33/34: Liver Pathology I - Carnevale Flashcards
liver tests indicating level of hepatocyte integrity
AST
ALT
LDH
liver tests indicating hepatocyte function
serum albumin
prothrombin time
serum ammonia
clotting factors produced by liver
2, 7, 9, 10
all vit K dependent
bile canaliculus enzymes
AP alkaline phosphatase
5NT 5’ nucleotidase
GGt gamma-glutamyl-transpeptidase
total bilirubin
unconjugate (indirect) and conjugated (direct)
0.1-1.2 is normal
greater than 2 mg/dL leads to jaundice
3 mechanisms of jaundice and cholestasis
- isolated disorders of bilirubin metabolism
- liver disease
- bile duct obstruction
what type of jaundice does the newborn typically present with?
impaired uptake
pre-hepatic dysfunction jaundice
2 major causes post-hepatic dysfunction
pancreatic carcinoma
gallstones
clinical s/s cholestasis
pruritus jaundice clay colored stools dark urine bleeding diathesis xanthomas osteoporosis
liver test results for cholestasis
increased AP, GGT, and 5NT
hyperbilirubinemia greater than 1.2 mg/dL
hyperlipidemia
how will the liver look like with intrahepatic cholestasis?
green like the gall bladder normally is
common causes of cirrhosis
- alcoholic liver disease ** 60-70%
viral hepatitis (10%)
obesity (5-10%)
cryptogenic (unknown)
pathogenesis of cirrhosis
- hepatocyte necrosis
- progressive fibrosis
- regenerative hepatocyte nodules
- abnormal vascular connections
- disruption of hepatocyte function
decompensated cirrhosis (4)
- portal hypertension
- hepatorenal syndrome
- liver failure
- hepatic encephalopathy
s/s cirrhosis
ascites skin spider angiomata esophageal varices splenomegaly hepatic encephalopathy breast formationa nd feminization (liver is supposed to break down estrogen)
lab test results for hepatic cirrhosis
decreased albumin
increased serum bilirubin, transaminases, GGT, and prothrombin time
hepatic failure is found with loss of ___ of liver function
80%
clinical signs of hepatic failure
encephalopathy
coagulopathy
jaundice
multiple organ failure (hypotension, pulmonary edema, DIC)
acute renal failure that occurs in the setting of cirrhosis or fulminant liver failure, sometimes also associated with portal hypertension, usually in the absence of other disease of the kidney
hepatorenal syndrome
hepatorenal syndrome is thought to be an alteration in blood flow and blood vessel tone in the intestinal system which results in and altered blood flow to the kidney
s/s and lab findings for hepatorenal syndrome
liver failure and renal failure normal kidney oliguria/anuria increastied BUN and creatinine low urinary Na concentration normal urinary sediment
poor prognosis
potentially reversible neuropsychiatric abnormality in the setting of either acute or chronic liver failure
hepatic encephalopathy
it can be diagnosed only after exclusion of other neurological, psychiatric, infectious and metabolic etiologies
increased NH3 brain diffusion with edema is the causes
clinical features of hepatic encephalopathy
- spatial perception distorted
- sleep disturbance
- personality changes
- asterixis
- abnormal EEG
- lethargy
- coma
- decerebrate posture
only dsDNA hepatitis virus
hepB
acute asymptomatic infection with recovery: serologic evidence only
hep A hep B C D coinfection E
acute symptomatic hepatitis with recovery: anicteric or icteric
hep A B C D coinfection E
chronic hepatitis: without or with progression to cirrhosis
Hep B few
C 85%
D superinfection most
fulminant hepatitis: with massive to submassive hepatic necrosis
hep A rare B rare C rare D co&super E pregnant
most common form of viral hepatitis
hep A
clinical disease tends to be mild or asymptomatic and rare after childhood
picorna virus -RNA
fecal-oral transmission
no carrier state or chronic hepatitis
rarely causes fulminant hepatitis
most common cause of cirrhosis worldwide and hepatocellular carcinoma worldwide
hepB
transmission parenteral, sexual, and vertical
of 1/3 symptomatic infected, 10% will progress to chronic hepatitis
hep D requires ______- to replicate
hepBsAg
therefore must be coinfection (at same time) or superinfection (B in past, now have D) (worse*)
transmission is parenteral
most common chronic liver disease
hep C (85% infected go chronic)
major source of infection is injection drug use
also leading indication for liver transplantation
chronic hep C progression to liver cancer determining factors
cirrhosis
age (have disease longer)
male sex
alcohol
uses of liver biopsy in chronic hepatitis
diagnosis of incidental lesions
assessment of histological activity
evaluation of types of necrosis
evaluation of structural changes
clue to aetiology and possible superinfection
immunohistochemical assessment of viral antigens
monitoring of therapy
ballooning and cholestasis =
acute viral hepatiits
also see councilman bodies and lobular disarray
piecemeal necrosis =
chronic viral hepatitis
ground glass hepatocytes =
chronic hep B
chronic hep C shows lymphoid aggregate
what amebic abscess may be seen in liver?
entamoeba histolytica
which liver cyst should you NEVER stick a needle in?
hydatid cyst
cuased by echinococcus grnulosus
components of the cell wall can cause an anaphylactic shock rxn
pipe stem fibrosis
schistoma japonicum
