Liver And Gallbladder- Chapter 18 Flashcards
Where is AST located
Mitochondria
Where is ALT located
Cytoplasm
What liver test can tell you if alk phos increase is due to bone or not
Gamma-glutamic transpeptidase (not elevated in bone)
What happens to cells with hepatic necrosis
Cells swell due to defective osmotic regulation at the cell membrane
What type of liver necrosis is described as widespread parenchymal loss’ severe, zonal loss of hepatocytes
Confluent necrosis
What type of liver necrosis is described as zone of necrosis that may link central veins to portal tracts or bridge adjacent portal tracts
Bridging necrosis
What is the principle cell type involved in scar formation of the liver
Hepatic stellate cell
What does hepatic stellate cells store in quiescent form
Vitamin A (lipid storing)
How does acute hepatic failure first manifest
Nausea, vomiting, jaundice followed by life-threatening encephalopathy and coagulation defects
What results from the hypoalbuminemia seen in hepatic failure
Peripheral edema; may cause low oncotic pressure
What are 2 ways to treat hyperammonemia seen with hepatic failure
Eat low protein diet and treatment with lactulose
What are the non-specific signs seen with cirrhosis
Anorexia, weight loss, weakness
What are some prehepatic causes of portal hypertension
Obstructive thrombosis; narrowing of portal vein
What are some intrahepatic causes of portal hypertension
Cirrhosis
What accounts for most causes of portal hypertension
Cirrhosis
What are some posthepatic causes of portal hypertension
Severe R-sided heart failure, constrictive pericarditis, hepatic vein outflow obstruction
What are some major clinical consequences of portal hypertension
Ascites, formation of portosystemic venous shunts, congestive splenomegaly, hepatic encephalopathy
Describe the type of virus HAV is
Positive sense SS RNA, naked
How does HAV spread
Ingestion of contaminated water and foods and is shed in stool for 2-3 weeks before and 1 week after onset of jaundice
What specific cell plays important key role in hepatocellular injury seen with HAV infection
CD8+ T cells
Describe the type of virus HBV is
DS circular DNA
What is the life cycle for HBV
DNA to RNA to DNA
When does HBsAg appear
Before onset of symptoms, peaks during overt disease, and often declines to undetectable levels in 12 weeks
What is the major virion of HBV
Dane particle
What is the most common chronic blood-borne infection cause
HCV
What type of virus is HCV
SS RNA Enveloped; flaviviridae family
What is the mean incubation time for HCV
9 was
What is the most common reason for liver transplant
HCV infection
What type of hepatitis is a quasi species
Hepatitis C
What hepatitis infection is associated with metabolic syndrome
HCV
What type of virus is HDV
Circular defective ssRNA
What type of virus is HEV
Positive sense ssRNA, non-enveloped
What viral hepatitis infection is zoonotic
Hep E
What population of people are most effected against HepE
Pregnant women
What is the form of transmission for HepD
Parenteral
Who does chronic liver disease occur in when infected with HepE
Immunocompromised host only
How do you diagnose HepA
Detection of serum IgM antibodies
What is the defining histo feature of chronic viral hepatitis
Mononuclear portal infiltration
What should you think of with ground glass hepatocytes
HBV
What is the term for cells with ER swollen by HBsAg
Ground glass hepatocytes
What bacteria causes toxic shock infection of the liver
S. Aureus
What are hydatid cysts of the liver usually caused by
Echinococcal infecitons
What is the most common cause of liver abscesses in developing countries
Echinococcal and amebic infections
What type of infections is the most likely cause of liver abscesses in developed countries
Pyogenic
What should you think of with hepatocyte rosettes
Autoimmune hepatitis
What lab findings are associated with type 1 autoimmune hepatitis
ANA, SMA/ AAA anti-SLA/LP
What lab findings are associated with type 2 autoimmune hepatitis
Anti-LKM-1, ACL-1
Who is type 1 autoimmune hepatitis most common in
Middle-aged to older individuals
What age group is type 2 autoimmune hepatitis most commonly seen in
Children and teenagers
Who does chlorpromazine cause cholestasis in
Patients who are slow to metabolize it to an innocuous byproduct
Who can halothane cause fatal immune-mediated hepatitis in
Some patients exposed to this anesthetic on multiple occasions
What is the most common cause of acute liver failure necessitating transplantation in USA
Acetaminophen
What zone of the liver does acetaminophen damage first
Zone 3
What are the key morphological findings with hepatocellular necrosis
Spotty hepatocyte necrosis, massive necrosis, chronic hepatitis
What is the major associated agent with buds-chiari syndrome
Oral contraceptives
What are the major associated agents with hepatocellular adenoma
Oral contraceptives, anabolic steroids
What are the major associated agents with liver angiosarcoma
Thorothrast, vinyl chloride
What is hepatitis steatosis usually due to
Alcohol consumption
What should you think of with Mallory denk bodies
Alcoholic hepatitis
What should you think of with chicken wire pattern
Laennec cirrhosis occuring with alcoholic hepatitis
What zone does budd chiari syndrome most commonly affect most
Zone 3 (congestion, necrosis, hemorrhage)
What is elevated in most patients with NASH
ALT and AST
What is the most common cause of chronic liver disease in the USA
NAFLD
What gene is involved in Wilson disease
ATP7B
What is impaired with Wilson disease
Copper excretion
Where does the toxic levels of copper seen in Wilson’s disease go
Brain, liver, eye
What should you think of with kayser-FLeisher rings
Wilson disease
What is the term for green to brown deposits of copper in descemet membrane in limbus of the cornea
Kayser-Fleisher rings
What age group does Wilson disease typically occur in
Young (6-40)
What is decrease in Wilson disease
Serum ceruloplasmin
What are the special stains used for Wilson disease
Rhodamine stain for copper; orcein stain for copper-associated protein
What is the main treatment for Wilson disease
Penicillamine
What is the issue in hemachromatosis
Excessive accumulation of iron
What clinical things could indicate severe iron overload in teh body
Micronodular cirrhosis in all patients; DM; skin pigmentation
Does hemachromatosis effect men or women more? Why?
Men because women are excreting some of the iron during menstruation
What type of cancer are people with hemochromatosis more likely to develop
Hepatocellular carcinoma
How is neonatal hemochromatosis manifested
Severe liver disease and extrahepatic hemosiderin deposition
What is the major function of alpha 1-antitrypsin
Inhibition of proteases released from neutrophils
What happens within alpha 1-antitrypsin
Pulmonary emphysema and liver disease develop
What is seen morphological with alpha 1-antitrypsin deficiency
Round-to-oval cytoplasmic globular inclusions in hepatocytes (acidophilic but strongly PAS+ and diastase-resistant)
What converts heme to biliverdin
Heme oxygenase
What is the uptake of bilirubin by hepatocytes and conjugation done by
UDP-glucuronic transferase
At what level of bilirubin does jaundice become evident
When levels rise above 2-2.5 mg/dL
What do mutations in UGT1A1 cause
Criggler-Najjar syndromes 1 and 2 and Gilbert syndrome
What hereditary hyperbilirubinemias are due to conjugated bilirubin
Dubin-Johnson syndrome and rotor syndrome
What is the liver pathology seen with Dubin-Johnson Syndrome
Pigmented cytoplasmic globules
What is the clinical presentation of cholestasis
Jaundice, pruritis, skin xanthomas, malabsorption, fat-soluble vitamin Deficiency
What should you think of with feathery degeneration
Cholestasis
What type of biliary atresia is disease that is limited to common duct
Type 1
What type of biliary atresia is where the disease goes into right and/or left hepatic bile ducts
Type 2
What type of biliary atresia is when there is also obstruction of bile ducts at or above the porta hepatis
Type 3
What does the biopsy of neonatal hepatitis show
Multinucleated giant hepatocytes
What cholangiopathy should you think of with anti-mitochondrial antibodies
Primary biliary cirrhosis
How does primary biliary cirrhosis commonly first present
Itching
What are some common clinical features seen in primary biliary cirrhosis
Fatigue, pruritis, hepatomegaly, hyperpigmentation, eyelid xanthelasmas, arthropathy
How do you treat primary biliary cirrhosis
Ursodeoxycholic acid
What autoimmune cholangiopathy is highly associated with IBD, particularly ulcerative colitis
Primary sclerosing cholangitis
What autoimmune cholangiopathy is associated with onion skinnning fibrosis
Primary sclerosing cholangitis
What autoimmune cholangiopathy is associated with increased IgM and positive p-ANCA
Primary sclerosing cholangitis
What autoimmune cholangiopathy is highly associated with Sjogrens
Primary biliary cirrhosis
What is the term for congenital dilations of common bile duct
Choledochal cysts
What disorder does fibrocystic disease often occur along with
Autosomal recessive polycystic renal disease
What is the most common cause of impaired intrahepatic blood flow
Cirrhosis
How does right sided cardiac decompensation effect the liver
Leads to passive congestion of liver
Describe the liver with right sided cardiac decompensation
Liver is slightly enlarged, tense and cyanosis, with rounded edges
How does left sided cardiac failure or shock effect the liver
Leads to hepatic hypoperfusion and hypoxia, causing ischemic coagulative necrosis of hepatocytes in the central region of the lobule
What are the key features of preeclampsia
Maternal HTN, proteinuria, peripheral edema, coagulation abnormalities
What is the HELLP syndrome associated with preeclampsia
Hemolysis, elevated liver enzymes, low platelets
What is dysfunctioning with acute fatty liver of pregnancy
Mitochondria
What can modular regenerative hyperplasia lead to the development of
Portal HTN
What is the most common benign liver tumor
Cavernous hemangiomas
Who are most likely to develop hepatocellular adenomas
Young women on oral contraceptives and those using anabolic steroids
What is the most common liver tumor in early childhood
Hepatoblastoma
What is frequently activated with hepatoblastoma
WNT signaling pathway
What infection do most causes of HCC occur with
HBV infection
What are the most common early mutational events with HCC
Activation of beta-catenin and inactivation of p53
What is typically elevated in HCC
Alpha fetoprotein levels
Describe large cell changes of HCC
Shows scattered hepatocytes, usually near portal tracts or septa
Describe small cell changes in HCC
Hepatocytes have high nuclear cytoplasmic ratio and mild nuclear hyperchomasia and/or pleomorphism
What is the most common hematogenous metastasis of HCC
Lung (late in disease)
What is fibrolamellar carcinoma a distinctive variant of
HCC
At what age do most fibrolamellar carcinomas occur
Under the age of 35
How does fibrolamellar carcinoma present
Single large, hard scirrhous tumor with fibrous bands coursing through it
What two exposures are most likely to lead to hepatic angiosarcoma
Vinyl chloride and arsenic
What type of tumor should be considered if a liver fluke is involved
Cholangiocarcinoma
What are the most common metastatic tumors of the liver
Colon, breast, lung, pancreas
What are the key findings with biliary atresia
Jaundice, dark urine, pale stools
What type of gallstones are radiolucent compared to radiopaque
Cholesterol stones are lucent; pigment stones are opaque
What demographic are cholesterol stones more common in
Northern Europeans, North and South Americans, and native Americans
What is the inflammation seen with acute calculus precipitate by usually
Obstruction of the neck or cystic duct
What is the cause of acute acalculous
Ischemia and stasis
What should you think of with porcelain gallbladder
Chronic cholecystitis
