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Hepatobiliary and pancreatic disorders > Goljan disorders circulatory, alcohol related liver disorder > Flashcards

Goljan disorders circulatory, alcohol related liver disorder Flashcards

1
Q

define prehepatic obstruction to blood flow

A

obstruction of blood flow to liver (hepatic artery, portal vein)

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2
Q

What are mechanisms that cause prehepatic obstruction to blood flow?

A

hepatic artery thrombosis w/ infarction;

portal vein thrombosis

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3
Q

How does hepatic artery thrombosis w/ infarction lead to prehepatic obstruction to blood flow?

A

liver infarction uncommon bc of dual blood supply => hepatic artery and portal vein tributaries normally empty blood into sinusoids

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4
Q

What are the causes of hepatic artery thrombosis w/ infarction?

A

liver transplant rejection;

vasculitis due to PAN

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5
Q

What are the causes of portal vein thrombosis?

A

pylephlebitis;
polycythemia vera;
hepatocellular CA

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6
Q

How does pylephlebitis cause portal vein thrombosis?

A

most often due to acute appendicitis;

air in portal vein from bacterial gas

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7
Q

how does hepatocellular Ca cause portal vein thrombosis?

A

tumor invasion into portal vein

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8
Q

clinical findings of portal vein thrombosis

A

portal HTN, ascites, splenomegaly;

NO hepatomegaly

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9
Q

What are the causes intrahepatic obstruction to sinusoidal blood flow?

A

cirrhosis;
centrilobular hemorrhagic necrosis;
peliosis hepatis;
sickle cell disease

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10
Q

what are diseases that lead to intrahepatic obstruction to sinusoidal blood flow?

A

centrilobular hemorrhagic necrosis;

peliosis hepatis

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11
Q

What is centrilobular hemorrhagic necrosis often due to?

A

LHF and RHF

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12
Q

how does LHF lead to centrilobular hemorrhagic necrosis?

A

LHF decreases cardiac output causing hypoperfusion of liver

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13
Q

How does hypoperfusion of liver from LHF decreased CO cause damage?

A

ischemic necrosis of hepatocytes located around central vein

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14
Q

how does RHF lead to centrilobular hemorrhagic necrosis?

A

causes backup of systemic venous blood into ventral veins and sinusoids

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15
Q

What does centrilobular hemorrhagic necrosis look like grossly?

A

enlarged liver w/ mottled red appearance=> nutmeg liver

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16
Q

What causes nutmeg liver?

A

congestion of central veins and sinusoids;

necrosis of hepatocytes around central vein

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17
Q

clinical findings in centrilobular hemorrhagic necrosis?

A

painful hepatomegaly w/ or w/o jaundice;
increased transaminases caused by ischemic necrosis;
may progress to cardiac cirrhosis (fibrosis around central veins)

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18
Q

Tx of centrilobular hemorrhagic necrosis?

A

treat HF

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19
Q

Define peliosis hepatis

A

sinusoidal dilation due to blood

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20
Q

what causes peliosis hepatis

A

anabolic steroids;

Bartonella henselae causing bacillary angiomatosis (in AIDS)

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21
Q

risks in peliosis hepatis

A

potential for intraperitoneal hemorrhage

22
Q

Define post-hepatic obstruction to blood flow

A

obstruction of blood flow out of the liver => hepatic vein

23
Q

What are the causes that lead to posthepatic obstruction to blood flow?

A

hepatic vein thrombosis;

veno-occlusive disease

24
Q

What are diseases assoc w/ posthepatic obstruction to blood flow?

A

hepatic vein thrombosis;

veno-occlusive disease

25
Q

what are the causes of hepatic vein thrombosis?

A 
polycythemia vera (MC);
hypercoag state (OCP, protein C/S def, anti-phospholipid syndrome);
hepatocellular carcinoma (invades hepatic vein)
26
Q

Clinical findings in hepatic vein thrombosis

A

enlarged, painful liver;
portal HTN, ascites, splenomegaly;
high mortality

27
Q

lab findings in hepatic vein thrombosis

A

increased transaminases;

increased PT

28
Q

how is hepatic vein thrombosis diagnosed?

A

ultrasound w/ pulsed Doppler 1st-line test;

MRI

29
Q

Tx of hepatic vein thrombosis

A

anticoag Tx;
in situ thrombolysis;
stenting, various shunts

30
Q

Px of hepatic vein thrombosis

A

approx 75% mortality rate in 1st yr

31
Q

How does veno-occlusive disease cause posthepatic obstruction to blood flow?

A

complication of bone marrow transplantation => collagen develops around central veins

32
Q

define hematobilia

A

blood in bile in patients w/ trauma to liver

33
Q

How does alcohol cause liver disease?

A 
fatty change (MC);
alcoholic hepatitis
34
Q

Why does alcohol cause fatty liver change?

A

substrates of alcohol metabolism used to synthesize liver triglyceride

35
Q

clinical findings in fatty change of liver

A

tender hepatomegaly WITHOUT fever or neutrophilic leukocytosis

36
Q

Tx of fatty change of liver from alcohol

A

alcohol rehab

37
Q

pathogenesis of alcoholic hepatitis

A

genetic predisposition likely;
ACETALDEHYDE damage to hepatocytes;
stimulation of collagen synthesis around central vein (perivenular fibrosis)

38
Q

micro findings in alcoholic hepatitis

A

fatty change WITH neutrophil infiltration;
Mallory bodies;
perivenular fibrosis

39
Q

what are Mallory bodies?

A

damaged cytokeratin intermediate filaments in hepatocytes of alcoholic hepatitis

40
Q

clinical findings alcoholic hepatitis

A

painful hepatomegaly;
fever, neutrophilic leukocytosis, ascites, hepatic encephalopathy;
may progress to alcoholic cirrhosis

41
Q

lab findings of alcoholic hepatitis

A 
absolute neutrophilic leukocytosis;
AST > ALT;
increased ALP and GGT (GGT disproportionately increase to ALP);
thrombocytopenia in some;
hypoglycemia in some
42
Q

Tx of alcoholic hepatitis

A

mandatory to stop alcohol intake;

corticosteroids may be helpful

43
Q

what can cause angiosarcoma in the liver?

A

vinyl chloride;
arsenic;
thorium dioxide (radioactive contrast)

44
Q

what can cause cholangiocarcinoma of the liver?

A

thorium dioxide

45
Q

what can cause hepatocellular carcinoma of liver?

A

vinyl chloride, alfatoxin (aspergillus mold)

46
Q

what can cause liver cell adenoma of liver?

A

oral contraceptive pills

47
Q

what are drugs/chemicals that can cause acute hepatitis?

A

isoniazid (toxic metabolite);
halothane;
acetaminophen;
methyldopa

48
Q

what are drugs/chemicals that can cause cholestasis?

A 
OCPs (estrogen interferes w/ intrahepatic bile secretion);
anabolic steroids (same mechs as OCPs)
49
Q

what are drugs/chemicals that can cause fatty change of liver?

A

amiodarone (resembles alcoholic hepatitis, Mallory bodies, cirrhosis progression);
methotrexate

50
Q

What drugs/chemicals can cause fibrosis of liver?

A

methotrexate;
retinoic acid;
amiodarone

Hepatobiliary and pancreatic disorders (7 decks)

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