Liver Flashcards
Cirrhosis histo
diffuse bridging fibrosis (via stellate cells) and regenerative nodules
Cirrhosis Etiologies include
1 alcohol (60–70% of cases in the US), 2 nonalcoholic steatohepatitis, 3 chronic viral hepatitis, 4 autoimmune hepatitis, 5 biliary disease, 6 genetic/metabolic disorders.
Portal hypertension 3 Etiologies
1 cirrhosis (most common cause in Western countries), 2 vascular obstruction (eg, portal vein thrombosis, Budd- Chiari syndrome), 3 schistosomiasis.
Cirrhosis 4 sxs Integumentary
Jaundice
Spider angiomas
Palmar erythema
Purpura Petechiae
Cirrhosis 2 sxs Neurologic
- Hepatic encephalopathy
2. Asterixis (”flapping tremor”)
Cirrhosis 5 sxs GI
Anorexia Nausea, vomiting Dull abdominal pain Fetor hepaticus
Fetor hepaticus
breath has a strong, musty smell. It’s a sign that your liver is having trouble doing its job of filtering out toxic substances, usually due to severe liver disease. As a result, sulfur substances end up in your bloodstream and can make their way to your lungs.
Cirrhosis 3 sxs Hematologic
Thrombocytopenia
Anemia
Coagulation disorders
Metabolic Cirrhosis 2 sxs
Hyperbilirubinemia
Hyponatremia
Cardiovascular Cirrhosis 2 sxs
Cardiomyopathy
Peripheral edema
Reproductive Cirrhosis sxs. in men v women
Testicular atrophy
Gynecomastia
Amenorrhea
Cirrhosis swelling 4 sxs
Splenomegaly
Caput medusae
Ascites
Anorectal varices
2 bleeding Effects of Portal HTN
Esophageal varices = hematemesis
Gastric varices = melena
AST > ALT in nonalcoholic liver disease suggests progression to
advanced fibrosis or cirrhosis
Alkaline phosphatase v GGT
both incr in biliary obstruction
Alk phos only incr. in bone dz.
Alkaline phosphatase or GGT assoc. w/ ETOH use?
GGT
Bilirubin incr in which 3 liver diseases
biliary obstruction, alcoholic or viral hepatitis, cirrhosis
Why plts. decr. in liver dz.?
decr. thrombopoietin, liver sequestration
portal hypertension-why plts decr?
portal hypertension (splenomegaly/splenic sequestration)
fatal childhood hepatic encephalopathy
Reye syndrome
Reye syndrome 4 symptoms?
hypoglycemia,
vomiting,
hepatomegaly,
coma
Reye syndrome occurs with which 2 viral infections?
Associated with viral infection (especially VZV and influenza B) that has been treated with aspirin
Avoid aspirin in children, except in those with
Kawasaki disease.
Reye syndrome MOA
inhibition of mitochondrial enzymes
Hepatic steatosis from ETOH path changes?
Macrovesicular fatty change
Mallory bodies
Alcoholic hepatitis
Alcoholic hepatitis change to hepatocytes
Swollen and necrotic hepatocytes with neutrophilic infiltration.
Is any cirrhosis reversible?
No
Sxs.
of chronic liver disease
jaundice, hypoalbuminemia).
Non-alcoholic fatty liver disease can lead to
cirrhosis and HCC
Hepatic encephalopathy with cirrhosis due to decreased metabolism of?
NH3=Ammonia
Tx. of hepatic enceph.?
lactulose–incr. NH4=Ammonium production
Hepatocellular carcinoma associated with which virus?
Hep B virus
7 Causes of Cirrhosis?
- HBV
- HCV,
- alcoholic and
- non-alcoholic fatty liver disease,
- autoimmune disease,
- hemochromatosis,
- α1-antitrypsin deficiency
Carcinogen causes HCC
aflatoxin
from Aspergillus
Cause of Budd-Chiari
syndrome.
HCC
5 HCC Sxs.
- jaundice,
- tender hepatomegaly,
- ascites,
- polycythemia,
- anorexia.
Diagnosis: HCC
- α-fetoprotein;
- ultrasound or contrast CT/MRI B ,
- biopsy
Cavernous hemangioma is a
benign liver tumor
Contraindicated in Cavernous hemangioma why?
because of risk of hemorrhage.
Benign liver tumor, often related to oral contraceptive or anabolic steroid use
Hepatic adenoma
Hepatic adenoma due to what in men v women?
Women-OCP
Men-Steroid
Malignant Liver tumor of endothelial origin
Angiosarcoma
Angiosarcoma due to exposure to what 3 ?
exposure to arsenic, vinyl chloride.
Budd-Chiari syndrome sxs
congestive liver disease (hepatomegaly, ascites, varices, abdominal pain, liver failure
Budd-Chiari syndrome associated with what 4 situations/dzs.?
hypercoagulable states,
polycythemia vera,
postpartum state,
HCC
nutmeg liver (mottled appearance
Budd-Chiari
cirrhosis with
PAS ⊕ globules A in liver
alpha1-antitrypsin deficiency
Emphysemia in alpha1-antitrypsin deficiency due to?
In lungs, decreased α1-antitrypsin->uninhibited elastase in alveoli, decreased elastic tissue–>panacinar emphysema.
Unconjugated (indirect) hyperbilirubinemia
- Hemolytic, physiologic (newborns),
- Crigler-Najjar,
- Gilbert syndrome.
Conjugated (direct) hyperbilirubinemia due to what kind of dzs.?
- Biliary tract obstruction
- Biliary tract disease
- Excretion defect
Biliary tract obstruction–5 types
gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke.
Mixed (direct
and indirect) hyperbilirubinemia in what 2 conditions
Hepatitis, cirrhosis.
Physiologic neonatal jaundice resolves when?
resolves without treatment in 1–2 weeks.
At birth, immature UDP-glucuronosyltransferase
Physiologic neonatal jaundice
Conjugated hyperbilirubinemia due to defective liver excretion 2 dzs
Dubin-Johnson syndrome
Rotor syndrome
black liver
Dubin-Johnson syndrome
Mutations in hepatocyte copper-transporting ATPase
Wilson disease
Wilson disease other name
hepatolenticular degeneration)
decr. serum ceruloplasmin, incr. urine copper
Wilson disease
Kayser-Fleischer rings
Wilson disease
Wilson Dz. 6 sxs.
=Liver, Brain, Eyes, Kidneys, Heme.
- Liver disease (eg, hepatitis, acute liver failure, cirrhosis),
- Neurologic disease (eg, dysarthria, dystonia, tremor, parkinsonism),
- Psychiatric disease,
- Kayser-Fleischer rings (deposits in Descemet membrane of cornea)
- Hemolytic anemia
- Renal disease (eg, Fanconi syndrome)
Wilson disease Treatment (3)
chelation with 1. penicillamine or 2. trientine, & 3. oral zinc.
Wilson dz. =inadequate copper excretion into…
bile and blood
Hemochromatosis due to mutations in
HFE gene
increased intestinal absorption of Fe
Hemochromatosis
Hemochromatosis:
ferritin,iron,TIBC–>transferrin saturation
incr. ferritin,
incr. iron,
decr. TIBC
incr. transferrin saturation
Ferritin
store iron in the tissues
Hemochromatosis can be due to 2 causes
- mutation 2. chronic Transfusion
Prussian blue stain
Hemochromatosis (Fe)
Where Fe accumulate in Hemochromatosis? 6 body parts
liver, pancreas, skin, heart, pituitary, joints
Hemochromatosis sxs.–triad plus 2 sxs.
Classic triad of
[1. cirrhosis,
2. diabetes mellitus,
3. skin pigmentation (“bronze diabetes”)]
- dilated cardiomyopathy (reversible),
- hypogonadism,
- arthropathy
(calcium pyrophosphate deposition; especially metacarpophalangeal joints).
Common cause of death in Hemochromatosis
HCC
Hemochromatosis Tx.- 3 chelators?
- repeated phlebotomy,
- chelation with:
1. deferasirox,
2. deferoxamine,
3. oral deferiprone.
Biliary tract disease sxs.
- pruritus,
- jaundice,
- dark urine,
- light-colored stool,
- hepatosplenomegaly
Increased bilirubin effect on cholesterol?
Increase
cholestatic pattern of LFTs
all incr.:
conjugated bilirubin,
cholesterol,
ALP
Transferrin
bind to and transport of Iron through blood
concentric “onion skin” bile duct fibrosis
Primary sclerosing cholangitis
alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP
Primary sclerosing cholangitis
Biliary tract disease assoc. w/ UC
Primary sclerosing cholangitis
antibody ⊕ in Primary sclerosing cholangitis
p-ANCA ⊕
antibody ⊕ in Primary biliary cirrhosis
Anti-mitochondrial antibody ⊕
Primary biliary cirrhosis assoc. with which dzs.?
other autoimmune conditions
Biliary tract disease due to Autoimmune reaction:
lymphocytic infiltrate–>destroy ducts
Primary biliary cirrhosis
Secondary biliary cirrhosis occurs due to
Extrahepatic biliary obstruction–>incr. pressure in intrahepatic ducts–>injury/ fibrosis and bile stasis.
Secondary biliary cirrhosis complication
ascending cholangitis.
