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Jason's GI Block > Liver Injury > Flashcards

Liver Injury Flashcards

1
Q

in hepatitis, injury is to what? how is the inflammatory response?

A

Sensitive Hepatocytes damages

inflammation is variable

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2
Q

When Jaundiced, what is liver ALT levels?

A

super high in the 1000s

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3
Q

what causes high ALT?

A

hepatocyte membrane damage

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4
Q

enlarged liver causes jaundice how?

A

swelling of hepatocytes obstruct bile flow

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5
Q

In hepatic lobules, there are zones, which ones are most vulnerable?

A

Zone 3 to toxins and ischemia

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6
Q

When do you get Mallory bodies?

A

alcoholic hepatitis

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7
Q

when do you get zonal coagulative necrosis?

A

paracetomol toxicity

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8
Q

acute viral hep A+B causes lobular ____

A

disarray and apoptosis

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9
Q

paracetomol toxicity causes?

A

zonal coagulative necrosis

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10
Q

alcoholic hepatitis you see what histologically?

A

Mallory bodies

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11
Q

in lobular disarray what happens? 3 things

A

hepatocyte swelling
sinusoids compressed
lymphocytes surround

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12
Q

neutrophils in acute viral hepatitis?

A

Nope

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13
Q

what is a Councilman body?

A

hepatocyte undergoing apoptosis

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14
Q

What else can cause zonal coagulative necrosis besides paracetomol? 3 others

A

toxic mushrooms
carbon tetrachloride
ischemia

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15
Q

what is the toxic metabolite that directly injures hepatocyte? causes what?

A

NAPQI

causes depletion of glutathione

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16
Q

tell tale sign of coagulative necrosis histologically?

A

no nucleus

ghost outline

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17
Q

hepatocyte undergoing apoptosis is called?

A

Councilman body

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18
Q

where do you normally get the most severe appearance of coagulative necrosis of hepatocytes histologically?

A

Zone 3

Zone 2 sometimes

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19
Q

inflammation with paracetemol toxicity?

A

Nope

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20
Q

Four dead giveaways of alcoholic hepatitis?

A

Mallory bodies
Neutrophils
Fat vacuoles
ballooned hepatocytes

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21
Q

Why are there neutrophils in alcoholic hepatitis and not other kinds of hepatitis?

A

Mallory bodies attracting them

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22
Q

describe a Mallory body:

A

‘c’ shaped collapse of hepatocyte cytoskeleton

in a ballooned hepatocyte

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23
Q

Damage in alcoholic hepatitis more likely in zone?

A

3

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24
Q

What is around the central vein in alcoholic hepatitis?

A

fibrous tissue

25
Q

Cholestasis histologically see?

A

yellow brown dots in dilated biliary canaliculi

26
Q

chronic liver disease is one or several diseases? causes what hallmark feature?

A

several diseases

causes scarring

27
Q

is chronic liver disease always symptomatic?

A

Nope, need to look at liver tests etc.

28
Q

definition of chronic liver disease?

A

raised ALT for >6 months

29
Q

what is most common cause of chronic liver disease?

A

chronic hep B and C

30
Q

chronic hepatitis is background for two things:

A

cirrhosis

hepatocellular carcinoma

31
Q

what is a hallmark feature of acute and chronic viral hepatitis?

A

APOPTOSIS

32
Q

what happens to portal tracts in chronic hepatitis C? 3 things

A
  1. lymphocytes infiltration
  2. germinal centre formation
  3. interface hepatitis
33
Q

What is periportal inflammation known as? how to assess it?

A

interface hepatitis

use grading system to measure extent of fibrosis

34
Q

what is the major reason for cell death in chronic hepatitis?

A

apoptosis

35
Q

what are the margins like in interface hepatitis?

A

irregular

36
Q

hallmark feature in chronic hepatitis?

A

interface hepatitis

37
Q

What kind of collagen and scar tissue deposition do you get in chronic hepatitis?

A

fibrous septa

Septal Fibrosis >cirrhosis>irreversible damage

38
Q

what is an important progression marker in septal fibrosis?

A

bridging fibrosis between portal tracts

39
Q

do you get lobular disarray in chronic viral hepatitis?

A

usually not

40
Q

Fibrosis in acute viral hepatitis?

A

Nope.

41
Q

What is a increasingly important DDx for abonormal liver function tests?

A

Non-alcoholic fatty liver disease (NAFLD)

42
Q

Two kinds of Non-alcoholic fatty liver disease?

A
  1. steatosis
    with or without
  2. steatohepatitis/fibrosis (NASH)
43
Q

What is NASH?

A

non-alcoholic steatohepatitis

44
Q

What is steatosis?

A

just fat in the liver

fatty liver

45
Q

What is steatosis with steatohepatitis

A

fat with inflammation AND fibrosis

46
Q

causes of Non-alcoholic fatty liver disease (NAFLD)? 5 things

A 
Obesity
diabetes
Metabolic syndrom
drugs
GI surgery
47
Q

2 types of steatosis are? describe epidemiology

A

macrovesicular/large droplet (very common)

microvesicular/small droplet (very rare)

48
Q

How big are the macrovesicular steatosis?

A

larger than background hepatocytes

49
Q

what causes macrovesicular steatosis? 2 reasons

A

increased triglyceride synthesis

decreased excretion

50
Q

can you tell from histology whether macrovesicular steatosis is from alcohol or NAFLD?

A

Nope. need clinical info

51
Q

Can you get steatohepatitis without steatosis?

A

No, steatohepatitis needs steatosis first

52
Q

macrovesicular steatosis alone has risk of fibrosis?

A

Nope.

53
Q

when do you increase risk of fibrosis with macrovesicular steatosis?

A

if have inflammation and hepatocyte injury

54
Q

hallmark feature of steatohepatitis?

A

hepatocellular ballooning degeneration

55
Q

Where else does hepatocellular ballooning degeneration happen besides steatohepatitis? how to distinguish?

A

alcoholic hepatitis

need to correlate clinical findings

56
Q

non-alcoholic steatohepatitis features? 5 main

A 
large fat droplets
inflammation
hepatocellular ballooning
mallory bodies (severe)
fibrosis
57
Q

What kind of fibrosis in non-alcoholic steatohepatitis? as opposed to chronic hepatitis?

A

pericellular fibrosis vs. septal fibrosis

58
Q

ASH vs NASH? distinction?

A

Alcoholic steatohepatitis vs. non-alcoholic steatohepatitis

distinction if clinical

Jason's GI Block (32 decks)

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