Liver II Flashcards
What serological markers are found in autoimmune hepatitis?
Anti-nuclear antibodies and anti-smooth muscle actin and elevated IgG
What is seen on biopsy of autoimmune hepatitis?
Plasma cells and inflammation
How do you treat AIH?
Corticosteroids
What causes most cases of cirrhosis?
Alcoholic liver disease
What are the three main causes of death associated with cirrhosis?
Progressive liver failure
Complications of portal hypertension
Hepatocellular carcinoma
What is the most common cause of acute liver failure?
Acetaminophen overdose
What is the most common cause of chronic liver failure?
Cirrhosis
What is the clinical manifestation of liver failure?
Jaundice Hypoalbumin Coagulopathy Hyperammonemia Fetor hepaticus AST/ALT Hypoglycemia Endocrine changes Decreased drug metabolism
What is the most common cause of portal hypertension?
Cirrhosis
What are the main complications of portal hypertension?
Splenomegaly
Hepatic Encephelopathy
Esophageal Varices
Ascites
What cells are often seen on liver biopsy for alcoholic hepatitis?
Swelling liver cells
Mallory bodies
Neutrophils
What can steatofibrosis oftentimes lead to?
cirrhosis
What are the major causes of death for alcoholic cirrhosis?
Encephalopathy, coma Esophageal varices Infection Hepatorenal syndrome Hepatocellular carcinoma
What is the gross appearance of alcoholic cirrhosis?
Early: Enlarged, fatty, micronodular
Late: Shrunken, nonfatty, nodules varying in size, cholestasis
What oftentimes leads to non-alcoholic liver disease?
Insulin resistance
What is defined as an autoimmune cholangiopathy characterized by porgressive inflammatory destruction of small and medium sized intrahepatic bile ducts?
Primary biliary cirrhosis
How does primary biliary cirrhosis present?
Anicteric pruritis
Xanthomas
Bile stuff
What serological marker is common in primary biliary cirrhosis?
Antimitochondrial antibodies
What are the four stages for PBC?
1: Lymphocytic/granulomatous cholangitis in portal tracts
2: Periportal hepatitis with periportal fibrosis
3: Bridging necrosis with bridging fibrosis
4: Cirrhosis
What causes secondary biliary cirrhosis?
Anything causing prolonged bile duct obstruction
What is defined as an autoimmune cholangiopathy with progressive, random, uneven fibroinflammatory destruction of extrahepatic and intrahepatic bile ducts?
Primary sclerosing cholangitis
Who usually gets PSC?
People with IBD
Male
40 years
What gene is oftentimes mutated in hereditary hemochromatosis? What is the change?
HFE, regulates hepcidin synthesis
C282Y
What is the clinical triad of Hereditary hemochromatosis?
Cirrhosis, diabetes, skin pigmentation
What is the best screening test for Hereditary Hemochromatosis?
Fasting transferrin saturation
What is different on liver biopsy for primary and secondary hemochromatosis?
In secondary, iron initially accumulates in the Kupffer cells, not hepatocytes
What is the inheritance pattern of Wilson’s disease and what is mutated?
Autosomal recessive
ATP7B is mutated
What serum levels are low in Wilson’s disease?
Ceruloplasmin
What causes liver disease with A1AT deficiency?
Accumulation of A1AT in hepatocytes
What is direct hepatotoxicity in terms of drug induced liver damage?
Toxic in a predictable, dose dependent manner.
What is unpredictable hepatotoxicity (with drugs)?
Idiosyncratic liver injury from drugs. Not all exposed will develop injury
What causes Reye’s syndrome?
Aspirin after acute viral illness
What are the symptoms for Reye’s syndrome?
Liver injury and encephalopathy
What is seen on liver biopsy for Reye’s syndrome?
Small lipid vacuoles in hepatocytes
Microvesicular steatosis
What is neonatal cholestasis?
Diseases caused by Prolonged conjugated hyperbilirubinemia in theanemia
What is defined as a complete or partial obstruction of the biliary tree in the first three months of life?
Biliary atresia
What are the most common causes of neonatal hepatitis?
Biliary atresia
Metabolic disorders (A1AT deficiency, CF)
Infections
Idopathic
What causes granulomatous hepatitis?
Idiopathic (50%)
Sarcoidosis (22%)
Drug related (6%)
Tuberculosis (3%)
