Pathology of the GI Tract- Liver and Gallbladder (1)

Question 1

What are two causes of conjugated hyperbilirubinemia?

Answer 1

1. deficiency of canalicular membrane transporters (Dubin-Johnson syndrome or Rotor syndrome) 2. impaired bile flow from duct obstruction or autoimmune cholangiopathies

Question 2

what tests assess the hepatocyte integrity?

Answer 2

AST, ALT, and LDH

Question 3

what tests assess the biliary excretory function?

Answer 3

serum bilirubin, serum bile salts, alk phos, GGT

Question 4

what tests assess the true functions of the liver?

Answer 4

albumin, coagulation factos (PT/PTT/INR), ammonia

Question 5

which test is particularly sensitive for liver disease?

Answer 5

GGT

Question 6

elevated ALP can suggest what?

Answer 6

either liver or bone disease

Question 7

what is the pattern of liver function tests seen in a person with obstructive liver disease?

Answer 7

elevated ALP and bilirubin

Question 8

injured or dysfunctional hepatocytes in a variety of disorders may demonstrate several potentially reversible morphologic changes. These include?

Answer 8

steatosis, cholestasis, ballooning (ballooning may form Mallory hyaline)

Question 9

what is the pattern of cell death seen in acute toxic or ischemic injuries or in severe viral or autoimmune hepatitis?

Answer 9

coagulative necrosis

Question 10

what is the principal cell type involved in scar deposition in the liver?

Answer 10

hepatic stellate cell

Question 11

regeneration of the liver occurs by two major mechanisms, what are they?

Answer 11

proliferation of remaining hepatocytes and repopulation from progenitor cells

Question 12

what are the stimuli for stellate cell activation?

Answer 12

inflammatory cytokines (TNF-alpha), altered interactions with ECM, and toxins and ROS

Question 13

in chronic liver disease, surviving hepatocytes replicate in an effort to restore the parenchyma, forming what?

Answer 13

regenerative nodules- predominant feature in most cirrhotic livers

Question 14

what defines hepatic failure?

Answer 14

80-90% of functional capacity must be lost

Question 15

what defines acute liver failure?

Answer 15

an acute liver illness associated with encephalopathy and coagulopathy that occurs within 26 weeks of the initial liver injury in the absence of pre-existing liver disease

Question 16

50% of ALF in the US is due to what?

Answer 16

acetaminophen

Question 17

acute liver failure is usually associated with what?

Answer 17

massive hepatic necrosis

Question 18

what are two cases that may result in acute liver failure with widespread dysfunction of liver cells?

Answer 18

diffuse microvesicular steatosis or idiosyncratic reactions to toxins

Question 19

what are the clinical features of acute hepatic failure?

Answer 19

nausea, vomiting, icterus and jaundice, itching, and elevated liver enzymes; life threatening coagulation abnormalities; hepatic encephalopathy (asterixis)

Question 20

what is chronic liver failure most often associated with?

Answer 20

cirrhosis

Question 21

what are the leading causes of chronic liver failure worldwide?

Answer 21

chronic hepatitis B, chronic hepatitis C, nonalcoholic fatty liver disease, and alcoholic liver disease

Question 22

what are the non-specific early symptoms of chronic liver failure?

Answer 22

anorexia, weight loss, and weakness

Question 23

what are the specific features of chronic liver failure?

Answer 23

palmar erythema, spider angiomata, hypogonadism, and gynecomastia (symptoms of acute liver failure+ portal hypertension)

Question 24

what are the major prehepatic conditions that lead to portal hypertension?

Answer 24

obstructive thrombosis, narrowing of the portal vein, or massive splenomegaly with increased splenic vein blood flow

Question 25

what is the main posthepatic causes of portal hypertension?

Answer 25

severe right sided heart failure, constrictive pericarditis, and hepatic vein outflow obstruction

Question 26

what is the dominant intrahepatic cause of portal hypertension?

Answer 26

cirrhosis

Question 27

what is ascites?

Answer 27

the accumulation of fluid in the peritoneal cavity

Question 28

what are the principal sites of shunts that form in cases of chronic portal hypertension?

Answer 28

veins around and within the rectum, esophagogastric junction, the retroperitoneum, and the falciform ligament of the liver

Question 29

what are the four major consequences of portal hypertension?

Answer 29

hepatic encephalopathy, ascites, the formation of portosystemic venous shunts, and congestive splenomegaly