Goljan disorders circulatory, alcohol related liver disorder Flashcards
define prehepatic obstruction to blood flow
obstruction of blood flow to liver (hepatic artery, portal vein)
What are mechanisms that cause prehepatic obstruction to blood flow?
hepatic artery thrombosis w/ infarction;
portal vein thrombosis
How does hepatic artery thrombosis w/ infarction lead to prehepatic obstruction to blood flow?
liver infarction uncommon bc of dual blood supply => hepatic artery and portal vein tributaries normally empty blood into sinusoids
What are the causes of hepatic artery thrombosis w/ infarction?
liver transplant rejection;
vasculitis due to PAN
What are the causes of portal vein thrombosis?
pylephlebitis;
polycythemia vera;
hepatocellular CA
How does pylephlebitis cause portal vein thrombosis?
most often due to acute appendicitis;
air in portal vein from bacterial gas
how does hepatocellular Ca cause portal vein thrombosis?
tumor invasion into portal vein
clinical findings of portal vein thrombosis
portal HTN, ascites, splenomegaly;
NO hepatomegaly
What are the causes intrahepatic obstruction to sinusoidal blood flow?
cirrhosis;
centrilobular hemorrhagic necrosis;
peliosis hepatis;
sickle cell disease
what are diseases that lead to intrahepatic obstruction to sinusoidal blood flow?
centrilobular hemorrhagic necrosis;
peliosis hepatis
What is centrilobular hemorrhagic necrosis often due to?
LHF and RHF
how does LHF lead to centrilobular hemorrhagic necrosis?
LHF decreases cardiac output causing hypoperfusion of liver
How does hypoperfusion of liver from LHF decreased CO cause damage?
ischemic necrosis of hepatocytes located around central vein
how does RHF lead to centrilobular hemorrhagic necrosis?
causes backup of systemic venous blood into ventral veins and sinusoids
What does centrilobular hemorrhagic necrosis look like grossly?
enlarged liver w/ mottled red appearance=> nutmeg liver
What causes nutmeg liver?
congestion of central veins and sinusoids;
necrosis of hepatocytes around central vein
clinical findings in centrilobular hemorrhagic necrosis?
painful hepatomegaly w/ or w/o jaundice;
increased transaminases caused by ischemic necrosis;
may progress to cardiac cirrhosis (fibrosis around central veins)
Tx of centrilobular hemorrhagic necrosis?
treat HF
Define peliosis hepatis
sinusoidal dilation due to blood
what causes peliosis hepatis
anabolic steroids;
Bartonella henselae causing bacillary angiomatosis (in AIDS)
risks in peliosis hepatis
potential for intraperitoneal hemorrhage
Define post-hepatic obstruction to blood flow
obstruction of blood flow out of the liver => hepatic vein
What are the causes that lead to posthepatic obstruction to blood flow?
hepatic vein thrombosis;
veno-occlusive disease
What are diseases assoc w/ posthepatic obstruction to blood flow?
hepatic vein thrombosis;
veno-occlusive disease
what are the causes of hepatic vein thrombosis?
polycythemia vera (MC); hypercoag state (OCP, protein C/S def, anti-phospholipid syndrome); hepatocellular carcinoma (invades hepatic vein)
Clinical findings in hepatic vein thrombosis
enlarged, painful liver;
portal HTN, ascites, splenomegaly;
high mortality
lab findings in hepatic vein thrombosis
increased transaminases;
increased PT
how is hepatic vein thrombosis diagnosed?
ultrasound w/ pulsed Doppler 1st-line test;
MRI
Tx of hepatic vein thrombosis
anticoag Tx;
in situ thrombolysis;
stenting, various shunts
Px of hepatic vein thrombosis
approx 75% mortality rate in 1st yr
How does veno-occlusive disease cause posthepatic obstruction to blood flow?
complication of bone marrow transplantation => collagen develops around central veins
define hematobilia
blood in bile in patients w/ trauma to liver
How does alcohol cause liver disease?
fatty change (MC); alcoholic hepatitis
Why does alcohol cause fatty liver change?
substrates of alcohol metabolism used to synthesize liver triglyceride
clinical findings in fatty change of liver
tender hepatomegaly WITHOUT fever or neutrophilic leukocytosis
Tx of fatty change of liver from alcohol
alcohol rehab
pathogenesis of alcoholic hepatitis
genetic predisposition likely;
ACETALDEHYDE damage to hepatocytes;
stimulation of collagen synthesis around central vein (perivenular fibrosis)
micro findings in alcoholic hepatitis
fatty change WITH neutrophil infiltration;
Mallory bodies;
perivenular fibrosis
what are Mallory bodies?
damaged cytokeratin intermediate filaments in hepatocytes of alcoholic hepatitis
clinical findings alcoholic hepatitis
painful hepatomegaly;
fever, neutrophilic leukocytosis, ascites, hepatic encephalopathy;
may progress to alcoholic cirrhosis
lab findings of alcoholic hepatitis
absolute neutrophilic leukocytosis; AST > ALT; increased ALP and GGT (GGT disproportionately increase to ALP); thrombocytopenia in some; hypoglycemia in some
Tx of alcoholic hepatitis
mandatory to stop alcohol intake;
corticosteroids may be helpful
what can cause angiosarcoma in the liver?
vinyl chloride;
arsenic;
thorium dioxide (radioactive contrast)
what can cause cholangiocarcinoma of the liver?
thorium dioxide
what can cause hepatocellular carcinoma of liver?
vinyl chloride, alfatoxin (aspergillus mold)
what can cause liver cell adenoma of liver?
oral contraceptive pills
what are drugs/chemicals that can cause acute hepatitis?
isoniazid (toxic metabolite);
halothane;
acetaminophen;
methyldopa
what are drugs/chemicals that can cause cholestasis?
OCPs (estrogen interferes w/ intrahepatic bile secretion); anabolic steroids (same mechs as OCPs)
what are drugs/chemicals that can cause fatty change of liver?
amiodarone (resembles alcoholic hepatitis, Mallory bodies, cirrhosis progression);
methotrexate
What drugs/chemicals can cause fibrosis of liver?
methotrexate;
retinoic acid;
amiodarone
