Exam 1: Gross and Histo Features of Hepatic Disorders Flashcards
Normal weight of liver
1400-1600g
Key anatomic features of the liver
Portal Triad (hepatic a., portal v., and bile duct
Hepatocellular parenchyma
Hepatic veins
Blood supply and blood flow
80%:
20%
80% Hepatic portal v. (from intestines)
20% Hepatic a. (from aorta)
Macrophages that permanently reside in the sinusoidal space
Von Kupffer cells
If there is a blood-borne toxin, which zone in the acinar model will be the first to die?
Zone 1
If there are non-toxic substances present that become hepatotoxic when metabolized by the liver, where will it be found?
Zone 3
If there are non-toxic substances present that become hepatotoxic when metabolized by the liver, where will it be found?
Zone 3
T or F: The liver has a tremendous amount of regenerative ability
T
What are the 3 morphologic paterns observed in an injured liver?
Coagulation necrosis (prototype of ischemic necrosis) Councilman bodies (toxic/immunologic etiology) Hydropic degeneration (cell swelling)
Types of necrosis
Focal (scattered or erratic cells)
Zonal (regional)
Submassive (entire lobules)
Massive (entire liver)
Types of necrosis observed in fulminant hepatitis
Submassive and massive
Earliest physiologic feature of hepatic damage
Hepatocyte swelling
Difference between Councilman bodies and Mallory bodies
Councilman: mummified hepatocytes
Mallory: cytoplasmic collections of denatured material
Difference between Councilman bodies and Mallory bodies
Councilman: mummified hepatocytes
Mallory: cytoplasmic collections of denatured material
Occurs in all but the most fulminant disease
Regeneration
Howe much of the hepatic capacity is lost to diagnose hepatic failure?
80-90%
Most common manifestation of hepatic failure
jaundice
How much of hemoglobin in the serum comes from senescent/dying red cells?
70%
How much of hemoglobin in the serum comes from hemoproteins?
30%
Heme metabolized by several enzymes, produces?
Bilirubin
jaundice is due to
The failure to metabolize bilirubin
Type of hyperbilirubinemia that is non-water soluble
UNconjugated
Type of hyperbilirubinemia that is water soluble
Follow-up question: What is attached to it?
Conjugated
Attached: glucose molecule
Type of hyperbilirubinemia that is water soluble
Follow-up question: What is attached to it?
Conjugated
Attached: glucose molecule
The three problem areas contributing to non H2O-soluble bilirubin
Hemeooxygenase, carrier protein, glucoronyl transferase
How many glucose attachments does it take to make bilirubin H2O-soluble?
1
2 Manners in which bile can be disposed
Bile to duodenum
Blood to kidney
Genetic deficiency of bilirubin UGT activity
Crigler-Najjar syndromes I and II
Possible reasons of Unconjugated Hyperbilirubinemia
Excess production of bilirubin
Reduced hepatic uptake
Impaired bilirubin conjugation
Possible reasons of Conjugated Hyperbilirubinemia
Decreased intrahepatic excretion of bilirubin
Extrahepatic biliary obstruction
Conjugated/unconjugated? Any lesion that tends to increase hemolysis
UNconjugated
Viral hepatitis produces what kind/s of hyperbilirubinemia?
Both UN and Conjugated
Normal limit of bilirubin
Jaundice will be grossly apparent when?
(1.2)(2) = >2-2.5mg/dL
Jaundice will be grossly apparent when?
(1.2)(2) = >2-2.5mg/dL
Where do most of our albumin come from?
Edi sa liver, kaya nga nandito tayo sa deck na ‘to eh!
T or F: We excessively bleed when our liver experiences coagulopathy
T
Activation of which factor causes the liver to have excessive intravascular coagulation?
Hageman factor
Liver failure leads to an in/decrease of ammonia?
Increase. The liver fails to rid our body of NH3
Condition producing odor of rotting fruit
Follow-up: This is caused by failure to metabolize which intestinal flora?
Fetor hepaticus
Follow-up: mercaptans
Condition producing odor of rotting fruit
Follow-up: This is caused by failure to metabolize which intestinal flora?
Fetor hepaticus
Follow-up: mercaptans
Why would men be “by-products of liver metabolism”? (Dimacali, 2013)
Because the liver metabolizes estrogen and without the liver functions, estrogen levels increase :)
Why would men be “by-products of liver metabolism”? (Dimacali, 2013)
Because the liver metabolizes estrogen and without the liver functions, estrogen levels increase :)
Increased estrogen in females can manifest as?
Palmar erythemas and spider angiomatas
True or False: Liver failure prevents _______ neurotransmitters from being detoxified causing interference with synaptic activity
Hahaha. False T or F question! False lang sagot diyan :)
Hepatic encephalopathy affects parts of the brain in what order?
From intelligence centers to more vegetative centers until death
Deepest manifestation of hepatic encephalopathy?
Coma
Distal limb with flapping tremors
Asterixis (due to false neurotransmitters; the longer the nerves, the more disturbed they can be)
Most common cause of hepatic insult
Alcoholic liver disease
Mildest form of hepatic lesion caused by alcohol
Fatty change
Is alcoholic hepatitis reversible?
Yes
Cirrhotic livers have an increased risk of developing what?
Hepatocellular CA
Cirrhotic livers have an increased risk of developing what?
Hepatocellular CA
Patho of Alcohol Liver Disease (MLE): Alcohol is a direct/indirect toxin?
Folow-up: It affects which structures?
Direct
Microtubules, Mitochondrial fxn, membrane fluidity
A primary metabolite of alcohol
Acetaldehyde
A primary metabolite of alcohol
Acetaldehyde
Histologic feature unique to Hep B
Ground glass swollen hepatocyte
Actual serum Hepatitic
Hep C
How many percent mortality/morbidity is Hep C? Hep B?
Hep C: 50%
Hep B: 10%
New grading system for Hepatitis
Knodell Score: 1) # or density of inflammatory cells, 2) distribution, 3) extent of hepatic cell death, 4) extent of cirrhosis and other changes
Onset of fulminant hepatitis
2-3 weeks after onset of symptoms
Reye’s Syndrome is aggravated by what medication?
Acetic salicylic acid. Replace meds with acetaminophen instead
Concave or convex? Fulminant hepatitis
Convex-Concave (kasi “shrunken” liver ay nag-dip lang sa normal level)
Drug-induced hepatitis may be indistinguishable from which etiology?
Viral hepatitis
Drugs causing microvesicular fatty exchange
Salicylates and tetracyclines
Drugs causing macrovesicular fatty exchange
Alcohol and methotrexate
Drugs causing macrovesicular fatty exchange
Alcohol and methotrexate
Nodular liver on gross can be classified as
Micro 0.3 ___
cm
2 processes happening simultaneously in a cirrhotic liver
fibrosis and regeneration
2 processes happening simultaneously in a cirrhotic liver
fibrosis and regeneration
Space between the endothelial cell of sinusoid and the hepatocyte
Space of Disse
guarding the Space of Disse
ITO Cell
Who responds to toxins and cytokines from Kupffer cells by producing collagen?
ITO Cells pa rin
Reticular framework is important because?
This is used by a guide for the hepatocytes. If this is damaged, hepatocytes will have a misguided attempt at fixing themselves
Mass of hepatocytes not arranged in the architecturally correct manner
Pseudolobule
Mass of hepatocytes not arranged in the architecturally correct manner
Pseudolobule
Inflammatory reaction due to accumulation of copper in the liver
Wilson’s Disease
In the Philippines, what is the most common etiology of hepatitis?
Viral. 10% lang ang alcohol
Treatment for Neonatal hepatitis
Supportive
Treatment for extrahepatic biliary atresia
Surgery
In Biliary Atresia, which part is atretic? Proximal or distal?
Distal. That’s why bile ends up accumulating in the liver
The Criggler-Najjar Syndrom type not compatible with life
Type 1. ABSENT AGT activity as compared to type 2 with REDUCED AGT activity
Rotor Syndrome (Philippine study). Three names you should remember:
Rotor, Florentin, Manahan
Histo presentation of Rotor Syndrome
Pumpkin-like appearance from time to time; bouts of occasional jaundice
Clinical presentation of Rotor
Acholic/Cement-like stools (kasi walang nakakalabas na conjugated bile)
Clinical presentation of Rotor
Acholic/Cement-like stools (kasi walang nakakalabas na conjugated bile)
Ratio of bile duct to portal area in bile duct proliferation
3:1
What do you do when a child presents with biliary atresia and neonatal hepa?
Treat atresia first. Hepa can be managed with meds easily
What do you do when a child presents with biliary atresia and neonatal hepa?
Treat atresia first. Hepa can be managed with meds easily
What parasite causes ascending cholangitis?
Ascaris
Triad of ascending cholangitis consists of
jaundice, RUQ pain, high fever
Synonymous to Biliary Hamartoma
Von Meyenberg Complex (Hamartoma of bile ducts; too many cells in one place even if there’s nothing wrong with them; occupies space and mistaken for a tumor)
Seconary biliary cirrhosis may be due to
malignancies/obstructions of the biliary tree or pancreatic head
Parasite responsible for portal v. obstruction and thrombosis (SOL)
Schistosoma
A drug-related lesion caused by external estrogen ingestion
Peliosishepatis
Syndrome that comes from Hepatic Vein Thrombosis
Buddi-Chiari; Nutmeg Liver (central pale and peripheral red)
Syndrome that comes from Hepatic Vein Thrombosis
Buddi-Chiari; Nutmeg Liver (central pale and peripheral red)
Most common malignancy in the liver
Mets
A low-grade malignancy pediatric tumore
Hemangiothelioma
Arises from the biliary tree, bile duct; seen in people who eat raw food
Cholangiocarcinoma (higher incidence of multifocality)
Parasite responsible for CholangioCA
Clonorchissinesis
Most common PRIMARY MALIGNANT tumor of the liver
Hepatocellular CA
Most common primary tumor
Hemangioma
Most famous marker of hepatocellular CA?
Alpha feto protein
Most famous marker of hepatocellular CA?
Alpha feto protein
Infective etiology for a single large abcess
Amoeba
Pyogenic small, multiple and diff etiologies abcess
From blood stream
Treatment for abcess
Surgical drainage or antibiotics
