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Flashcards in Wk5 Liver Path pt2 Deck (70)
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1

early EtOH abuse

enlarged, lipid filled liver

How does it look microscopically?

Alcoholic steatosis--fatty liver

large lipid vacuoles

**reverses with abstinence

2

Alcoholic hepatitis = steatosis + ?

hepatocyte injury and/or inflammation

"steatohepatitis"

3

Cytokeratin aggregates in hepatocytes:

Associated with?

Mallory bodies

Alcoholic hepatitis

4

Usually seen surrounding Mallory bodies:

neutrophilic inflammation

5

Alcoholic hepatitis occurrence

pre-cursor to cirrhosis

steatofibrosis

**perivenular and pericellular

6

Grossly: fibrosis + nodules

cirrhosis

7

Liver in early stages of alcoholic cirrhosis

enlarged

fatty

micronudular (less 3 mm)

8

Liver in late stages of alcoholic cirrhosis:

shrunken

non-fatty

variable nodule size

cholestasis usually present

9

5 major causes of death from alcoholic liver disease:

1. hepatic encephalopathy and coma

2. Massive GI tract hemorrhage (esophageal varicies)

3. infx

4. hepatorenal syndrome

5. hepatocellular carcinoma

10

NAFLD?

Patient profile?

Non-alcoholic fatty liver disease

-metabolic syndrome
-obesity
-DM2
-dyslipidemia
-insulin resistance

11

autoimmune cholangiopathy

progressive destruction of small and medium sized INTRAhepatic bile ducts

extrahepatic ducts are spared

middle age females

Primary biliary cirrhosis

12

AMA (antimitochondrial antibodies)

associated with other autoimmune disorders

Primary biliary cirrhosis

13

fatigue

anicteric pruritis

xanthomas

steatorrhea

vit D malabsorption

Primary biliary cirrhosis

14

Tx for PBC:

urodeoxycholic acid

liver transplant

15

Dx of PBC:

liver biopsy

16

Damage due to prolonged EXTRAhepatic bile duct obstruction

Secondary biliary cirrhosis

17

progressive

RANDOM

autoimmune

uneven fibroinflammatory

extra/intrahepatic bile ducts

Primary sclerosing cholangitis (PSC)

18

pANCA

IBD association

Primary sclerosing cholangitis

19

"beaded" appearance on cholangiogram

PSC

primary sclerosing cholangitis

20

disorders of excessive iron absorption resulting in accumulation of iron in tissues producing organ injury

hemochromotosis

21

Inheritance pattern of primary hemochromotosis

autosomal recessive

22

Liver protein decreased in hemochromotosis

hepcidin --> excessive intestinal iron absorption

23

Most common genetic mutation in hereditary hemochromotosis

HFE -- chromosome 6

C282Y -- 80% of cases in adults

**most common in male of northern european descent

low penetrance so not all homozygotes express disease

24

Causes of secondary hemochromotosis

parenteral Fe overloads (transfusions)

ineffective erythropoesis --> increased Fe absorption
-(B-thalassemis, sideroblastic anemia)

increased oral intake of Fe

Chronic EtOH liver disease

25

Reread slide 42

distribution of excess Fe

26

Early pathological finding of primary hemochromotosis:

periPORTAL iron deposits in hepatocytes

27

Early pathological finding of secondary hemochromotosis (different from primary):

Fe accumulates in Kupffer cells not hepatocytes

28

Classic triad for hemochromotosis presentation:

1. cirrhosis

2. diabete

3. skin pigmentation

"Bronze diabetes"

**also may see sx in other organ systems (heart, joints, etc.)

29

Best screening test for hemochromotosis:

fasting transferrin saturation

if greater than 45% --> serum ferritin

if ferritin elevated --> HFE gene test

30

Reason for liver bx in hemochrmatosis:

concern for cirrhosis