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Path III Quizzes > Liver Part 2 > Flashcards

Liver Part 2 Flashcards

1
Q

What are some conditions other than hep B,C,D that can lead to chronic hepatitis?

A 
Chronic alcoholism
Wilson's disease
alpha-1 antitrypsin def
drugs and other hepatoxins
autoimmune diseases
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2
Q

What is hist of chronic hep B?

A

ground glass appearance

- hazy because lots of antigen

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3
Q

Which hep virus is most likely to cause fulminant liver?

A

Hep B

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4
Q

What happens to liver in fulminant hepatitis?

A

shrinks, stained with bile, soft consistency, wrinkled appearance

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5
Q

What is number one cause of fulminant liver?

A

acetaminophen

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6
Q

What happens with alcohol and acetaminophen?

A

impaired hepatic metabolism of methionine -> decreased glutathion -> cyt p 450 increases breakdown of alcohol and increases conversion of acetaminophen to toxic metabolites (especially NAPQI)

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7
Q

what does cytochrome p-450 do?

A

produces reactive oxygen species that react with cellular proteins, damage membranes and alter hepatocellular function

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8
Q

What are three forms of liver disease caused by chronic alcohol consumption?

A
  • hepatic steatosis
  • alcoholic hepatitis
  • cirrhosis
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9
Q

hepatic steatosis

A

accumulation of lipid droplets
no inflammation
reversible
large, fatty liver

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10
Q

alcoholic hepatitis

A

hepatocyte swelling and necrosis
ballooning necrosis
mild deposition of hemosiderin
mallory bodies

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11
Q

when are mallory bodies present?

A

alcoholic hepatitis

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12
Q

mallory bodies

A

hepatocytes accumulate keratin

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13
Q

where else do you see mallory bodies?

A 
alcoholic hepatitis
NASH
primary biliary cirrhosis
Wilsons disease
hepatocellular tumors
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14
Q

alcoholic cirrhosis

A
  • final and irreversible form of alcoholic liver disease
  • shrunken, non-fatty, brownish green liver
  • fibrous bands and lumpy bumpy appearance
  • scar tissue
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15
Q

can cirrhosis develop without previous evidence of steatosis or alcoholic hep?

A

yes

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16
Q

alcoholic hepatitis

A 
appears acutely
weight loss, anorexia, upper abd pain
hyperbilirubinemia
elevated alkaline phosphatase
neutrophilic leukocytosis
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17
Q

labs for alcoholic hep

A

AST 2 or more times higher than ALT because alcohol use has decreased vitamin absorption and damaged brush border

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18
Q

what are clinical symptoms of liver disease

A 
jaundice
echymosis
gynecomasticy 
yellow buccal mucosa
bright red tongue
spider something (nevi?)
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19
Q

top 5 causes death due to end stage alcoholic liver disease?

A
  1. hepatic coma
  2. massive GI bleed
  3. concurrent infection
  4. hepatorenal syndrom
  5. hepatocellular carcinoma
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20
Q

cirrhosis

A

portal HTN

caput medusae

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21
Q

risk factors for steatosis?

A 
genetic
diet
obesity
dyslipedemia
metabolic syndrome
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22
Q

iron in pancreas leads to what?

A

bronze diabetes

23
Q

Wilsons

A

copper

keyser-flasure rings around iris

24
Q

NAFLD lab work

A

elevated ALT and AST
AST not elevated more than ALT
GGT elevated prior to ALT and AST

25
Q

NAFLD accounts for what % of cases of chronic hepatitis of unknown cause?

A

70%

26
Q

NASH (non alcoholic steato hepatitis)

A

intermediate form of liver damage

  • mallory bodies
  • ballooning degeneration and apoptosis
  • sinusoidal fibrosis
27
Q

hemochromatosis

A

excess iron in liver and pancreas

28
Q

primary hemochromatosis

A

genetic defect

29
Q

secondary hemochromatosis

A

excessive administration of iron (transfusions)

30
Q

Wilsons disease

A

autosomal recessive
copper in liver, brain, eyes
hepatocyte necrosis
kayser-fleishcer rings

31
Q

90-95% of plasma copper is what?

A

ceruloplasmin

32
Q

alpha-1 antitrypsin deficiency

A

autosomal recessive
abnormally low serum levels of a1antitrypsin
liver and lung repair cannot happen

33
Q

microscopic changes of alpha 1 antitrypsin def?

A

presence of round or oval globular inclusions
hepatocytes larger and lose shape
acid-schiff PAS positive stain

34
Q

What disease is more likely to occur in adults and children with AAT?

A

adults: lung disease and emphysema
children: liver disease

35
Q

why is cirrhosis likely to develop with AAT?

A

genetic mutation with substitution of lysine residue in place of glutamine during enzyme synthesis makes proteins non-functional

36
Q

what would you think if there was an unexplained change at base of lunge seen on an X-ray?

A

AAT

37
Q

primary biliary cirrhosis

A

autoimmune
t-cell mediated destruction of bile ducts in liver
liver disease starts around small bile ducts
bile duct clogged or destroyed = fibrosis
whole architecture changed

38
Q

what is hist feature of primary biliary cirrhosis?

A

granulomatous destruction of medium sized intrahepatic bile ducts

39
Q

how do you test for primary biliary cirrhosis?

A

anti mitochondrial ab test

40
Q

signs of PBC?

A 
xanthelasmas (soft nodules)
xanthomas (deposition on eyelid)
fatigue
pruritis
jaundice
41
Q

complications of PBC?

A

cirrhosis
portal HTN
end stage = hepatic encephalopathy and hepatic coma

42
Q

what extra hepatic autoimmune disorder is PBC associated with?

A

RA

Sjogrens

43
Q

primary sclerosing cholangitis

A

bile ducts initially become inflamed and over time become fibroses and scarred
segmental stricture and dilations of bile ducts
beaded appearance with barium

44
Q

what is primary sclerosing cholangitis associated with?

A

UC

70% of pt with PSC have UC

45
Q

hist of sclerosing cholangitis?

A

onion skin

fibrous tissue

46
Q

workup for PSC?

A

elevated alkaline phosphatase

47
Q

what is there an increased risk of developing with PSC?

A

cholangiocarcinoma

48
Q

hist of degeneration?

A

ballooning

49
Q

eosin body formed after apoptosis?

A

councilman body

50
Q

lipid accumulation in hepatocytes without inflammation

A

steatosis

51
Q

hazy cell with ground glass appearance found in what?

A

hep B

52
Q

alcoholic hep from keratin?

A

mallory body

53
Q

kupfer cells stained brown found in?

A

hemachromatosis

Path III Quizzes (10 decks)

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