Liver Path Flashcards
Describe drug induced liver disease
Very common, may cause any type of liver injury, may mimic any clinical liver disease, will recover when drug is stopped.
Characteristics of intrinsic drugs
predictable, dose dependent, short latency, specific lesions
Characteristics of idiosyncratic drugs
unpredictable, dose independent, variable latency, variable lesions, hypersensitivity
Harmful effects from tetracycline
microsteatosis
methotrexate
macrosteatosis
acetaminophen
necrosis
isoniazid, halothane
hepatitis
amiodarone
fibrosis
steroids, erythromycin
cholestasis
amt of alcohol for a man or woman to develop alcoholic liver disease
Men-over 80g/day
Women-over 40g/day
What is steatosis?
Fatty change of the liver. May revert back to normal.
What is hepatitis
Inflammation of the liver, can reverse back to normal
what is cirrhosis
fibrosis and hyperplastic nodules. Not reversible
Clinical presentation of pt with alcoholic steatohepatitis
Elevated AST-ALT2 Increased AP Jaundice Leukocytosis Fever
Causes of death in end stage alcoholism
hepatic coma, massive GI hemorrhage, infection, hepatorenal syndrome following bout of alcoholic hepatitis.
Portal vein thrombosis-Extrahepatic causes
abdominal infection and inflammation including appendicitis, diverticulitis, pancreatitis. Hypercoagulability, surgery
Hepatic vein obstruction-cardiac related
venous passive congestion, centrilobular hemorrhagiv necrosis, cardiac sclerosis.
Budd chiari syndrome also causes obstruction
What is budd chiari syndrome
clotting or obstruction of hepatic vein and/or IVC. Most pts have underlying condition that predisposes to blood clotting.
What is veno occlusive disease
a complication following bone marrow transplantation or ingestion of certain plant alkaloids. Arises bc nonspecific vasculitis arising in response to inflammatory challenge, such as bone marrow transplant conditioning regimen.
Symptoms of veno occlusive disease
tender hepatomegaly, weight gain, jaundice, portal hypertension/ascites, renal failure, liver failure, recovery/cirrhosis
Hereditary hemochromatosis
Defective regulation of intestinal Fe absorption leading to increased absorption. Mutations of HFE gene encodes for membrane prtn regulating the interaction of transferrin receptors with transferrin. Mutant alleles C282Y and H63D.
Complications of hereditary hemochromatosis
Diabetes, cardiomyopathy, hypogonadism, skin pigmentation , pseudo gout
Function of copper
Pigment formation, neurotransmitter production ,peptide formation, connective tissue biosynthesis, and antioxidant defense
what is wilson disease
hereditary disease that causes body to retain copper.
Cause of wilson disease
Autosommal recessive. Mutation of ATP7B copper-transporter. Impaired copper biliary excretion. Copper accumulation.
Clinical manifestations of Wilson disease in children
hepatitis, acute/chronic/fulminant
Wilson in adults
neurologic/psych disease. Fatal if untreated
Alpha1-antitrypsin deficiency
autosomal recessive. Primary liver metabolic disease, primary genetic liver disease in children, 2nd cause of liver transplatation in children
Cause of alpha1 antitrypsin deficiency
Misfolding of PiZ
focal nodular hyperplasia
solitary mass, central scar, fibrous septa, oral contraceptives, rare complications
What is a hemangioma
most common benign hepatic tumor. Asymptomatic or abdominal pain. Risk of rupture/hemorrhage, so no biopsy. Dx thru angiogram/CT
Liver cell adenoma
young women, oral contraceptives, glycogen storage disease, may rupture in pregnancy, may harbor hepatocellular carcinoma (rare)
Risk factors for hepatocellular carcinoma
CIRRHOSIS, alcoholism, HBV, HCV, hereditary hemochromatosis, alpha1AT deficiency, aflatoxin, tyrosinemia
Clinical presentation in hepatocellular carcinoma
painful hepatomegaly, abdominal mass, weight loss, portal/hepatic vein thrombosis, hemorrhagic ascites, hepatic failure, massive bleeding
Hepatocellular carcinoma Dx
AFP>1000. Imaging too
Common primary sites of malignant metastatic tumors
GI tract, breast, lung, pancreas, melanoma
