Liver 2 Flashcards
What are 4 histological features of acute steatohepatitis?
- fat
- ballooned hepatocytes
- mallory bodies
- acute inflammation (neutrophils)
What pattern of fibrosis do we see on trichome stain of alcoholic steatohepatitis damage?
spider web (sinusoidal)
What is the recommended drinks per day for men? women? what is the individual susceptibility for ETOH liver damage?
- 2
- 1
- 1 in 6 heavy ETOH users
What is it called when there is just fatty change without inflammation or liver damage?
steatosis
What do mallory bodies look like?
pink, ropey material
T-f—damage from steatohepatitis first leads to portal fibrosis?
False, central vein
What is the AST:ALT ratio in steatohep.?
2:1
T_F– Alk phos is often elevated out of proportion to GGT in steatohepatitis?
False- the other way around
Amyloidosis affecting the liver would look like what histologically?
waxy pink material filling the sub sinusoidal spaces
poor prognoses (in the case his alk phos was huge compared to the GGT even though AST:ALT was 2:1
NASH is related to what other metabolic issues?
insulin resistance and metabolic syndrome
What might explain cryptogenic cirrhosis?
NASH
What are the differences histologically between NASH and alcohol damage?
Similar but more fat and glycogenated nuclei and less inflammation, ballooning and mallory hyaline
What is the AST ALT ratio in NASH?
Usually ALT will be higher
Is NASH or alcoholic steatohepatitis related to macrocytic anemia?
alc. steatohep.
T-F—NASH usually has a high titre positive ANA?
False- low
What histo features do we see in acute heart failure? Chronic?
- centrilobar congestion and necrosis
2. nutmeg liver
What is buds chiari syndrome?
obstruction of hepatic vein—associated with hypercoaguable state
Where do we see the fibrosis in chronic congestive heart failure?
centrilobar fibrosis leading to cirrhosis
what is the mottled color of nutmeg liver due to?
combination of congestion and pale fibrous tissue
In budd chiari what do we see histologically around the central vein?
marked congestion with surrounding sinusoidal congestion.
[hepatocytes get choked off and undergo necrosis
In budd chiari- do light pink areas or dark pink areas mean more necrosis?
light pink
T-F– ferritin is an acute phase reactant?
True
In hemochromatosis, the liver is often first to accumulate…what follows?
pancreas-->diabetes heart-->cardiomyopathy joints-->arthralgia pituitary-->infertile thyroid-->hypothyroid skin-->bronze
What gene is defective in hemochromatosis?
HFE Gene
usually homozygous C282Y (europeans)
T-F– hemochromatosis liver disease is often found concurrently with HCV or alcohol which accelerates the fibrosis?
True
Is hemochromatosis a risk factor for developing hepatocellular carcinoma?
YEs
how do we treat hemochromatosis?
phlebotomy
is alpha-1 antitrypsin deficiency autosomal dominant?
no- recessive
what abnormal protease inhibitor alleles are associated with liver disease in alpha-1 antitrypsin deficiency?
Z and M
PIMM is wild type.
how do we visualize histologically alpha-1 antitrypsin deficiency?
PAS-D stain- globules are bright pink inside hepatocytes
is alpha-1 antitrypsin deficiency less treatable than hemochromatosis? is it a risk factor for hepatocellular carcinoma?
yes, yes
Is wilson’s disease autosomal dominant?
No recessive
What is wilson’s disease?
impaired copper excretion into bile and a failure to incorporate copper into ceruloplasmin
Where is copper accumulation highest?
liver, brian and eye.
also kidney
What is bland cholestasis?
only bile stasis is seen without other findings of liver damage
in his to you just see brown bile blobs in normal looking hepatocytes
can bland cholestasis lead to jaundice?
yes
what is the classic cause of bland cholestasis?
drugs–> oral contraceptives
also gilbert’s, pregnancy, post-operative and infection
Does gilbert’s syndrome lead to unconjugated or conjugated hyperbilirubinemia?
unconjugated
how does one become jaundiced when they have gilbert’s syndrome?
illness fasting/eating low calories dehydration menstruation stress lack of sleep exercise
What is the most common cause of obstruction of extra hepatic duct? what are some others?
- gallstone
2. tumor in bile duct, ampulla, head of pancreas, also congenital problems
