18-7: Hepatic Complications

Question 1

what is the mechanism underlying liver allograft rejection?

Answer 1

CD4 and CD8 T cells are activated and initiate rejection

B cells are also activated which start an antibody-mediated response against the graft

Question 2

what is the timing and cause of hyperacute rejection?

Answer 2

minutes-hours

preformed anti-donor antibodies and complement activation

Question 3

what is the timing and cause of acute rejection?

Answer 3

days-months

T cell activation

Question 4

what is the timing and cause of chronic rejection?

Answer 4

months-years

mechanism unknown

Question 5

what is the timing and cause of antibody mediated rejection?

Answer 5

minutes-years

preformed or de novo anti-donor antibodies. Unclear mechanism

Question 6

what is the effect of acute antibody-mediated rejection?

Answer 6

inflammation and endothelial damage leads to ischemic changes in the parenchyma

vanishing bile duct syndrome

Question 7

what is the effect of chronic rejection?

Answer 7

interstitial fibrosis and gradual narrowing of graft blood vessels by activation of fibroblasts

vanishing bile duct syndrome

Question 8

what is preeclampsia?

Answer 8

maternal hypertension
proteinuria
peripheral edema
coagulation abnormalities

Question 9

what is eclampsia?

Answer 9

preeclampsia + hyperreflexia and convulsions

Question 10

What is HELLP syndrome?

Answer 10

a variant of preeclampsia characterized by:
hemolysis
elevted liver enzymes
low platelets

Question 11

what are the morphological features of preeclampsia?

Answer 11

periportal sinusoids contain fibrin deposits associated with hemorrhage into the space of Disse – leads to periportal hepatocellular coagualtive necrosis

Question 12

what is the clinical presentation of acute fatty liver of pregnancy?

Answer 12

3rd trimester

hepatic failure leading to jaundrice, bleeding, nausea, vomiting and coma

Question 13

what is the treatment of acute fatty liver of pregnancy?

Answer 13

termination of pregnancy

Question 14

what are the morphological features of acute fatty liver of pregnancy?

Answer 14

diffuse micro-vesicular steatosis of hepatocytes

Question 15

what is intrahepatic cholestasis of pregnancy?

Answer 15

onset of pruritis in the 2nd or 3rd trimester due to retention of bile salts

in 10-25% of cases this is followed by darkened urine, lightened stools and jaundice

resolves weeks after delivery

Question 16

what labs results are associated with intrahepatic cholestasis of pregnancy?

Answer 16

Total Bili <5
ALP +/-
Biopsy shows canalicular cholestasis

Question 17

which conditions of pregnancy may result in maternal death?

Answer 17

eclampsia

acute fatty liver of pregnancy