massive liver necrosis inficates
acute liver failure
casues acute liver failure
drugs or viral hepatitis
signs of chronic liver failure
palmer erythema
apider angioma
hypogonadism/gynomastia in men
signs of acute liver failure
jaundice and encephalopathy, coaguopathy
retention of bile causes
jaundice
retention of bilirubin, bile salts and cholesterol
cholestasis
most common causes of jaundice
hepetitis, bile obstruction, hemolytic anemia
mild, fluctuating unconjugated hyperbilirubinmea - inborn
Gilbert
charecteristic of hepatic encephalopathy
flapping tremor
pathenogensis of hepatic encephalopathy
severe loss of hepatocellular function
shunting of blood from portal to systemic circulation around chronically diseased liver
causes hepatic encephalopathy in actute/chronic setting
ammonia/deranged NT production (especially GABA)
fibrosis and concersion of normal liver architecture into structuraly abnormal nodules
cirrhosis
fibrous septa and parachymal nodules
cirrhosis
pathogenesis process of cirrhosis
death of hepatocytes
extracellular matrix deposition
vascular reorg
anoerxia, weight loss, weakness may indicate
cirrohsis
fatal outcomes of liver cirrhosis
progressive liver failure
portal hypertension complications
hepatocellular carcinoma
signs of portal hypertension
ascites esophogeal varices splenomegaly caput medusae hemorroids
can cause massive and fatal bleeding in portal hypertension
esophogeal varices
most important agent that produces toxic liver injury
EtOH
clues of heppatopulmonary syndrome
eaiser breathing lying down, fall of arterial blood oxygen with upright posture
most common toxin leading to acute liver failure needed transplant
acetomenophen
type of hepititis with less inflammation and more hepatocyte death
acute
female, elevated IgG, high titwers of autoantiboodies and liver damage signs
autoimmune hepatitis
“chicken-wire fence” histology
non-alchoholic fatty liver disease
manifestations of alchoholic liver disease
hepatic steatosis, alchoholic hepatitis, cirrohsis
years it takes most people to progress to alchoholic cirrhosis
10-15 years
risk factors of NAFLD
DM type 2
obesity
syslipidemia
hypertension
pathogensis of NAFLD
impaired oxidation of fatty acids
increasd synthesis and uptake of fatty acids
decreasd hepatic secretion of VLDL cholesterol
what you see in EtOH fatty liver disease, but not NAFLD
heptocyte balloning
denk bodies
neutophillic infiltration
casues EtOH fatty liver disease
changes in lipid metabolism
ROS
cytokines
time period of neonatal cholestasis
birth to 14days
collapse of liver parenchyma leaving only shriveled organ with wrinkled capsule
fulminant hepatic failure
most common cause of fulminant hepatic failure
viral hepatitis
most common cause of cirrhosis
EtOH
compression of sinusoids and central veins, reduction in number of functional sinusoids
cirrhosis
metabolism functions affected in liver failure
nitrogen metabolism
circulating protein production
biliary excretory function
steroid hormone metabolism
most common type of autoimmune hepatitis
type 1
HLA-DR3/4 associated with
autoimmune hepatitis
lab findings in autoimmune hepatitis
positive antinuclear antibody test and anti-smooth muscle antbodies
anti-smooth muscle antibodies
autoimmune hepatitis
multinucleated cells
neonateal hepititis
most common causes of neonate hepatitits
CMV or inborn errors of metabolism
causes of microvesicular fatty liver
reye’s syndrome
fatty liver of pregnancy
tetracycline tox
get from taking asprin with acute viral infections
reye’s
encephalopathy, fatty liver changes, transaminase elevation in kid home-treated with an acute viral infection; think -
reye’s
groosly enlarged, pale, waxy liver
fatty liver
treatment for EtOH liver
stop drinking. Can be reversed
causes EtOH hepatitis
acetaldehyde damage to hepatocytes
hepatocyte swelling and necrosis
intracytoplasmic depositis of cytokeratin
neutophilic infiltrate
alchoholic hepatits
point of no return of alcholic hepatists
fibrosis
chronic progressive cholestatic liver disease with destruction of intrahepatic ducts
Primary biliary cirrohosis
woman with pruitis, fatige. elevated Alkaline phostphatase and cholersterol
Primary biliary cirrohosis
anti-mitochondiral antibodies
Primary biliary cirrohosis
franulomatous destruction of intrahepatic bile ducts
Primary biliary cirrohosis
inflamation, obiliterative fibrosis, segmental involvement of intra and extra heptic bile ducts
primary schlerosiing cholangitis
associated with inflammatory bowel disease
primary schlerosiing cholangitis
male, 30-60 with fatige, itching and jaundice
primary schlerosiing cholangitis
primary schlerosiing cholangitis has increased risk, long term, of
cholangiocarcinoma
onion skin lesion
cholangiocarcinoma
diagnosing test of primary schlerosiing cholangitis
ERCP (“beading” of bile ducts)
leads to obiliteration od bile duct, leading to cholestatis and cirrhoss
primary schlerosiing cholangitis
primary liver disease with p-ANCA
primary schlerosiing cholangitis