Liver Pathology Flashcards Preview

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Flashcards in Liver Pathology Deck (28):
1

Acetaminophen Overdose

What actually causes the liver damage?

Too much acetaminophen cannot be metabolized by your liver (overwhelms the glutathione). Therefore, the drug is made into NAPQI, a toxic metabolite

2

Acetaminophen Overdose

How should it be treated?

NAC (N-acetylcysteine)

3

What is the characteristic histologic marker of autoimmune hepatitis?

Plasma cell infiltrate

4

"Interface hepatitis" almost always indicates the patient has...

Autoimmune hepatitis

5

Autoimmune hepatitis
Describe the basic pathology and treatment

Presents as acute or chronic hepatitis. Elevated IgG and gamma globulins and auto-antibodies (ANA, anti SMA). T cell mediated autoimmunity

Treat with immunosuppression (steroids)

6

Alcohol Fatty Liver Disease
Is it reversible? What causes it?

Generally yes

Short term ingestion of alcohol is most common cause

7

Alcohol Fatty Liver Disease
How do the cells appear histologically?

Macrovesicular cells (nucleus pushed to the side with lots of fat in cells)

May see pericellular fibrosis

8

What is Mallory Hyaline? What disease does it indicate?

Large proteinaceous debris in cells

Classic for alcoholic hepatitis

9

Non Alcoholic Fatty Liver Disease
How might it appear histologically?

Could be identical to alcoholic fatty liver disease

Steatosis
Hepatocyte ballooning
Lobular inflammation

10

Hemochromatosis
What are the causes?

Hereditary- homozygous recessive mutation

Secondary- excess transfusions or hemolysis

11

Hemochromatosis
Treatment

Phlebotomy
Chelation

12

Hemochromatosis
What is the pathological issue?

Iron deposition in parenchymal tissues

Elevated serum iron, ferritin

Elevated risk for hepatocellular carcinoma in setting of cirrhosis

13

Hemochromatosis
What mutations may be present?

HFE gene mutation (chr 6)

C282Y Homozygote

H63D homozygote

Compound heterozygote for C282Y/H63D

14

Wilson's Disease
What is the basic pathological issue?

Copper accumulation in the liver and brain

Autosomal recessive disorder

15

Wilson's Disease
Symptoms

Low ceruloplasmin

Neuropsychiatric (Cu deposition in brain)

Kayser Fleischer rings (Cu deposition in eye)

Liver failure

Hemolytic anemia

16

Wilson's Disease
How would you diagnose it?

Screening - look for low ceruloplasmin

Check urine copper- should be high in Wilson's

Liver biopsy and stain for copper

Look for KF rings in eyes

17

Alpha 1 Antitrypsin Deficiency
What is the genetic mutation commonly associated?

PiZZ

18

Alpha 1 Antitrypsin Deficiency
What is the basic pathological issue?

Errors in coding sequence to prevent its export from hepatocyte, resulting in cell death, inflammation, fibrosis, cirrhosis

Causes pulmonary emphysema

19

Alpha 1 Antitrypsin Deficiency
How might this be viewed histologically?

PAS stain will be positive for cytoplasmic globules

20

Budd-Chiari Syndrome
What is the primary pathological problem and symptoms?

Hepatic vein obstruction/thrombosis

Symptoms:
Hepatomegaly
Ascites
Abd pain
Hepatic dysfunction

21

Budd-Chiari Syndrome
Commonly occurs with what disorders?

Myeloproliferative disorders

Inherited disorders of coagulation (Factor V Leiden)

22

Budd-Chiari Syndrome
How does the liver appear grossly and on histology?

Large, congested liver

Engorged and congested sinusoids
(Centrilobular congestion)

23

Veno-Occlusive Disease
Also known as...?

Sinusoidal obstructive syndrome

24

Veno-Occlusive Disease
What patients most commonly get this disease?

Bone marrow transplant

Chemotherapy pts

25

Veno-Occlusive Disease
What is the pathological issue? Symptoms?

Injury to sinusoidal endothelium resulting in occlusion of small hepatic veins

Also get fibrosis and obliteration of the central vein

Hepatomegaly
Weight gain
Jaundice

26

Acute Fatty Liver of Pregnancy
When is is most likely to occur?

3rd trimester

27

Acute Fatty Liver of Pregnancy
Describe the histology and pathology of the disorder

Microvesicular fatty infiltration of the liver

Leads to acute liver failure and encephalopathy

28

Acute Fatty Liver of Pregnancy
Treatment

Need to induce labor ASAP

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