Introduction to Liver Pathology Flashcards
what are the three mechanisms by which jaundice occurs?
Red blood cell destruction
Hepatocellular disease
Obstruction of the intrahepatic or extrahepatic bile ducts
Normal direct bilirubin levels
0.0-0.3 mg/dL
what do high levels of direct bilirubin indicate?
High levels implicate jaundice and hemolytic anemia
Normal Total bilirubin levels
0.3-1.9 mg/dL
what do high levels of total bilirubin indicate?
High levels implicate liver disease, gallstones, hepatitis
ALT
Alanine aminotransferase
what is ALT?
Previously referred to as serum glutamic pyruvic transaminase (SGPT). ALT is normally present in large concentrations in the liver.
ALT normal level
Normal level 10-40 IU/L
what do high levels of ALT indicate
High levels implicate hepatitis, cirrhosis, liver necrosis
AST normal level
Normal level 10-34 IU/L
what do high levels of AST indicate?
High levels implicate heart attack, muscle trauma, hepatitis, cirrhosis
what is AST?
Previously referred to as serum glutamic oxaloacetic transaminase (SGOT). AST is present in brain, kidney, muscle, heart and liver.
AST
Aspartate aminotransferase
ALP normal levels
Normal levels 44-147 IU/L
high levels of ALP
implicate leukemia, lymphoma, hepatitis
low levels of ALP
protein deficiency, malnutrition
ALP
Alkaline phosphatase
total protein normal level
Normal level 6.0-8.3 g/dL
High levels of total protein
implicate pregnancy, chronic inflammation, HIV
Low levels of total protein
hemorrhage, extensive burns, liver disease
what are developmental anomalies of the liver?
Agenesis
Anomalies of position
Accessory fissures
Vascular anomalies
agenesis of the liver is ______with life
Incompatible
where can agenesis of the liver occur?
the right, left, or caudate lobes.
what occurs when there is agenesis of the liver
Hypertrophy of other lobes
what two conditions cause the liver to be found in other locations
situs inversus, in which the organs are reversed, with the liver on the left and spleen on the right
congenital diaphragmatic hernia or omphalocele, where varying amounts of liver tissue may herniate into the thorax or outside the abdominal cavity.
what are true accessory fissures caused by?
caused by infolding of the peritoneum.
Are true accessory fissures common
No
inferior accessory hepatic fissure
is a true accessory fissure that stretches inferiorly from the right portal vein to the inferior surface of the right lobe of the liver.
Are vascular anomalies common?
in 45% of patients
what are common vascular anomalies?
Replaced left hepatic artery originating from the left gastric artery
Replaced right hepatic artery originating from the superior mesenteric artery
Replaced common hepatic artery originating from the superior mesenteric artery
Variations in the portal venous anatomy
include atresias, strictures, and obstructing valves
Variations in the branching of the hepatic veins
are common
most common hepatic vein variation
when the accessory vein drains the superoanterior segment of the right lobe.
It may empty into the middle hepatic vein or join the right hepatic vein
Reidel’s Lobe
tongue-like, inferior projection of the right lobe of the liver beyond the level of the most inferior costal cartilage on cross-sectional images 1. It is not considered a true accessory lobe of the liver but an anatomical variant of the right lobe of the liver 3.
heptaceullar disease
Liver cells (hepatocytes) are the immediate problem. Usually treated medically with supportive measures and drugs
Obstructive disorders
Bile excretion is blocked.
Usually treated surgically
Diffuse heptacellular disease
disease affects the hepatocytes and interferes with liver function.
Functions of the liver
metabolism, digestion, storage and detoxification
What is bilirubin
The pigment that is released when the red blood cells are broken down
Hepatocellular disease
Liver cells (hepatocytes) are the problem
Obstructive disease
Bile excretion is blocked
Prothrombin time
liver enzyme that is part of the blood clotting mechanism
Does the prothrombin time increase or decrease with cellular damage?
increased in the presence of liver disease with cellular damage
Indirect Bilirubin
unconjugated bilirubin.
Direct bilirubin
conjugated bilirubin
LDH
Lactic Acid Dehydrogenase
where is lactic acid dehydrogenase found
kidneys, heart, skeletal muscle,
brain, liver, and lungs
When is LDH elevated
infectious mononucleosis and mildly elevated in hepatitis, cirrhosis, and obstructive jaundice. I
Heptapetal
Towards the liver
Heptafugal
Away from the liver
