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Gastrointestinal System > EXAM #2: LIVER PATHOLOGY III > Flashcards

EXAM #2: LIVER PATHOLOGY III Flashcards

1
Q

Draw the liver acinus and label the zones. What zone of the liver (acinus) is usually affected by drug injury?

A

Zone 3

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2
Q

Why is the centrilobular region (center of the liver lobule, i.e. the central vein) or zone 3 the most affected by toxic drug effects?

A
  • Drug biotransformation occurs in the mitochondria of the liver acinus/lobule
  • Mitochondria require oxygen
  • Zone 3 has the lowest oxygen content as it is farthest from the portal triad carrying incomin-oxygenated blood
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3
Q

What are the two types of drugs that cause liver injury?

A

1) Intrinsic

2) Idiosyncratic

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4
Q

What is an intrinsic drug reaction?

A

This is a predictable drug reaction that occurs in response to sufficient quantity of a hepatotoxic agent e.g. Tylenol

Note that this type of reaction is dose-dependent and acute.

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5
Q

What is an idiosyncratic drug reaction?

A

This is an unpredictable drug reaction that is dependent on the genetic susceptibility of the host.

Note that this type of reaction is dose-independent and has a variable (though commonly subacute) onset.

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6
Q

What is the morphology of the liver injury seen with Tetracycline?

A

Microsteatosis

This is the abnormal retention of lipids within a cell. Micro simply refers to the fact that the lipid filled vesicles that accumulate do NOT distort the nucleus.

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7
Q

What is the morphology of the liver injury seen with Methothrexate?

A

Macrosteatosis

This is the abnormal retention of lipids within a cell. Macro simply refers to the fact that the lipid filled vesicles that accumulate DO distort the nucleus.

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8
Q

What is the morphology of the liver injury seen with Acetaminophen?

A

Necrosis

*Note that this is the leading cause of drug-induced acute liver failure

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9
Q

What is the morphology of the liver injury seen with Isoniazid?

A

Hepatitis

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10
Q

What is the morphology of the liver injury seen with Halothane?

A

Hepatitis

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11
Q

What is the morphology of the liver injury seen with Amiodarone?

A

Fibrosis

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12
Q

What is the morphology of the liver injury seen with Steroids?

A

Cholestasis

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13
Q

What is the morphology of the liver injury seen with Erythromycin?

A

Cholestasis

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14
Q

How much chronic alcohol consumption is required to induce alcoholic liver disease?

A

Males= more than 80g/day (six drinks)

Females= more than 40 g/day (three drinks)

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15
Q

What is the first pathologic change in the progression toward alcoholic liver disease with simple exposure?

A

Steatosis i.e. fat accumulation in hepatocytes

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16
Q

What is the first pathologic change in the progression toward alcoholic liver disease with severe exposure (binge drinking)?

A

Hepatitis–results from chemical injury to hepatocytes

*Note that the toxic effects of alcohol on the liver are specifically mediated by the toxic metabolite, acetaldehyde

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17
Q

Is fatty change or steatosis of the liver in alcoholic liver disease reversible?

A

Yes

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18
Q

What are Mallory Bodies?

A

Damaged intermediate filaments, or “alcoholic hyalin” acute alcoholic hepatitis

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19
Q

What are the histologic markers of chronic alcoholic liver disease?

A

Necrosis and fibrosis

*Note that this is long-term, chronic alcohol induced liver damage

20
Q

What are the morphologic markers of alcoholic cirrhosis?

A

Extensive fibrosis and regenerative nodules

21
Q

What cell mediates the inflammatory process seen in alcoholic hepatitis?

A

Neurtophils

22
Q

What stain is used to demonstrate fibrosis in alcoholic hepatitis?

A

Trichrome stain

23
Q

What are the clinical manifestations of Alcoholic Steatohepatitis?

A
  • Fever
  • Leukocytosis
  • Jaundice
  • AST/ALT elevation
24
Q

What ratio of AST: ALT is indicate of continued drinking?

A

2:1 or greater

25
Q

List the most common causes of death in chronic alcoholism.

A

1) Hepatic coma
2) Massive GI hemorrhage
3) Infection
4) Hepatorenal Syndrome

26
Q

What is the alternate name for Nonalcoholic Steatohepatitis? How can you tell this apart from alcohol-related liver disease?

A

Non-alcoholic fatty liver disease

  • ALT will be higher than AST
  • Patients commonly asymptomatic
27
Q

What causes Nonalcoholic Steatophepatitis?

A

1) Insulin resistance/ metabolic syndrome
2) Drug hepatotoxicity
3) Pregnancy

28
Q

What two drugs can induce Nonalcoholic Steatohepatits?

A

Tamoxifen

Nifedipine

29
Q

What are the symptoms of hepatic vein outflow obstruction?

A 
Ascites 
Hepatomegaly 
Abdominal pain 
AST/ALT elevation
Jaundice

*Note that this is what is seen in Budd-Chiari Syndrome

30
Q

What are the symptoms of impaired intrahepatic blood flow?

A

Ascites
Esophageal varices
Hepatomegaly
AST/ALT elevation

*Note that this is what is seen in cirrhosis

31
Q

What are the symptoms of impaired blood inflow to the liver?

A

Esophageal varices
Splenomegaly
Intestinal congestion

*Note that this is what is seen in hepatic artery compromise or portal vein obstruction.

32
Q

What are the common etiologies of liver infarct?

A

This is rare b/c of the livers dual blood supply, but when it does happen it is caused by:

1) Liver transplant
2) Chemoembolism
3) Polyarteritis nodosa
4) Surgery

33
Q

What causes ischemic hepatitis/ shock liver/ hypoxic hepatitis??

A
  • Left sided heart failure
  • Heart surgery
  • Shock
34
Q

What are the manifestations of ischemic hepatitis?

A
  • Centrilobular coagulative necrosis
  • ASt/ALT elevation
  • Jaundice
35
Q

What are the extrahepatic etiologies of Portal Vein Thrombosis?

A

1) Abdominal infection
2) Hypercoaguability
3) Surgery

36
Q

What are the intrahepatic etiologies of Portal Vein Thrombosis?

A

1) Cirrhosis
2) Malignancy e.g. HCC
3) Stasis
4) Pregnancy
5) Idiopathic

37
Q

What are the clinical manifestations of portal vein thrombosis?

A

1) Abdominal pain
2) Portal HTN
- Esophageal varices
- Splenomegaly
- Ascites
3) Bowel Infarction

38
Q

What are the etiologies of Hepatic Vein Obstruction?

A
  • Cardiac related
    1) Venous congestion
    2) Centrolobular hemorrhage
    3) Cardiac sclerosis
  • Budd-Chiari Sydrome
39
Q

What causes Hepatic Passive Congestion?

A
  • Right heart failure
  • Constrictive pericarditis
  • Congenital heart disease
40
Q

What is Budd-Chiari Syndrome?

A

Thrombosis of the hepatic vein or IVC–prevents the liver from draining

41
Q

What are the etiologies of Budd-Chiari Syndrome?

A

1) HCC
2) Abdominal cancer
3) Myeloproliferative disorder
4) PNH
5) Hypercoagulability
6) Pregnancy
7) Contraceptives

42
Q

What are the clinical features of acute Budd-Chiari Syndrome?

A
  • Abdominal pain
  • Hepatomegaly
  • Ascites
  • Jaundice
  • Liver failure
43
Q

What are the clinical features of chronic Budd-Chiari Syndrome?

A
  • Portal HTN
  • Cirrhosis
  • Obliterative Hepatocavopathy
44
Q

What is an Obliterative Hepatocavopathy?

A

IVC obstruction at its hepatic portion

*Note that this is endemic in Nepal and is suspected to have an infectious etiology

45
Q

What is Veno-Occlusive Disease of the liver?

A

Complication following bone marrow transplant or ingestion of plant alkaloids (Jamaican)
- Vasculitis causes sinusoid obstruction

Gastrointestinal System (42 decks)

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