GI - Pathology (Liver Part I: Cirrhosis & other conditions) Flashcards
Pg. 360-361 in First Aid 2014 Sections include: -Cirrhosis and portal hypertension -Serum markers of liver and pancreas pathology -Reye syndrome -Alcoholic liver disease -Non-alcoholic fatty liver disease -Hepatic encephalopathy
What are 8 signs/symptoms of cirrhosis that result from effects of portal hypertension?
(1) Esophageal varices => (2) Hematemesis => (3) Peptic ulcer disease, (4) Melena (from esophageal varices and/or peptic ulcer disease), (5) Splenomegaly, (6) Caput medusae/Ascites, (7) Portal hypertensive gastropathy (8) Anorectal ascites
What are 11 signs/symptoms of cirrhosis that result from effects of liver cell failure?
(1) Hepatic encephalopathy (2) Scleral icterus (3) Fetor hepaticus (breath smells musty) (4) Spider nevi (5) Gynecomastia (6) Jaundice (7) Testicular atrophy (8) Liver “flap” = asterixis (coarse hand tremor) (9) Bleeding tendency (decreased clotting factors, increased prothrombin time) (10) Anemia (11) Ankle edema
Of the 11 signs/symptoms of cirrhosis that result from effects of liver cell failure, which 3 are due to increased estrogen?
(1) Spider nevi (2) Gynecomastia (3) Testicular atrophy
What gross/histological features define cirrhosis?
Diffuse fibrosis and nodular regeneration destroys normal architecture of liver
What risk does cirrhosis increase?
Increased risk for hepatocellular carcinoma (HCC)
What are 4 etiologies of cirrhosis?
(1) Alcohol (60-70%) (2) Viral hepatitis (3) Biliary disease (4) Hemochromatosis
What is a vascular consequence of cirrhosis, and why? Give 2 examples of this.
Portosystemic shunts partially alleviate portal hypertension: (1) Esophageal varices (2) Caput medusae
Name 6 serum markers of liver and pancreas pathology.
(1) Alkaline phosphatase (ALP) (2) Aminotransferases (AST and ALT) (often called “liver enzymes”) (3) Amylase (4) Ceruloplasmin (5) gamma-glutamyl transpeptidase (GGT) (6) Lipase
What are 3 major diagnostic uses for alkaline phosphatase (ALP)?
(1) Obstructive hepatobiliary disease (2) HCC (3) Bone disease
What are 2 major diagnostic uses for Aminotransferases (AST and ALT) (often called “liver enzymes”)?
(1) Viral hepatitis (ALT > AST) (2) Alcoholic hepatitis (AST > ALT)
What are 2 major diagnostic uses for Amylase?
(1) Acute pancreatitis (2) Mumps
What is the major diagnostic use for Ceruloplasmin?
Decreased in Wilson disease
What is the major diagnostic use of gamma-glutamyl transpeptidase (GGT)? With what condition is it associated?
Increase in various liver and biliary diseases (just as ALP can), but NOT in bone disease; Associated with alcohol use
What is the major diagnostic use for Lipase?
Acute pancreatitis (most specific)
What is Reye syndrome, and in what patient population does it occur?
Rare, often fatal childhood hepatoencephalopathy
What are 6 clinical findings associated with Reye syndrome?
Findings: (1) mitrochondrial abnormalities, (2) fatty liver (microvesicular fatty change), (3) hypoglycemia, (4) vomiting, (5) hepatomegaly, (6) coma.
What preceding exposures are associated with Reye syndrome?
Associated with viral infection (especially VZV and influenza B) that has been treated with aspirin.
What is the mechanism of damage in Reye syndrome?
Mechanism: aspirin metabolites decreased Beta-oxidation by reversible inhibition of mitochondrial enzyme
What is the general rule for Aspirin use in children? What is the exception?
Avoid aspirin in children, except in those with Kawasaki disease
What are 3 types of alcoholic liver disease?
(1) Hepatic steatosis (2) Alcoholic hepatitis (3) Alcoholic cirrhosis
What kind of change does hepatic steatosis lead to, and what causes it?
Reversible change with moderate alcoholic intake
What is the key histologic finding in hepatic steatosis? How may it be reversed?
Macrovesicular fatty change (see hepatocytes filled with clear fat droplets) that may be reversible with alcohol cessation
What causes alcoholic hepatitis?
Requires sustained, long-term consumption
What are 2 major histologic findings in alcoholic hepatitis?
(1) Swollen and necrotic hepatocytes with neutrophilic infiltration. (2) Mallory bodies (intracytoplasmic eosinophilic inclusions) are present.
Of ALT and AST, which is greater in alcoholic hepatitis? What is their ratio?
AST > ALT (ratio usually > 1.5); Think: “make toAST with alcohol”
What is the final and irreversible form of alcoholic liver disease?
Alcoholic cirrhosis
What is the major histologic description of alcoholic cirrhosis?
Micronodular, irregularly shrunken liver with “hobnail” appearance. Sclerosis around central vein (zone III).
What vascular structure is sclerosed in liver cirrhosis, and in what zone of the liver is this?
Sclerosis around central vein (zone III).
What defines the manifestations of alcoholic cirrhosis?
Has manifestations of chronic liver disease (e.g., jaundice, hypoalbuminemia)
What is the pathophysiology and resultant histologic finding of non-alcoholic fatty liver disease? How does it relate to alcohol use?
Metabolic syndrome (insulin resistance) => fatty infiltration of hepatocytes => cellular “ballooning” and eventual necrosis. Independent of alcohol use.
What are 2 conditions that may result from non-alcoholic fatty disease?
May cause cirrhosis and HCC
Of ALT and AST, which is greater in non-alcoholic fatty liver disease?
ALT > AST; Think: “L = aLt & Lipids”
Briefly give the pathogenesis of hepatic encephalopathy.
Cirrhosis => portosystemic shunts => decreased NH3 metabolism => neuropsychiatric dysfunction
What is the spectrum of symptoms/signs defining hepatic encephalopathy?
Spectrum from disorientation/asterixis (mild) to difficult arousal or coma (severe)
What are 2 triggers of hepatic encephalopathy? Give at least 3 examples in which each occur.
Triggers: (1) Increased NH3 production (due to dietary protein, GI bleed, constipation, infection) (2) Decreased NH3 removal (due to renal failure, diuretics, post-TIPS)
What are the treatments for hepatic encephalopathy?
Treatment: Lactulose (increased NH4+ generation), Low-protein diet, and Rifaximin (kills intestinal bacteria)
