis