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Gastrointes 2 > 011215 hepatic inflam and fibrosis > Flashcards

011215 hepatic inflam and fibrosis Flashcards

1
Q

in fibrosis, where is periportal fibrosis?

A

around portal triad and extending a bit beyond

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2
Q

what stage is cirrhosis called?

A

stage 4

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3
Q

hepatic necrosis

A

ACUTE cell death

can lead to acute liver failure

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4
Q

fulminant liver failure

A

acute liver failure complicated by coagulopathy and encephalopathy

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5
Q

most common causes of acute and fulminant liver failure

A 
meds (acetaminophen)
viral hepatitis (causes fibrosis, which takes longer, and necrosis, which is acute)
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6
Q

pathophysiology of alcoholic liver disease

A 
increased NADH 
increased acetaldehyde (activates stellate cells to form collagen, microfilaments that maintain intracellular skeleton are sheared causing ballooning, Kupffer cells produce TNFalpha)
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7
Q

what changes do you see at the microscopic level with alcoholic liver disease?

A

dense extracellular matrix laid down in the space of Disse

loss of fenestrations in the sinusoids

loss of microvilli on hepatocytes

activated Kupffer cell

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8
Q

what are the 3 complications of alcoholic liver disease

A

steatosis/fatty liver
alcoholic hepatitis
cirrhosis

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9
Q

alcoholic hepatitis

A

fat plus inflammatory cells

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10
Q

risk factors for alcoholic liver dis

A

more than 30g alcohol/day in men, 20g/day in women

alcohol outside of meals
binge drinking

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11
Q

lab abnormalities in ALD

A 
AST/ALT ratio greater than 2
ALT usually under 300 IU/mL
rarely raised alk phos
low albumin
increased INR (advanced disease)
increased bilirubin

thrombocytopenia (advanced dis)
macrocytosis/anemia

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12
Q

tx for alcoholic HEPATITIS

A

abstinence, nutritional support

anti-inflammatory drugs (glucocorticoids, Pentoxifylline)

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13
Q

jaundice can be attributable to

A

many conditions

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14
Q

alcoholic liver disease is histoliogically like

A

non-alcoholic fatty liver dis

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15
Q

most common cause of elevated transaminases in the US

A

NAFLD

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16
Q

NAFLD is histologically categorized into 2 categories

A

non alcoholic fatty liver (NAFL)–abnormal liver tests, no ballooning of hepatocytes

non alcoholic steatohepatitis (NASH)–steatosis and inflam present. with hepatocellular injury (ballooning of hepatocytes) with or without fibrosis

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17
Q

prevalence of chronic liver disorders in US–what is most common?

A

nonalcoholic fatty liver, then
nonalcoholic steatohepatitis
then chronic hep C
then alcoholic liver dis

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18
Q

risk factors for non alcoholic liver disease

A

abdominal OBESITY
hypertriglyceridemia
high fasting glucose/diabetes

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19
Q

causes of steatosis and steatohepatitis

A

alcohol
meds
nutritional (TPN, etc)
insulin resistance

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20
Q

therapeutic strategies for NAFLD

A

WEIGHT LOSS

for NASH:
vitamin E (first line)
pioglitazine

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21
Q

HFE gene

A

mutated in hereditary hemochromatosis

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22
Q

what does HFE doe?

A

downregulates transferrin when iron supplies are adequate so that iron is not absorbed from small intestine

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23
Q

hemochromatosis occurs most commonly in what population?

A

Europeans

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24
Q

clinical presentation of hereditary hemochromatosis

A

liver fxn abnormalities
SKIN HYPERPIGMENTATION-BRONZE
DIABETES

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25
what gene combination results in hereditary hemochromatosis
C282Y/C282Y (homozygous recessive) C282Y is the mutant form of the wildtype gene
26
C282Y/H63D suggests
10% chance of developing hereditary hemochromatosis
27
tx for C282Y/C282Y hereditary hemochromatosis
if older than 40 or if elevated ALT/AST, consider biopsy to assess for cirrhosis and phlebotomy
28
two defects in Wilson's disease
gene mutation in ATB7B | also can't make enough ceruloplasmin
29
pathophysiology of Wilson's dis
due to mutation in ATB7B, liver can't transport copper into biliary excretion to be fecally excreted also, ceruloplasmin is reduced. so non-ceruloplasmin-bound copper deposits in liver
30
what is one of the few diseases that can cause necrosis and fibrosis
Wilson's disease
31
damage in Wilson's dis occurs mainly to
liver and brain
32
ceruplasmin test for Wilson's dis
not the best test b/c high levels will occur in inflam and may lead to false negatives
33
Kayser Fleischer rings
Wilson's disease
34
tx for Wilson's dis
Trientine (binds unbound copper to excrete in urine) | zinc (prevents copper absorption from GI tract)
35
alpha1anti trypsin
inhibitor of the proteolytic enzyme elastase
36
M gene
normal gene for alpha1anti trypsin. this gene produces normal amts of the protein
37
the most common mutant form for alpha1 anti trypsin deficiency
Z
38
what organs are involved in alpha1anti trypsin deficiency
lungs | liver
39
the mechanisms for alpha1 anti trypsin deficiency disease
lung: loss of fxn mutation liver: gain of fxn in that the small amts of A1AT are abnormal so they accumulate in liver and induce toxicity
40
what form of A1AT deficiency causes lung disease only?
PiSZ | and Pi null-null
41
what form of A1AT deficiency causes both lung and liver dis
PiZZ
42
what do you find in the serum of autoimmune hepatitis pts?
autoantibodies against hepatocytes (IgG)
43
the few things that have ALT, AST elevation over 1000
autoimmune hepatitis viral hepatitis A, B meds ischemic
44
interface hepatitis
around the portal triad | seen in autoimmune hepatitis
45
plasma cell infiltrate
autoimmune hepatitis
46
ANA, ASMA are positive in
type 1 autoimmune hepatitis
47
anti liver kidney microsomal antibody is postive in
type 2 autoim hepatitis
48
associated conditions of autoim hepatitis
THYROID DISEASE RA other autoimmune diseases
49
tx for autoim hepatitis
prednisone and azathioprine combo
50
primary biliary cirrhosis is a misnomer b/c
the disease can actually have stage 1-4 of fibrosis (only 4 is cirrhosis)
51
PBC
chronic, progressive, cholestatic liver disease | destruc of intrahepatic ducts (the very small bile ducts)
52
AMA +
PBC
53
what markers do you see for PBC?
AMA positive | elevated IgM
54
AMA targets what?
PDC E2 on the membrane of biliary epithelial cells
55
symptoms of PBC
asymptomatic or FATIGUE PRURITUS
56
itching-think?
bile duct problem
57
xanthelasma (fat deposits)
PBC
58
consequences of PBC?
steatorrhea | deficiency of vit A,D,E,K
59
florid duct lesion
PBC
60
florid duct lesion-define
lymphocytes and mononuclear cells causing inflam changes around bile ducts
61
tx for PBC
ursodeoxycholic acid (a hydrophilic bile acid that balances the ratio of excessive hydrophobic bile acid accumulation in PBC) for pruritis-use benadryl at night and cholestyramine during day
62
Wilson's dis pt-what ages?
3-40
63
if synthetic fxn is intact, don't think
cirrhosis
64
meds can cause hepatocellular injury or cholestatic injury?
both
65
can you burn out the bile ducts?
no (you can however burn out hepatocytes)

Gastrointes 2 (15 decks)

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