Liver Pathology III

Question 1

True or false: many of the drug induced liver diseases mimic other liver clinical diseases

Answer 1

True

Question 2

What is phase I part of drug metabolism?

Answer 2

Oxidation
Reduction
Hydrolysis

Question 3

What is phase II parts of liver metabolism?

Answer 3

Glucuronidation

and others

Question 4

What zone of the liver is susceptible to toxic metabolites? WHy?

Answer 4

Zone 3

has lowest oxygen content

Question 5

What type of drugs produce specific, predictable lesions of the liver?

Answer 5

Intrinsic

Question 6

What type of drugs cause unpredictable lesions in the liver, and hypersensitivity reactions?

Answer 6

Idiosyncratic

Question 7

Macrovesicular fatty change occurs with what type of liver insult? Microvesicular?

Answer 7

Maco = EtOH
Micro = tetracyclines, salicylates,

Question 8

What is the effect of acetaminophen on the liver?

Answer 8

Necrosis

Question 9

What is the effect of tetracycline on the liver?

Answer 9

Microsteatosis

Question 10

What is the effect of methotrexate on the liver?

Answer 10

Macrosteatosis

Question 11

What is the effect of halothane on the liver?

Answer 11

Hepatitis

Question 12

What is the effect of isoniazid on the liver?

Answer 12

Hepatitis

Question 13

What is the effect of amiodarone on the liver?

Answer 13

Fibrosis

Question 14

What is the effect of steroids on the liver?

Answer 14

Cholestasis

Question 15

What is the effect of erythromycin on the liver?

Answer 15

Cholestasis

Question 16

Porto-central bridging necrosis happens with what drug?

Answer 16

Halothane

Question 17

Pathologic changes in the liver are seen with what level of daily EtOH consumption in men? Women?

Answer 17

Men >80g/day

Women >40g/day

Question 18

What is the initial liver change with EtOH consumption? Is this reversible?

Answer 18

Steatosis

Reversible

Question 19

What is the intermediate liver change with EtOH consumption? Is this reversible?

Answer 19

hepatitis

Reversible

Question 20

What is the chronic liver change with EtOH consumption? Is this reversible?

Answer 20

Cirrhosis

Not reversible

Question 21

What type of inflammation occurs with acute hepatitis? Chronic?

Answer 21

Acute = PMN infiltration, mild fibrosis
Chronic = hyaline change + severe fibrosis

Question 22

Where in the liver does most of the fat accumulate?

Answer 22

Pericentral (centrilobular) zone

Question 23

Mallory bodies = ?

Answer 23

Hyaline change in the liver secondary to fatty liver EtOH

Question 24

What are the large eosinophilic bodies in hepatocytes secondary to EtOH consumption?

Answer 24

Megamitochondria

Question 25

Trichrome stain highlights what?

Answer 25

Fibrosis/collagen deposition

Question 26

What is the pattern of fibrosis in fatty liver?

Answer 26

Chicken-wire

Question 27

What forms the nodules in livers?

Answer 27

Bridging fibrosis

Question 28

What are the lab findings characteristics of alcoholic steatohepatitis? (CBC, LFTs x2)

Answer 28

- Leukocytosis - AST:ALT >(2:1) - Alk Phos increased

Question 29

What is the cause of Wernicke-Korsakoff syndrome?

Answer 29

It is a manifestation of thiamine (vitamin B1) deficiency

Question 30

What are the four usual causes of death with chronic alcoholism?

Answer 30

Hepatic coma Massive GI hemorrhage Infx Hepatorenal syndrome

Question 31

What are the two drugs that can cause steatohepatitis?

Answer 31

Tamoxifen | Nifedipine (DHP CCB)

Question 32

What are the two arterial supplies to the liver?

Answer 32

Hepatic artery | Portal vein

Question 33

What is Budd-Chiari syndrome?

Answer 33

Hepatic vein obstruction and/or IVC

Question 34

How does right heart failure cause liver failure? Left heart failure?

Answer 34

Right = Backup of blood causes congestion in the liver. Left = Hypoxia secondary to loss of blood supply from the hepatic artery

Question 35

Why is liver infarction rare?

Answer 35

Liver has dual blood supply

Question 36

What is chemo-embolisation?

Answer 36

Giving chemo to the liver via the portal vein

Question 37

What is polyarteritis nodosa? What liver pathology can this cause?

Answer 37

Systemic vasculitis of unknown etiology, that often presents with nonspecific symptoms. Infarction d/t fibrosis of arteries

Question 38

What are the intrahepatic causes of portal vein thrombosis? (4)

Answer 38

Cirrhosis Malignancy Stasis Pregnancy

Question 39

What are the usual causes of extrahepatic portal vein thrombosis?

Answer 39

Appendicitis Diverticulitis Pancreatitis Coagulopathies

Question 40

What are the ssx of poratal vein thrombosis?

Answer 40

Abdo pain Portal HTN Varices/ascites

Question 41

What is pylephlebitis?

Answer 41

An uncommon thrombophlebitis of the portal vein or any of its branches (ie a portal vein thrombosis) that is caused by infection

Question 42

What are infarcts of Zahn?

Answer 42

Infarcts in the hepatocytes causing atrophy without necrosis

Question 43

What can cause Budd-Chiari syndrome?

Answer 43

Clotting or obstruction of the hepatic vein and/or IVC

Question 44

Long term right heart failure can have what effect on the liver?

Answer 44

Cardiogenic sclerosis of the liver

Question 45

What are the heart diseases that can affect the liver?

Answer 45

Pericarditis Right heart failure Congenital heart disease

Question 46

What causes nutmeg liver?

Answer 46

centrilobular hemorrhage necrosis usually d/t right heart failure

Question 47

What is the cause of paroxysmal nocturnal hemoglobinuria? What effect does this have on the liver?

Answer 47

Acquired loss of Decay Accelerating Factor (DAF) on RBCs causes complement destruction Causes hypercoagulable state, which can lead to Budd-Chiari syndrome

Question 48

What are the ssx of chronic Budd-Chiari syndrome?

Answer 48

Portal HTN Cirrhosis Obliterative hepatocavopathy

Question 49

What are the ssx of acute Budd-Chiari syndrome?

Answer 49

Abdo pain Hepatomegaly Ascites Jaundice

Question 50

What is obliterative hepatocavopathy?

Answer 50

IVC obstruction due to membranous webs, leading to edema of the legs and abdominal wall

Question 51

What is veno-occlusive disease of the liver?

Answer 51

A condition in which some of the small veins in the liver are obstructed. It is a complication of high-dose chemotherapy given before a bone marrow transplant (BMT) and is marked by weight gain due to fluid retention, increased liver size, and raised levels of bilirubin in the blood.

Question 52

What are the chemicals that can cause veno-occlusive disease?

Answer 52

Bush tea alkaloids

Question 53

What are the ssx of veno-occlusive disease of the liver?

Answer 53

``` Portal HTN Tender hepatomegaly Weight gain Jaundice Renal failure ```

Question 54

What does silver stain highlight?

Answer 54

Reticular fibers

Question 55

What does trichrome stain highlight?

Answer 55

Collagen