18.7 Flashcards
What are complications orthotopic tranplantation
Liver damage is host-vs-graft after liver transplantation
mediated by T cells and Ab and the principle cause of early graft failure.
what is the acute rxn that occurs with complications of orthotopic transplantation
Ab-mediated rejection, Ab binds to vascular endothelium and activates complement path via classical path –>
result in inflam and endothelial damage leading to ischemic changes in liver parenchyma
-may present suddenly after transplant if immunosuppression is tapered or terminated. This can cause vanishing bile duct syndrome
CD8+ cells destroy graft cells or CD4+ secrete cytokines and induce inflam. The T cells may also react against graft vessels and lead to vascular damage
what is the chronic rxn that occurs with complications of orthotopic transplantation
progressive loss of graft functio
interstitial fibrosis and gradual narrowing of graft BVs (graft atherosclerosis) due to T cells that react against graft alloAg and secrete cytokines that stimulate prolif and activities of fibroblasts and vascular Sm. M cells in the graft
inflam leads to ischemic changes in liver parenchyma due to obliterative arteriopathy of small/large As
cause vanishing bile duct syndrome
what is the complication of Hematopoietic stem cell tranplantation
liver damage is due to acute/chronic graft-vs-host dz
explain viral hepatitis in pregnancy
MCC of jaundice in pregnancy
pregnancy does NOT alter the course of viral hepatitis (except HEV). HEV has a more severe course and fatality is also 20%
liver - 2ndarly involved by infxn during pregnancy, including HSV - causing rare acute liver failure in pregnancy & L. monocytogenes - liver abscess (bc bacteria thrives in placental tissue)
Abnormal liver tests can be present w/ no clinical reason
what are serious complications of that may occur in pregnancy relating to hepation fxn
preeclampsia, eclampsia, acute fatty liver of preg and intrahepatic cholestasis of preg
In extreme cases, eclampsia and acute fatty liver of preg may be fatal.
what is preeclampsia
compare it to eeclampsia
characterized by maternal HTN, proteinuria, peripheral edema and coagulation abnormalities. If dysfxn is enough to cause coagulopathy, this shows advances, lethal dz
HELLP syndrome, hemolysis, elevated lipase enzyme and low platelets
mod to severe increase in AST/ALT and mild elevation of bilirubin
If accompanied by hyperreflexia and convulsions the condition is eclampsia & it could be life-threatening
how does acute fatty liver present in pregnacy
MC - mild course BUT can progress w/i days to hepatic failure and death.
usually in 3rd trimester with hepatic failure, including bleeding, N/V, jaundice and coma
20-40% of cases may be coexistent w/ preeclampsia. The primary treatment is termination of pregnancy.
How does intrahepatic cholestasis in pregnancy
the onset of pruritus (bc of retention of bile sales) in the 2nd/3rd trimester, it may also present with darkened urine and light stool and jaundice
It resolves w/i 2-3 weeks of delivery
The total bilirubin is <5 mg/dl, (+/-) ALP and the Bx shows canalicular cholestasis.
There is a modest risk of fetal loss. This can recur in subsequent pregnancies.
