Liver Part 2 Flashcards
What are some conditions other than hep B,C,D that can lead to chronic hepatitis?
Chronic alcoholism Wilson's disease alpha-1 antitrypsin def drugs and other hepatoxins autoimmune diseases
What is hist of chronic hep B?
ground glass appearance
- hazy because lots of antigen
Which hep virus is most likely to cause fulminant liver?
Hep B
What happens to liver in fulminant hepatitis?
shrinks, stained with bile, soft consistency, wrinkled appearance
What is number one cause of fulminant liver?
acetaminophen
What happens with alcohol and acetaminophen?
impaired hepatic metabolism of methionine -> decreased glutathion -> cyt p 450 increases breakdown of alcohol and increases conversion of acetaminophen to toxic metabolites (especially NAPQI)
what does cytochrome p-450 do?
produces reactive oxygen species that react with cellular proteins, damage membranes and alter hepatocellular function
What are three forms of liver disease caused by chronic alcohol consumption?
- hepatic steatosis
- alcoholic hepatitis
- cirrhosis
hepatic steatosis
accumulation of lipid droplets
no inflammation
reversible
large, fatty liver
alcoholic hepatitis
hepatocyte swelling and necrosis
ballooning necrosis
mild deposition of hemosiderin
mallory bodies
when are mallory bodies present?
alcoholic hepatitis
mallory bodies
hepatocytes accumulate keratin
where else do you see mallory bodies?
alcoholic hepatitis NASH primary biliary cirrhosis Wilsons disease hepatocellular tumors
alcoholic cirrhosis
- final and irreversible form of alcoholic liver disease
- shrunken, non-fatty, brownish green liver
- fibrous bands and lumpy bumpy appearance
- scar tissue
can cirrhosis develop without previous evidence of steatosis or alcoholic hep?
yes
alcoholic hepatitis
appears acutely weight loss, anorexia, upper abd pain hyperbilirubinemia elevated alkaline phosphatase neutrophilic leukocytosis
labs for alcoholic hep
AST 2 or more times higher than ALT because alcohol use has decreased vitamin absorption and damaged brush border
what are clinical symptoms of liver disease
jaundice echymosis gynecomasticy yellow buccal mucosa bright red tongue spider something (nevi?)
top 5 causes death due to end stage alcoholic liver disease?
- hepatic coma
- massive GI bleed
- concurrent infection
- hepatorenal syndrom
- hepatocellular carcinoma
cirrhosis
portal HTN
caput medusae
risk factors for steatosis?
genetic diet obesity dyslipedemia metabolic syndrome
iron in pancreas leads to what?
bronze diabetes
Wilsons
copper
keyser-flasure rings around iris
NAFLD lab work
elevated ALT and AST
AST not elevated more than ALT
GGT elevated prior to ALT and AST
NAFLD accounts for what % of cases of chronic hepatitis of unknown cause?
70%
NASH (non alcoholic steato hepatitis)
intermediate form of liver damage
- mallory bodies
- ballooning degeneration and apoptosis
- sinusoidal fibrosis
hemochromatosis
excess iron in liver and pancreas
primary hemochromatosis
genetic defect
secondary hemochromatosis
excessive administration of iron (transfusions)
Wilsons disease
autosomal recessive
copper in liver, brain, eyes
hepatocyte necrosis
kayser-fleishcer rings
90-95% of plasma copper is what?
ceruloplasmin
alpha-1 antitrypsin deficiency
autosomal recessive
abnormally low serum levels of a1antitrypsin
liver and lung repair cannot happen
microscopic changes of alpha 1 antitrypsin def?
presence of round or oval globular inclusions
hepatocytes larger and lose shape
acid-schiff PAS positive stain
What disease is more likely to occur in adults and children with AAT?
adults: lung disease and emphysema
children: liver disease
why is cirrhosis likely to develop with AAT?
genetic mutation with substitution of lysine residue in place of glutamine during enzyme synthesis makes proteins non-functional
what would you think if there was an unexplained change at base of lunge seen on an X-ray?
AAT
primary biliary cirrhosis
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
what is hist feature of primary biliary cirrhosis?
granulomatous destruction of medium sized intrahepatic bile ducts
how do you test for primary biliary cirrhosis?
anti mitochondrial ab test
signs of PBC?
xanthelasmas (soft nodules) xanthomas (deposition on eyelid) fatigue pruritis jaundice
complications of PBC?
cirrhosis
portal HTN
end stage = hepatic encephalopathy and hepatic coma
what extra hepatic autoimmune disorder is PBC associated with?
RA
Sjogrens
primary sclerosing cholangitis
bile ducts initially become inflamed and over time become fibroses and scarred
segmental stricture and dilations of bile ducts
beaded appearance with barium
what is primary sclerosing cholangitis associated with?
UC
70% of pt with PSC have UC
hist of sclerosing cholangitis?
onion skin
fibrous tissue
workup for PSC?
elevated alkaline phosphatase
what is there an increased risk of developing with PSC?
cholangiocarcinoma
hist of degeneration?
ballooning
eosin body formed after apoptosis?
councilman body
lipid accumulation in hepatocytes without inflammation
steatosis
hazy cell with ground glass appearance found in what?
hep B
alcoholic hep from keratin?
mallory body
kupfer cells stained brown found in?
hemachromatosis
