33/34: Liver Pathology I - Carnevale

Question 1

liver tests indicating level of hepatocyte integrity

Answer 1

AST
ALT
LDH

Question 2

liver tests indicating hepatocyte function

Answer 2

serum albumin
prothrombin time
serum ammonia

Question 3

clotting factors produced by liver

Answer 3

2, 7, 9, 10

all vit K dependent

Question 4

bile canaliculus enzymes

Answer 4

AP alkaline phosphatase
5NT 5’ nucleotidase
GGt gamma-glutamyl-transpeptidase

Question 5

total bilirubin

Answer 5

unconjugate (indirect) and conjugated (direct)

0.1-1.2 is normal

greater than 2 mg/dL leads to jaundice

Question 6

3 mechanisms of jaundice and cholestasis

Answer 6

1. isolated disorders of bilirubin metabolism
2. liver disease
3. bile duct obstruction

Question 7

what type of jaundice does the newborn typically present with?

Answer 7

impaired uptake

pre-hepatic dysfunction jaundice

Question 8

2 major causes post-hepatic dysfunction

Answer 8

pancreatic carcinoma

gallstones

Question 9

clinical s/s cholestasis

Answer 9

pruritus
jaundice
clay colored stools
dark urine
bleeding diathesis
xanthomas
osteoporosis

Question 10

liver test results for cholestasis

Answer 10

increased AP, GGT, and 5NT

hyperbilirubinemia greater than 1.2 mg/dL

hyperlipidemia

Question 11

how will the liver look like with intrahepatic cholestasis?

Answer 11

green like the gall bladder normally is

Question 12

common causes of cirrhosis

Answer 12

• alcoholic liver disease ** 60-70%
  viral hepatitis (10%)
  obesity (5-10%)
  cryptogenic (unknown)

Question 13

pathogenesis of cirrhosis

Answer 13

• hepatocyte necrosis
• progressive fibrosis
• regenerative hepatocyte nodules
• abnormal vascular connections
• disruption of hepatocyte function

Question 14

decompensated cirrhosis (4)

Answer 14

• portal hypertension
• hepatorenal syndrome
• liver failure
• hepatic encephalopathy

Question 15

s/s cirrhosis

Answer 15

ascites
skin spider angiomata
esophageal varices
splenomegaly 
hepatic encephalopathy
breast formationa nd feminization (liver is supposed to break down estrogen)

Question 16

lab test results for hepatic cirrhosis

Answer 16

decreased albumin

increased serum bilirubin, transaminases, GGT, and prothrombin time

Question 17

hepatic failure is found with loss of ___ of liver function

Answer 17

80%

Question 18

clinical signs of hepatic failure

Answer 18

encephalopathy
coagulopathy
jaundice
multiple organ failure (hypotension, pulmonary edema, DIC)

Question 19

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

Answer 19

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

Question 20

s/s and lab findings for hepatorenal syndrome

Answer 20

liver failure and renal failure
normal kidney
oliguria/anuria
increastied BUN and creatinine
low urinary Na concentration 
normal urinary sediment

poor prognosis

Question 21

potentially reversible neuropsychiatric abnormality in the setting of either acute or chronic liver failure

Answer 21

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

Question 22

clinical features of hepatic encephalopathy

Answer 22

• spatial perception distorted
• sleep disturbance
• personality changes
• asterixis
• abnormal EEG
• lethargy
• coma
• decerebrate posture

Question 23

only dsDNA hepatitis virus

Answer 23

hepB

Question 24

acute asymptomatic infection with recovery: serologic evidence only

Answer 24

hep A
hep B
C
D coinfection
E

Question 25

acute symptomatic hepatitis with recovery: anicteric or icteric

Answer 25

hep A
B
C
D coinfection
E

Question 26

chronic hepatitis: without or with progression to cirrhosis

Answer 26

Hep B few
C 85%
D superinfection most

Question 27

fulminant hepatitis: with massive to submassive hepatic necrosis

Answer 27

hep A rare
B rare
C rare
D co&super
E pregnant

Question 28

most common form of viral hepatitis

Answer 28

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

Question 29

most common cause of cirrhosis worldwide and hepatocellular carcinoma worldwide

Answer 29

hepB

transmission parenteral, sexual, and vertical

of 1/3 symptomatic infected, 10% will progress to chronic hepatitis

Question 30

hep D requires ______- to replicate

Answer 30

hepBsAg

therefore must be coinfection (at same time) or superinfection (B in past, now have D) (worse*)

transmission is parenteral

Question 31

most common chronic liver disease

Answer 31

hep C (85% infected go chronic)

major source of infection is injection drug use

also leading indication for liver transplantation

Question 32

chronic hep C progression to liver cancer determining factors

Answer 32

cirrhosis
age (have disease longer)
male sex
alcohol

Question 33

uses of liver biopsy in chronic hepatitis

Answer 33

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

Question 34

ballooning and cholestasis =

Answer 34

acute viral hepatiits

also see councilman bodies and lobular disarray

Question 35

piecemeal necrosis =

Answer 35

chronic viral hepatitis

Question 36

ground glass hepatocytes =

Answer 36

chronic hep B

chronic hep C shows lymphoid aggregate

Question 37

what amebic abscess may be seen in liver?

Answer 37

entamoeba histolytica

Question 38

which liver cyst should you NEVER stick a needle in?

Answer 38

hydatid cyst

cuased by echinococcus grnulosus

components of the cell wall can cause an anaphylactic shock rxn

Question 39

pipe stem fibrosis

Answer 39

schistoma japonicum