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Liver path II Flashcards

1
Q

What is decompensated cirrhosis? (4)

A

Liver is failing:

  • portal HTN
  • Hepatorenal syndrome
  • liver failure
  • hepatic encephalopathy
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2
Q

What is the definition of portal HTN?

A

> 12 mmHg

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3
Q

Why is there gynecomastia and testicular atrophy with liver cirrhosis?

A

Decreased ability to breakdown estrogen

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4
Q

What are ascites? What can cause them?

A

Excess fluid in the peritoneal cavity

Heart failure or cirrhosis

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5
Q

What is the Serum-ascites albumin gradient (SAAG)?

A

[albumin] in the serum - [albumin] of ascitic fluid

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6
Q

What is the range of SAAG for portal HTN?

A

> 1.1 g/dL

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7
Q

What is the range of SAAG for non-portal HTN?

A

less than 1.1 g/dL

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8
Q

What is the MOA of ascites formation with cirrhosis?

A

Increased portal pressure, and increased hydrostatic pressure d/t loss of albumin

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9
Q

What happens with the angiotensin system with cirrhosis?

A

Activated d/t decreased intravascular volume

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10
Q

What is the cause of hepatic failure? Loss of what % of the liver is needed for this to happen?

A

Cirrhosis

> 80% loss of hepatocytes

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11
Q

What is fulminant hepatitis? Subfulminant?

A

Hepatocytes are wiped out in the liver

Subfulminant = most, but not all hepatocyte are destroyed, causing a loss of lobules

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12
Q

What are the three clinical features of liver failure?

A

Encephalopathy
Coagulopathy
Jaundice

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13
Q

What can cause multi organ failure with liver failure?

A

DIC and hypotension

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14
Q

What is acute liver failure? Subacute? Chronic?

A 
HyperAcute = 7 days or less of ssx
Acute = within 4 weeks
Subacute= 5-12 weeks
Chronic = >12 weeks
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15
Q

Chronic liver failure occurs in the context of what?

A

Decompensated Cirrhosis

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16
Q

What is hepatorenal syndrome? What causes it?

A

Kidneys crash d/t peripheral vasodilation, but kidney’s constrict, causing ischemia/infarction

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17
Q

What happens to BUN and creatinine with hepatorenal failure? Urinary sedimentation rate?

A

Significant rise in BUN

Normal urinary sed rate

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18
Q

What are the histological changes in the kidney with hepatorenal syndrome?

A

There are none

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19
Q

What is hepatorenal syndrome?

A

Kidneys crash d/t peripheral vasodilation, but kidney’s constrict, causing ischemia/infarction

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20
Q

What is type I hepatorenal failure? Type II?

A

I = doubling of initial serum Cr to >2.5 mg/dL

II = slow increase of serum Cr of 1.5 mg/dL

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21
Q

What is hepatopulmonary syndrome? Cause?

A

Triad of chronic liver disease, hypoxemia, and intrapulmonary vascular dilation

Pulmonary circulation is dilated by NO, causing a v/q mismatch

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22
Q

What is the key mediator for hepatopulmonary syndrome?

A

NO

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23
Q

What causes hepatic encephalopathy? What can this lead to?

A

Increased NH3 brain diffusion with subsequent edema and mercaptans from bacterial in the intestines.

This can lead to herniation of the brain through the foramen magnum

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24
Q

What is decerebrate posturing? Cause?

A

Decerebrate posturing indicates brain stem damage, specifically damage below the level of the red nucleus (e.g. mid-collicular lesion). It is exhibited by people with lesions or compression in the midbrain and lesions in the cerebellum.

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25
What is the only hep virus that is not a ssRNA virus? What type of genetic make up is it?
B--dsDNA
26
What is the transmission of Hep A-E?
BCD = parenteral | A E = waterborne
27
Which Hep cause carrier states? Which cause chronic hepatitis?
B C D
28
Which Hep viruses cause hepatocellular CA?
B C D
29
Acute asymptomatic hepatitis happen in which hep viruses?
A B C D and E
30
Acute symptomatic hepatitis with recovery happen in which hep viruses?
ABCDE
31
Chronic hepatitis wwo progression to cirrhosis happen in which hep viruses?
C especially but B and D can as well
32
What is a superinfection of hepatitis?
B and D together
33
Fulminant hepatitis occurs with which Hep viruses?
E if prego D if superinfected Others only rarely
34
What is the most common form of Hep? How does this usually present?
A, usually asymptomatic
35
What is the viral family of Hep A? Genetic make up? Transmission?
Picrona-- +ssRNA Fecal-oral route
36
How often does Hep A cause fulminant hepatitis?
Rarely
37
What is the viral family of Hep B? Genetic makeup? Ssx? How is it transmitted?
hepadnavirus dsDNA Usual liver stuff Parenteral/sexual
38
What is the most common worldwide cause of cirrhosis?
Hep B
39
What are the outcomes of Hep B infection? (4)
- Complete recovery wwo symptoms - Hepatocellular CA - Death - Chronic hepatitis
40
True or false: most pts with HBV infection will recover without problems
True
41
What are the two main extrahepatic manifestations of HBV?
Glomerulonephritis | Polyarteritis nodosa
42
What is polyarteritis nodosa that can occur with HBV?
Fibrosing of large vessels
43
What Hep virus needs another? Which is needed?
D need B surface antigens
44
What is the virus family and genetic makeup of HDV? Route of transmission?
Delta virus -ssRNA Parenteral
45
What specifically does HDV need to cause disease?
HBsAg
46
What is HDV coinfection?
B and D infect together in an otherwise healthy individual
47
What is HDV superinfection?
D after B infection (in a HBV carrier), causing fulminant hepatitis more often
48
Why is HCV particularly bad compared to the other forms of hepatitis?
Most commonly goes to chronic hepatitis
49
How is HCV transmitted?
Parenteral Sexual drug use
50
What percent of Hep C infections develop chronic Hep? What percent of the % go on to develop cirrhosis?
85% | 20%
51
What are the extrahepatic manifestations of HCV infection? (4)
- Cryoglobulinemia (cold agglutination) - Thyroiditis - Glomerulonephritis - Thrombocytopenia
52
Which genotype of HCV leads to more severe inflammation: 1 or 2?
2
53
What are the factors that drive Hep C to cirrhosis? (4)
Immune response Immunosuppression EtOH use HBV infx
54
Which gender is more likely to progress from chronic Hep C infection to liver CA?
Male
55
Hep E is only really serious in whom?
Prego
56
What are the two types of liver biopsies that you can order?
Percutaneous | Transvenous
57
What are the histological changes that occur in hepatocytes with viral hepatitis (2)?
Ballooning and cholestasis
58
What are councilman bodies?
Councilman or acidophilic bodies are individually dead hepatocytes. They appear as small cells with eosinophilic cytoplasm and, at times, a dark, degenerative, pyknotic nucleus
59
What happens to the lobular arrangement with acute viral hepatitis?
Lobular disarray
60
What are the characteristics of the necrosis with a chronic hepatitis infex?
Piecemeal necrosis | destruction of the limiting plate of collagen about the portal vein
61
What are the "ground glass" cells in chronic hepatitis infection? Which hepatitis virus does this appear in?
hepatocytes are laden with hepatitis B surface antigen.
62
What are the typical histological characteristics of chronic HCV?
Lymphoplasmacellular inflammation and interface hepatitis. Portal-portal fibrous septa.
63
What are the three immune diseases of the liver?
1. Primary biliary cirrhosis 2. Primary sclerosing cholangitis 3. Autoimmune hepatitis
64
What is fibrosis of the biliary tree?
Sclerosing cholangitis
65
Granulomatous cholangitis is seen in what disease?
Primary biliary cirrhosis
66
What is the cause of primary biliary cirrhosis?
Granuloma formation via T cell cytotoxicity
67
What are the ssx of primary biliary cirrhosis?
Signs of slow liver destruction: Fatigue and itching Jaundice Steatorrhea
68
What are the Abs that are in primary biliary cirrhosis?
AMA IgM Anti Me PDH-E2
69
What are the four phases of primary biliary cirrhosis?
1. Florid duct lesions (granulomas) 2. Ductular proliferation 3. Severe cholestasis 4. Cirrhosis
70
What is the treatment for primary biliary cirrhosis?
Ursodeoxycholic acid | Liver transplant
71
How long do pts survive with primary biliary cirrhosis?
10-20 years
72
What is primary sclerosing cholangitis? Who does this occur in?
**Fibrous** obliterative cholangitis Older males with UC
73
What are the ssx of primary sclerosing cholangitis?
Ssx of slow liver failure: Jaundice Pruritis Liver failure
74
What is the gross appearance of primary sclerosing cholangitis?
Beads on a string
75
p-ANCA is positive in what?
primary sclerosing cholangitis
76
What labs are elevated with primary sclerosing cholangitis? (4)
Isolated alk phos GGT 5-NT ERCP
77
What are the histological characteristics of acute and chronic sclerosing cholangitis?
PMN infiltration, then cirrhosis
78
What cancer are pts with primary sclerosing cholangitis susceptible to
cholangioCA
79
What is autoimmune hepatitis?
Chronic inflammation destroying liver tissue causing acute liver failure. Usually occurs concurrently with some other autoimmune disease
80
What gender is usually affected with autoimmune hepatitis?
females
81
What are the three abs that are elevated with autoimmune hepatitis?
ANA SMA anti-LKM1
82
What is the gene that predisposes to autoimmune hep?
HLA DR4
83
What are the histological characteristics of autoimmune hepatitis?
Plasma cell infiltrate
84
What are types I - III of autoimmune hepatitis?
``` I = SMA + ANA II = Anti-LKm1 III = Anti-SLA/LP ```
85
What is the treatment for autoimmune hepatitis?
Immune suppressors | Liver transplant
86
What happens if there is no treatment with autoimmune hep?
Cirrhosis, hepatocellular CA
87
Which of the hepatitis viruses is most likely to lead to chronic hepatitis?
C
88
What diseases are associated with primary biliary cirrhosis?
CREST SLE other autoimmune diseases
89
Increased AMA is seen in what particular liver disease?
Primary biliary cirrhosis

Gastrointestinal (42 decks)

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