Liver Injury Flashcards
in hepatitis, injury is to what? how is the inflammatory response?
Sensitive Hepatocytes damages
inflammation is variable
When Jaundiced, what is liver ALT levels?
super high in the 1000s
what causes high ALT?
hepatocyte membrane damage
enlarged liver causes jaundice how?
swelling of hepatocytes obstruct bile flow
In hepatic lobules, there are zones, which ones are most vulnerable?
Zone 3 to toxins and ischemia
When do you get Mallory bodies?
alcoholic hepatitis
when do you get zonal coagulative necrosis?
paracetomol toxicity
acute viral hep A+B causes lobular ____
disarray and apoptosis
paracetomol toxicity causes?
zonal coagulative necrosis
alcoholic hepatitis you see what histologically?
Mallory bodies
in lobular disarray what happens? 3 things
hepatocyte swelling
sinusoids compressed
lymphocytes surround
neutrophils in acute viral hepatitis?
Nope
what is a Councilman body?
hepatocyte undergoing apoptosis
What else can cause zonal coagulative necrosis besides paracetomol? 3 others
toxic mushrooms
carbon tetrachloride
ischemia
what is the toxic metabolite that directly injures hepatocyte? causes what?
NAPQI
causes depletion of glutathione
tell tale sign of coagulative necrosis histologically?
no nucleus
ghost outline
hepatocyte undergoing apoptosis is called?
Councilman body
where do you normally get the most severe appearance of coagulative necrosis of hepatocytes histologically?
Zone 3
Zone 2 sometimes
inflammation with paracetemol toxicity?
Nope
Four dead giveaways of alcoholic hepatitis?
Mallory bodies
Neutrophils
Fat vacuoles
ballooned hepatocytes
Why are there neutrophils in alcoholic hepatitis and not other kinds of hepatitis?
Mallory bodies attracting them
describe a Mallory body:
‘c’ shaped collapse of hepatocyte cytoskeleton
in a ballooned hepatocyte
Damage in alcoholic hepatitis more likely in zone?
3
What is around the central vein in alcoholic hepatitis?
fibrous tissue
Cholestasis histologically see?
yellow brown dots in dilated biliary canaliculi
chronic liver disease is one or several diseases? causes what hallmark feature?
several diseases
causes scarring
is chronic liver disease always symptomatic?
Nope, need to look at liver tests etc.
definition of chronic liver disease?
raised ALT for >6 months
what is most common cause of chronic liver disease?
chronic hep B and C
chronic hepatitis is background for two things:
cirrhosis
hepatocellular carcinoma
what is a hallmark feature of acute and chronic viral hepatitis?
APOPTOSIS
what happens to portal tracts in chronic hepatitis C? 3 things
- lymphocytes infiltration
- germinal centre formation
- interface hepatitis
What is periportal inflammation known as? how to assess it?
interface hepatitis
use grading system to measure extent of fibrosis
what is the major reason for cell death in chronic hepatitis?
apoptosis
what are the margins like in interface hepatitis?
irregular
hallmark feature in chronic hepatitis?
interface hepatitis
What kind of collagen and scar tissue deposition do you get in chronic hepatitis?
fibrous septa
Septal Fibrosis >cirrhosis>irreversible damage
what is an important progression marker in septal fibrosis?
bridging fibrosis between portal tracts
do you get lobular disarray in chronic viral hepatitis?
usually not
Fibrosis in acute viral hepatitis?
Nope.
What is a increasingly important DDx for abonormal liver function tests?
Non-alcoholic fatty liver disease (NAFLD)
Two kinds of Non-alcoholic fatty liver disease?
- steatosis
with or without - steatohepatitis/fibrosis (NASH)
What is NASH?
non-alcoholic steatohepatitis
What is steatosis?
just fat in the liver
fatty liver
What is steatosis with steatohepatitis
fat with inflammation AND fibrosis
causes of Non-alcoholic fatty liver disease (NAFLD)? 5 things
Obesity diabetes Metabolic syndrom drugs GI surgery
2 types of steatosis are? describe epidemiology
macrovesicular/large droplet (very common)
microvesicular/small droplet (very rare)
How big are the macrovesicular steatosis?
larger than background hepatocytes
what causes macrovesicular steatosis? 2 reasons
increased triglyceride synthesis
decreased excretion
can you tell from histology whether macrovesicular steatosis is from alcohol or NAFLD?
Nope. need clinical info
Can you get steatohepatitis without steatosis?
No, steatohepatitis needs steatosis first
macrovesicular steatosis alone has risk of fibrosis?
Nope.
when do you increase risk of fibrosis with macrovesicular steatosis?
if have inflammation and hepatocyte injury
hallmark feature of steatohepatitis?
hepatocellular ballooning degeneration
Where else does hepatocellular ballooning degeneration happen besides steatohepatitis? how to distinguish?
alcoholic hepatitis
need to correlate clinical findings
non-alcoholic steatohepatitis features? 5 main
large fat droplets inflammation hepatocellular ballooning mallory bodies (severe) fibrosis
What kind of fibrosis in non-alcoholic steatohepatitis? as opposed to chronic hepatitis?
pericellular fibrosis vs. septal fibrosis
ASH vs NASH? distinction?
Alcoholic steatohepatitis vs. non-alcoholic steatohepatitis
distinction if clinical
