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Flashcards in Liver Path V Deck (49):
1

autoimmune hepatitis

chronic hepatitis - immune abnormalities
-neg sero tests for virus

type 1 - female
type 2 - children

-elevated IgG

has titers

majority have other autoimmune

2

type 1 autoimmune hepatitis

female

ANA, ASMA
negative AMA

3

type 2 autoimmune hepatitis

children

ALKM1, ACL-1

4

predictable

intrinsic

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unpredicatable

idiosyncratic

6

DDx for liver disease

always include exposure to toxin or drug

7

budd chiari

oral contraceptives

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angiosarcoma

vinyl chloride

9

zone 3 necrosis

acetaminophen

10

zone 1 hepatotoxicity

Fe overload
allyl alcohol

11

zone 3 hepatotoxicity

acetaminophen
ethanol
CCl4

12

acetaminophen and ethanol

increased zone 3 necrosis

13

isoniazid

first line anti-TB drug

hepatic damage occurs

14

microvesicular fatty change

tetracycline
salicylates

15

cholestatic reactions

estrogens
antibiotics

16

NAPQI

problematic in path of acetaminophen toxicity

depletion of GSH

acetylcysteine - reduces NAPQ1 to APAP

17

drug metabolism

in zone 3 - centrilobular

18

reye syndrome

aspirin use
-rare
-chilren
-mito dysfunction - liver and brain

extensive accumulation of fat droplets - microvesicular steatosis**

19

oil red O stain

for reye syndrome

stains lipids**

20

5th leading cause of death

alcoholic liver disease

21

alcoholic liver disease path

ethanol > actaldeyde
-alters lipid metabolism
-decreased export lipoproteins
-cell injury caused by ROS and cytokines**

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patterns of alcoholic liver disease

zone 3
-hepatic steatosis, alcoholic hepatitis, cirrhosis

23

fatty liver

all drinkers with moderate intake

microvesicular to macrovesicular

completely reversible***

24

alcoholic hepatitis

ballooning and necrosis of hepatocytes

25

mallory bodies

alcoholic hepatitis

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AST:ALT >1 and AST <500, malaise, fever, jaundice, RUQ pain

alcoholic hepatitis

27

alcoholic hepatitis

PMNs surrounding necrotic hepatocytes

28

mallory bodies

tangles of keratin complexed with proteins like ubiquitin

in alcoholic hepatitis

29

non-alcoholic fatty liver

fatty change in liver - no alcohol

25% of US adults

with metabolic syndrome

30

diagnosis non-alcoholic fatty liver

biopsy gold standard

31

NASH

non-alcoholis steatohepatitis
-ballooning degeneration, necrosis, lobular inflammation

32

fatty liver

with fatty heart, HTN, diabetes

33

elevated ALT/AST with no symptoms

think NASH

34

iron overload

hemochromatosis

35

copper overload

wilson disease

36

hepcidin

inhibits Fe absorption in GI tract

acts as basolateral side of cells

37

tx for hemochromatosis

bleeding

38

anemia of chronic disease

IL-6 - increases hepcidin - inhibits iron absorption

39

HFE

mutated in hereditary hemochromatosis - adults

no Fe recognition - and no hepcidin**

40

childhood hemochromatosis

mutations - HAMP, HJV

41

secondary hemochromatosis

thalassemia major
sideroblastic anemia

42

inhibition of hepcidin

erythroblasts release - GDF-15 anf TWSG1

43

acute phase reactant

hepcidin
-so is released with chronic inflammation**

44

genetic hemochromatosis

auto recessive

increased iron in tissue - oxidative stress damage

genet defect HFE
-C282Y

finding of homozygous C282Y genotype confirms diagnosis of HH

45

screening test for hemochromatosis

transferrin saturation

46

specific test for hemochromatosis

iron biopsy
MRI of liver
HFE mutation - C282Y

47

skin pigmentation, cirrhosis, diabetes

triad of hemochromatosis

also can see hepatocellular carcinoma

48

prussian blue

Fe stain

49

TIBC

indirect measure of transferrin

normal in hemochromatosis