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pathology/histology > Hepatic And Biliary System > Flashcards

Hepatic And Biliary System Flashcards

1
Q

80 percent of blood supply to the liver

A

portal vein

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2
Q

20 percent of blood supply to the liver

A

hepatic artery

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3
Q

hepatic artery

A

brings oxygen rich blood

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4
Q

portal vein

A

brings oxygen poor blood from GI containing nutrients and toxins, and blood cells an breakdown products from the spleen

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5
Q

sinusoids

A

transport connection of the liver from portal vein and hepatic artery to thin-walled central veins

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6
Q

blood flow of liver

A

portal vein + hepatic artery > sinusoids > central veins > hepatic veins > inferior vena cava

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7
Q

hepatocytes

A

polygonal shape; large centrally located nucleus, often binucleate cells are present, glycogen granules and lipids present

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8
Q

bile canaliculus

A

channel between two adjacent hepatocytes

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9
Q

lobular model

A

plates of hepatocytes and sinusoids are arranged in a radial pattern around a central vein

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10
Q

hepatocyte integrity - serum measurement

A

Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT)

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11
Q

biliary excretory function - serum measurements

A

bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (GGT)

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12
Q

hepatocyte synthetic function - serum measurements

A

serum albumin and coagulation factors

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13
Q

Bile functions

A

emulsification of dietary fat and elimination of bilirubin

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14
Q

liver functions

A

process nutrients, storage, removal of toxins, syntesis of bile

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15
Q

jaundice

A

serum levels of bilirubin above 2 mg/dL - yellowing of skin and sclera

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16
Q

cholestasis

A

systemic retention of not only bilirubin but also other solutes eliminated in bile (due to impaired bile flow)

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17
Q

bilirubin

A

end product of heme degradation

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18
Q

pathogenesis of jaundice

A

excess bilirubin production, reduced hepatic uptake, impaired conjugation, decreased hepatocellular excretion, or impaired secretion

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19
Q

gilbert’s syndrome

A

increased unconjugated bilirubin (causes jaundice)

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20
Q

uridine diphosphate gluconosyltransferase

UGT

A

help conjugate bilirubin with glucuronic acid at sinusoidal membrane of liver (which is needed to excrete bilirubin)

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21
Q

Dubin-Johnson syndrome

A

increased conjugated bilirubin due to deficiency of bilirubin canalicular transport protein

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22
Q

cholestasis

A

obstruction of bile flow

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23
Q

bilirubin metabolism

A

uptake from circulation > intracellular storage > conjugation with glucuronic acid > biliary excretion

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24
Q

kernicterus

A

brain damage caused by excessive jaundice - high levels of unconjugated bilirubin accumulates in basal ganglia in new born can cause cerebral palsy

25
Q

phototherapy/bilirubin

A

converts bilirubin into water soluble isomers

26
Q

liver failure

A

loss of 80% of hepatic functional capacity

27
Q

acute liver failure

A

sudden and massive hepatic destruction

EX: acetaminophen overdose

28
Q

chronic liver failure

A

12th most common cause of mortality, progressive liver injury for years

29
Q

cirrhosis

A

end-stage process - marked by diffuse transformation of the entire liver into regenerating parenchymal nodules surrounded by dense bands of scar and variable degrees of vascular shunting

30
Q

space of Disse

A

between endothelial cells of sinusoids and hepatocytes….

31
Q

stellate cells

A

activated in liver fibrosis to produce a dense layer of matrix material that is deposited in the space of Disse

32
Q

Kuppfer cells

A

activated in liver fibrosis and produce cytokines that contribute to fibrosis and hepatocyte dysfunction and death

33
Q

portal hypertension

A

increased resistance to portal blood flow. clinical consequences (1) ascites (2) portosystemic venous shunts (3) congestive splenomegaly (4) hepatic encephalopathy

34
Q

ascites

A

accumulation of excess fluid in the peritoneal cavity

35
Q

portosystemic shunts

A

reversed flow from portal to systemic circulation by dilation of collateral vessels and development of venous bypass due to rise in portal system pressure.

36
Q

hepatic encephalopathy

A

cerebral edema and impaired neuronal function due to elevated ammonia levels in blood and the central nervous system

37
Q

caput medusa

A

abdominal wall collaterals appear as dilated subcutaneous veins extending from the umbilicus toward the rib margins (outcome of portosystemic shunts of portal hypertension)

38
Q

hemorrhoids

A

veins around and within the rectum (outcome of portosystemic shunts of portal hypertension)

39
Q

esophageal varices

A

can cause massive hematemesis and death (outcome of portosystemic shunts of portal hypertension)

40
Q

cellular level of cirrhosis

A

myofibroblasts (activated stellate cells), dense extracellular matrix, loss of fenestration, loss of microvilli, activation of kuptfer cells

41
Q

3 forms of alcoholic liver injury

A
  1. hepatocellular steatosis (fatty change) 2. alcoholic hepatitis 3. steatofibrosis (including cirrhosis)
42
Q

reversible alcoholic liver injury

A

steatosis and hepatitis

43
Q

irreversible alcoholic liver injury

A

cirrhosis

44
Q

hepatic steatosis

A

“fatty liver” accumulation of lipid droplets which distend the hepatocyte and push the nucleus aside. Liver becomes large, soft, yellow and greasy (reversible with abstention from further alcohol)

45
Q

pathogenesis of hepatic steatosis

A

changes in lipid metabolism and cell injury by reactive oxygen species

46
Q

morphology of hepatic steatosis

A

fat droplets most prominent where is begins (around the Central Vein) and extends outwards

47
Q

Alcoholic hepatitis morphology

A

hepatocyte swelling and necrosis, mallory-denk bodies, and neutrophilic reactions

48
Q

mallory-denk bodies

A

clumped, amorphous, eosinophilic material in ballooned hepatocytes - made up of tangled intermediate filaments such as keratin 8 and 18 in complex with ubiquitin

49
Q

alcoholic steatofibrosis

A

chicken wire fence pattern of fibrosis

50
Q

micronodular (Laennec) cirrhosis

A

first described for end-stage alcoholic liver disease,

diffuse nodules on surface, green tint, and microscopically fatty accumulation is “burned out”

51
Q

greenish tint of micronodular cirrhosis

A

cholestasis

52
Q

Hepatits A transmission

A

contaminated water and food

53
Q

HAV virus category

A

non-enveloped, positive strand RNA picornavirus

54
Q

Hep A immunology

A

IgM appear with onset, followed by IgG anti HAV, creating lifelong immunity

55
Q

HBV virus category

A

hepadnaveridae DNA virus

56
Q

Hepatitis B transmission

A

unprotected sex/childbirth transmission

57
Q

Hep B immunology

A

vaccination induces effective immunity with protective anti HBs antibody response

58
Q

Hep B outcomes

A

(1) acute hepatitis followed by recovery and clearance, (2) acute hepatic failure, (3) non-progressive chronic hepatitis, (4) chronic ending in cirrhosis, (5) carrier state, (6) hepatocellular carcinoma

pathology/histology (14 decks)

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