34/36: Liver Pathology II - Carnevale Flashcards
presentation of primary biliary cirrhosis
pts present with fatigue and itching and progresses over 10-15 yrs presenting with progressive jaundice
pruritus jaundice steatorrhea osteomalacia/osteoporosis xanthomas portal hypertension hepatic failure
lab results primary biliary cirrhosis diagnosis
increased AMA, anti M2, IgM, AP5’NT/GGT, cholesterol
risk factors for primary sclerosing cholangitis
fibrous obliterative cholangitis
M>F
less than 50 yo
ulcerative colitis
s/s primary sclerosing cholangitis
jaundice pruritus WL abdominal pain cholangitis liver failure
lab results that diagnose primary sclerosing cholangitis
increase all of the following: AP GGt 5NT ALT/AST ANA, anti SMAb pANCA globulins
ERCP (endoscopic retrograde cholangiography shows beaded sclerosis)
complications of primary sclerosing cholangitis
chronic cholestasis cholangitis secondary biliary cirrhosis liver failure cholangiocarcinoma
condition in which the patients own immune system attacks the liver causing inflammation and liver cell death
autoimmune hepatitis
- a chronic and progressive condition but may present acutely and be confused
autoantibodies: ANA, SMA, anti-LKM1
no viral markers, no AMA
increased globulines/IgG
autoimmune hepatitis
associated with other autoimmune disease as well
increase association with HLA DR4
which zone is affected by hepatic injury first?
zone 3 - centrilobular regions usually affected first because less oxygen here
phase I biotransformation is associated with… phase II is associated with
P450
glutathione S transferase
glucuronyl transferase
drug-induced liver disease morphology
tetracycline methotextrate acetaminophen isoniazid halothane amiodarone steroids erythromycin
microsteatosis macrosteatosis necrosis hepatitis hepatitis fibrosis clholestasis cholestasis
alcoholic liver disease develops in man who consumes… and woman who consumes…
greater than 80 g/day (6 pack)
greater than 40 g/day
liver
fatty change
perivenular fibrosis
steatosis
liver liver cell necrosis inflammation mallory bodies fatty change
hepatitis
liver
fibrosis
hyperplastic nodules
cirrhosis
foal lytic necrosis
mallory bodies
megamitochondria
indicate…
alcoholic hepatitis
longer abuse will see central hyaline sclerosis or chicken wire fibrosis or bridging fibrosis
clinical s/s alcoholic steatohepatitis
fever leukocytosis jaundice increased AST and ALT less than 500 IU/L increased AP
AST/ALT ratio greater than 2
in the end stage alcoholic the proximate cases of death are…
hepatic coma
massive GI hemorrhage
infection
hepatorenal syndrome following a bout of alcoholic hepatitis
nonalcoholic steatohepatitis NASH causes (3)
insulin related/metabolic syndrome
drug hepatoxicity
pregnancy
inherited disorder that increases the amount of iron that the body absorbs from the gut
hereditary hemochromatosis
most cases are caused by mutations in the HFE gene
lab results hereditary hemochromatosis
increased serum Fe greater than 300 mg/dL transferrin saturation greater than 2X serum ferritin 2X hepatic Fe index greater than 2
if transferrin saturation and ferritin concentrations are high…
genetic testing for hemochromatosis is warranted
pt who are either homozygous for C282Y or heterozygous for C282y and H63D have hereditary hermochromatosis
complications of hemochromatosis
hypopituitarism skin pigmentation cardiac failure hepatocellular carcinoma cirrhosis diabetes arthropathy testicular atrophy
hereditary disease that causes the body to retain copper
wilson’s disease
pts have decreased ceruloplasmin and excessive deposition of copper
w/o tx can cause severe brain damage, liver failure and death
kaiser-fleischer rings =
wilson disease
also see
decreased serum ceruloplasmin less tahn 20 mg/dl
and increased hepatic copper above 250 and increased urinary copper above 100
describe alpha antitrypsin defiicency
autosomal recessive
primary liver metabolic diasea
primary genetic liver diseas in children
2nd cause of liver transplantation in children
alpha-antitrypsin deficiency diagnosis
low serum alphaAT
abnormal electrophoretic alpha AT
liver biopsy
risks of liver cell adenomas
may rupture in pregnancy and may harbor hepatocellular carcinoma
risk factors hepatocellular carcinoma
cirrhosis alcoholism HBV, HCV hereditary hemochromatosis alphaAT deficiency
s/s hepatocellular carcinoma
painful hepatomegaly abdominal mass weight loss portal/hepatic vein thrombosis hemorrhagic ascites heaptic failure massive bleeding
AFP above what is diagnositc of hepatocellular carcinoma>
1000
malignant primary tumor of the bile duct epithelium
cholangiocarcinoma
risk factors for cholangiocarcinoma
primary sclerosing cholangitis
thorotrast
liver flukes
*** most common malignant tumor of the liver
metastatic tumors
common primary sites are GI tract, breast, lung, pancreas, and melanoma
three types of gallstones
cholesterol stones (biliary hypersecretion of cholesterol/supersaturation o f bile with cholesterol) pigmented stones ( bilirubin calcium salts) mixed
four contributing factors for cholelithiasis
supersaturation
gallbladder hypmotility
crystal nucleation
accretion within the gallbladder mucous layer
usual microscopic appearance of chronic cholecystitis
collagen in wall (scarring)
lymphocytes
plasma cells
macrophages
acute epigastric pain with radiation to the back
acute pancreatitis
laboratory findings of acute pancreatitis
elevation of serum amylase during first 24 hrs
rising serum lipas levels w/i 72-96 hrs
hypocalcemia may result from precipitation of calcium soaps in fat ecrosis – poor prognosis
- clinical triad of chronic pancreatitis
diabetes
steatorrhea
calcifications
along with permanent impairement of function and irreversible morphologic changes
most commonly caused by alcohol ingestion
where do most carcinomas of pancreas arise?
head
all arise from ductal epithelium
