Liver I Flashcards
What transports unconjugated bilirubin?
Albumin
What is added to make bilirubin “conjugated”?
Glucuronic acid
Which bilirubin is toxic to tissues?
Unconjugated bilirubin
What types of processes lead to high levels of unconjugated bilirubin?
Increased bilirubin production
Impaired bilirubin uptake (heart failure, shunts, some drugs)
Impaired conjugation (Gilbert’s, Hyperthyroidism, liver diseases)
What processes lead to increased conjugated bilirubin?
Extrahepatic cholestasis
Intrahepatic cholestasis
What is Gilbert’s syndrome?
Decreased glucuronyltransferase activity, leading to increased unconjugated bilirubin
What is the inheritance pattern of Gilbert’s syndrome?
Autosomal recessive
What is the difference between hepatocellular cholestasis, canalicular cholestasis, and acute cholangitis?
Hepatocellular: Bile stasis in hepatocytes
Canalicular: Bile plugged within bile ducts
Acute cholangitis: Inflammation of bile ducts with neutrophils in ducts
What is chronic passive congestion?
Centrilobular circulation congestion
What is defined as centrilobular congestion with centrilobular necrosis?
Centrilobular hemorrhagic necrosis
What is defined as a fibrosing reaction of pericardium following longstanding CPC and/or centrilobular necrosis?
Cardiac sclerosis
What is described as a “nutmeg” liver?
Centrilobular hemorrhagic necrosis
What areas are spared in centrilobular hemorrhagic necrosis?
periportal areas
What is defined as a thrombosis of two or more hepatic vein branches?
Budd chiari syndrome
What does Budd-Chiari syndrome often present as?
Triad: Hepatomegaly, ascites, abdominal pain
What is the pathology of Budd-Chiari syndrome?
Centrilobular hemorrhagic necrosis
Cardiac sclerosis
What is defined as an obstructive, nonthrombotic lesion of central hepatic veins?
Sinusoidal obstruction syndrome
What is the main problem with sinusoidal obstruction syndrome?
Increased exposure to hepatotoxins
What are acute symptoms of Sinusoidal obstruction syndrome? Chronic?
Acute: Hepatomegaly, weight gain, jaundice
Chronic: Pyrrolizidine alkaloids causing toxic effects, leading to Budd Chiari symptoms
Which vessels are affected in Sinusoidal obstruction syndrome?
central veins
What is defined as sinusoidal dilatation with rupture, leading to blood filled spaces?
Peliosis hepatis
What causes peliosis hepatis?
Anabolic steroids, contraceptives, danazol, AIDS infection, malignancy
What is done to prevent perinatal HBV?
treat with HepB immune globulin and HepB vaccine. Prevents chronic carrier state when administered 2-12 hours after birth
What are the phases of acute viral hepatitis?
Incubation
Preicteric (symptoms)
Icteric
Convalescence/liver failure/chronic hep
What is the pathology of acute hepatitis?
Diffuse liver cell degenration with focal hepatocellular necrosis and apoptosis
What liver cells are proliferated in acute hepatitis?
Kupffer cells
Do you biopsy acute hepatitis?
Seldom.
