21 - Liver Path Flashcards
clinical presentation of acute liver disease
malaise, fatigue, N/V, anorexia, fever, localized tenderness
more severe: jaundice, dark urine, pale stool, bleeding, seizures/coma, hepatic encephalopathy, renal failure
clinical presentation of chronic liver disease
any signs of acute bleeding / thrombotic complications small firm liver or hepatomegaly splenomegaly ascites spontaneous bacterial peritonitis abd collateral vessels varices gynecomastia testicular atrophy dec libido pruritis glucose intolerance aminoaciduria vit defs gi complaints anemia muscle wasting
ballooning vs feathery degeneration of liver
ballooning - cell swelling w/ damage from toxic or immunologic insults
feathery - diffuse foamy appearance due to chronic cholestasis
____ serve as reserve for restitution of severe hepatic injury
bile ductules
etiology of cholestasis
intrahepatic: hepatocellular dysfunction and drugs
large duct obstruction: CBD stricture, stones, flukes, CA pancreas
path signs of chronic cholestasis
feathery degeneration
copper storage
mallory hyaline
bile pigment
relationship between steatosis and alcohol
metabolizing alcohol makes reducing equivalents, can’t be disposed of, so used for lipid biosynth > accumulation of lipid droplets in hepatocytes
steatosis in nonalcoholic fatty liver disease
excess carb ingestion > inc fat synth
lab tests which measure liver excretion
serum and urine bilirubin
lab tests of liver synthetic ability
total protein, albumin coag tests (PT, INR)
lab tests to assess hepatocellular damage
ALT/AST
diff between ALT and AST
AST - in liver, heart, skeletal muscle, pancreas, lung, RBC. >80% in mito and ER
ALT - mainly in liver, low in kidney, heart, skeletal muscle. mainly cytoplasmic. better index of liver injury
highest transaminases seen in
acute hepatitis
alcoholic hepatitis transaminases (relative)
AST > ALT
gamma glutamyltransferase (GGT)
sensitive but not specific for liver damage
