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Gastrointestinal Pathophysiology > General Concepts in Hepatobiliary Disease > Flashcards

General Concepts in Hepatobiliary Disease Flashcards

1
Q

what does the lobular model divide the liver lobes into?

A

centrilobular
midzonal
periportal

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2
Q

what makes up bile?

A

bile salts
bilirubin
cholesterol
protein
fatty acids
phospholipids

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3
Q

what can cause hyperbilirubinemia?

A

pre-hepatic
hepatic cholestasis
post-hepatic cholestasis

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4
Q

what are the consequences of cholestasis?

A

failure to excrete cholesterol into bile
fat malabsorption
retain cytotoxic substances
increased toxicity of drugs normally excreted in bile

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5
Q

will bile acids increase or decrease with liver disease?

A

increase

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6
Q

when does hypoglycemia occur with liver disease?

A

severe liver disease: acute liver failure
congenital portosystemic shunt dogs

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7
Q

why does BUN decrease and ammonia increase with severe liver disease or a congenital portosystemic shunt?

A

loss of urea cycle function

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8
Q

when does hepatic encephalopathy occur?

A

portosystemic shunts
acute liver failure
end stage (fibrotic) liver

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9
Q

where is albumin made?

A

only liver

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10
Q

when might vitamin K absorption be impaired?

A

cholestasis

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11
Q

what can cause prehepatic portal hypertension?

A

portal vein thrombosis

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12
Q

what leads to multiple acquired portosystemic shunts?

A

persistent portal hypertension: opening of embryonic vessels
collateral circulation direct into systemic circulation

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13
Q

what is the mechanism of ascites due to portal hypertension?

A

increased interstitial fluid
overwhelms lymphatics

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14
Q

what is fine needle aspirate more useful for?

A

diffuse disease: hepatocyte vacuolization or neoplasia (lymphoma)

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15
Q

what is the least invasive type of biopsy?

A

ultrasound guided needle biopsy

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16
Q

what are the pros of laparotomy?

A

no special equipment
can visualize most regions of liver
can remove lobectomy for larger masses or abscesses

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17
Q

what can cause glycogen deposition?

A

steroids: cortisol

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18
Q

in whom is lipid accumulation most common?

A

cats
ruminants
ponies
ferrets
diabetic dogs, toy puppies

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19
Q

what stains lipid accumulation?

A

oil red O

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20
Q

what type of inflammation/cellular infiltrates do most bacteria cause?

A

neutrophils

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21
Q

what is the most common zonal lesion?

A

centrilobular necrosis

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22
Q

what is hepatitis?

A

inflammation of liver: hepatocytes

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23
Q

what is cholangitis?

A

inflammation of bile ductules

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24
Q

what are the sequelae of injury?

A

regeneration
bile duct hyperplasia
fibrosis
end stage liver/cirrhosis

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25
Q

how much of the hepatic blood flow is from the arterial circulation?

A

30%
hepatic artery

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26
Q

what is the reserve and regenerative capacity like of the liver?

A

tremendous: can remove 75% in healthy animal

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27
Q

what are the functions of the periportal zone?

A

gluconeogenesis
oxidation of fatty acids
ureagenesis

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28
Q

what are the functions of the centrilobular zone?

A

drug metabolizing enzymes
glycolysis
liponeogenesis

29
Q

what cells are in the lobules?

A

hepatocytes, sinusoidal endothelium
kupffer cells
stellate (ito) cells

30
Q

what is the enterohepatic circulation?

A

bile acids actively absorbed in ileum
delivered to portal circulation
actively taken up by hepatocytes from sinusoidal surface
re-secreted into canaliculi

31
Q

what causes hepatic cholestasis?

A

loss of hepatic mass
obstruction of canaliculi
sepsis: interference with transporters

32
Q

why is there an increase in bile acids with liver disease?

A

shunting
failure of removal from portal circulation

33
Q

why might you see hypoglycemia with severe liver disease?

A

decreased insulin clearance
decreased hepatic gluconeogenesis

34
Q

if there is hepatic atrophy or cirrhosis, should cholesterol go up or down?

A

down: loss of ability to make lipoproteins

35
Q

what can you treat hepatic encephalopathy with?

A

low protein diet
antibiotics to change bacterial flora
lactulose: changes flora and pH

36
Q

which globulins are not made in the liver?

A

immunoglobulins

37
Q

what with clotting is a poor prognostic indicator with liver disease?

A

elevated PT/PTT

38
Q

what can cause intrahepatic portal hypertension?

A

end-stage liver
granulomatous inflammation
arteriovenous shunts

39
Q

what can cause posthepatic portal hypertension?

A

occlusion at hepatic veins, vena cava, right heart
congestive heart failure: especially right
constrictive pericarditis

40
Q

in whom is ascites due to portal hypertension common?

A

dogs and cats
rare in horses and cattle

41
Q

what causes primary photosensitization?

A

ingest preformed photodynamic agents

42
Q

which biopsy has the highest risk of being non-diagnostic?

A

ultrasound guided needle biopsy

43
Q

which biopsy method is associated with higher patient mortality?

A

laparotomy

44
Q

what makes taking a biopsy contraindicated?

A

coagulation disorder
hepatic abscess or vascular tumor

45
Q

what is vacuolation due to glycogen like?

A

indistinct, hazy vacuolation

46
Q

what causes hydropic degeneration?

A

reverible cell injury: decreased ATP, influx of water, cellular swelling

47
Q

what is lipofuscin?

A

wear and tear: fine, tan granules in hepatocytes

48
Q

is hemosiderin normal in hepatocytes?

A

small amounts normal

49
Q

what can be used to stain for copper?

A

rhodanine

50
Q

what are some connective tissue stains?

A

trichrome
reticulin silver
sirius red

51
Q

what type of cellular infiltrates are seen with Salmonella?

A

lymphocytes
macrophages

52
Q

what is choledochitis?

A

inflammation of common bile duct

53
Q

what percentage of the body weight in dogs/cats is made up of the liver?

A

3-4%

54
Q

how much of the hepatic oxygen is provided by the hepatic artery and how much by the portal circulation?

A

50% by each

55
Q

what do stellate/ito cells do?

A

fat soluble vitamin storage
transform into myofibroblasts to contribute to fibrosis

56
Q

what cells are at the junction?

A

oval cells: bipotential stem cells

57
Q

what is a pre-hepatic cause of hyperbilirubinemia?

A

increased red cell breakdown

58
Q

why is hypoglycemia seen with congenital portosystemic shunts?

A

atrophied liver with poor glycogen stores

59
Q

when might globulins be low?

A

severe loss of functional mass

60
Q

what are some causes of portal vein thrombosis?

A

local inflammation
hypercoagulable state
secondary to tumor emboli

61
Q

what is seen in an end stage liver that leads to intrahepatic portal hypertension?

A

fibrosis
nodular regeneration
capillarization of sinusoids

62
Q

what contributes to gastric ulceration?

A

portal hypertension: relative ischemia
bile acids cytotoxic
increased gastric levels?

63
Q

what is seen with hepatocutaneous syndrome?

A

erosions and ulceration of muzzle, pressure points, mucocutaneous junctions

64
Q

what accumulates in skin in photosensitization?

A

photodynamic substance

65
Q

what is inherited porphyria?

A

defects in hemoglobin synthesis

66
Q

what are some rare complications of a liver biopsy?

A

infections
perforation of gallbladder
pneumothorax
vasovagal response

67
Q

is it expected to see bile in a biopsy?

A

no

68
Q

what is interface necrosis/apoptosis usually seen with in dogs?

A

idiopathic hepatitis

Gastrointestinal Pathophysiology (18 decks)

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