Liver Pathology I Flashcards Preview

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Flashcards in Liver Pathology I Deck (35):
1

Bile is produced in the

1. Small Intestine
2. Pancreas
3. Liver
4. Stomach
5. Gallbladder

3. Liver

2

Oxygenated blood is supplied to the liver via the:

1. Portal and Hepatic Vein
2. Hepatic Vein and Hepatic Artery
3. Portal Vein and Hepatic Artery
4. Hepatic artery only

3. Portal Vein and Hepatic Artery

3

What comprises the portal triad?

- Hepatic Artery
- Bile Duct
- Portal Vein

4

Which hepatocytes are the most susceptible to ischemic injury?

Zone 3 - those closest to the hepatic vein

5

What fluid flows within hepatic sinusoids?
1. Bile
2. Lymph
3. Venous blood from intestine and spleen
4. Arterial blood from hepatic artery
5. Mixed arterial and venous blood

5. Mixed arterial and venous blood

6

What are some of the key proteins synthesized by the liver?

- Albumin
- Acute Phase Proteins
- Clotting Factors
- Alpha-1 Antitrypsin

7

Ballooning Degeneration

Swelling of hepatocytes

8

Feathery Degeneration

Retained biliary material in swollen hepatocytes

9

Macrovesicular Steatosis

Accumulation of fat droplets in hepatocytes where the large droplets push the nuclei to one side

10

Microvesicular Steatosis

Accumulation of fat droplets in hepatocytes that are smaller so the nuclei remain in the central position

11

Interface Hepatitis

If inflammation passes the interface then it is
considered to be interface hepatitis

12

What is interface hepatitis specific for?

Autoimmune Hepatitis

13

What cells are responsible for collagen deposition in the liver?

Stellate Cells

14

What are ALT levels more specific for?

Hepatocyte damages

15

What is the ratio of ALT:AST like in most liver diseases?

ALT is greater than AST

16

When is AST greater than ALT?

- Alcoholic liver disease
- Wilson's disease

17

What is the most common cause of MARKEDLY elevated AST and ALT levels?

Acetaminophen overdose

18

What will increase with cholestasis?

Alkaline phosphatase

19

Cholestasis

Loss of ability to excrete bile acids

20

What are the common causes of fulminant (acute) liver failure?

Drugs, Viral Hepatitis, Autoimmune Hepatitis

21

What is the common cause chronic liver failure?

Cirrhosis

22

50 yo man with known ETOH abuse and a history of chronic back and joint pains comes for an office visit. Labs show AST 6145, ALT 5090, T.bili is 4.6, INR is 2.3.
Most likely diagnosis?

• 1. Alcoholic Hepatitis
• 2. Acetaminophen Toxicity
• 3. Acute hepatitis A
• 4. Ischemic hepatitis
• 5. Choledocholithiasis

• 2. Acetaminophen Toxicity

23

What is the most common route to hepatic failure?

Cirrhosis

24

Acute Liver Failure

Sudden loss of hepatic function in a person without evidence of preexisting liver disease

• Coagulopathy (INR > 1.5) AND
• Any degree of Hepatic Encephalopathy
• Both occurring within 24 weeks of the first onset of symptoms in patients without underlying liver disease

25

Cirrhosis

A diffuse process with fibrosis and a conversion of normal tissue into abnormal nodules

26

What stain can be used to better visualize cirrhosis?

Trichrome to see the collagen

27

Pericellular Fibrosis

Fibrosis surrounds each cell - alcohol and non-alcohol liver disease both can present like this

28

What are some causes of cirrhosis?

- Alcohol Liver Disease
- Viral Hepatitis
- Non-alcohol Liver Disease
- Biliary Disease

29

What are the clinical symptoms of cirrhosis?

Most are asymptomatic until liver failure develops. Others will have non-specific symptoms.

30

How does cirrhosis lead to portal HTN?

- Increased vascular resistance – Distortion of vascular architecture with increase in vascular tone
- Increased portal influx from splanchnic vasodilation

31

What are the consequences of portal HTN?

• Portal hypertension leads to the development of intra- and extrahepatic venous collaterals
• Shunts are created to allow blood to by-pass the intrahepatic resistance to blood flow

32

A 60 yo woman with a long-standing history fo cirrhosis develops esophageal varices and hepatic encephalopathy. An abdominal ultrasound reveals thrombosis of the portal vein. Which of the following pressure measurements would you most likely expect to find?

1. Normal hepatic vein pressure gradient
2. Elevated wedged hepatic vein pressure
3. Elevated free hepatic vein pressure
4. Elevated hepatic vein pressure gradient
5. Low wedged hepatic vein pressure

4. Elevated hepatic vein pressure gradient

33

What are some of the complications of cirrhosis?

– Ascites
– Variceal bleeding
– Hepatic encephalopathy
– Hepatorenal syndrome
– Hepatocellular carcinoma

34

A 55 yo man with chronic hepatitis C related cirrhosis presents to the Liver Transplant clinic for an evaluation. He has had a large esophageal variceal bleed in the past and is now bothered by ascites. Which of the following best characterizes this patient’s circulation?

1. Low peripheral vascular resistance, low cardiac output, high rate of blood flow to splanchnic circulation
2. Low peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation
3. Low peripheral vascular resistance, high cardiac output, low rate of blood flow to the splanchnic circulation
4. High peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation

2. Low peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation

35

Which of the following lab tests is the most reliable indicator of liver function?

1. GGT
2. AST
3. Lipase
4. Indirect Bilirubin
5. Prothrombin Time(INR)

5. Prothrombin Time(INR)

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