Liver Path II Flashcards
centrilobular
zone 3
necrosis - with right heart failure
periportal
zone 1
necrosis with phosphorus, eclampsia, mushroom toxicity
fulminant masive necrosis of liver
usually fatal
amanita mushroom
bridging fibrosis
portal to portal
seen with trichrome stain
fulminant liver failure
acute liver failure
acute liver illness with enceophalopathy and coagulopathy within 26 weeks of initial liver injury
massive hepatocyte necrosis >80%
acetaminophen toxicity, drug rxns, toxins, viruses
ICU and liver transplant
chronic liver failure
loss of 80-90% liver function
jaundice, edema, forgetful (hyperammonia)
fetor hepatis - smelly breath
parotid gland enlargement
PT time - factor VII
hepatic encephalopathy
hyper ammonia
PT time
increased bc of factor VII decrease in chronic liver failure
nodules of liver
can be palpable
12th leading cause of death
cirrhosis
cirrhosis characteristics
bridging fibrosis
parenchymal nodules
disruption of enter liver - diffuse
nodularity of cirrhosis
from regeneration of hepatocytes
cirrhosis
irreversible
-rarely - regression can occur
but do still have risk of hepatocellular carcinoma
diagnosis of cirrhosis
see regenerating hepatocytes
etiology of cirrhosis
hep C - alcohol - cryptogenic
stellate cells
to myofibroblasts - by PDGFR and TNF
-induce ECM deposition and cirrhosis**
kupffer cells - cytokines stimulate fibrogenesis in stellate cells
collagen in space of disse
biliary channels
rate limiting step in bilirubin excretion - lost in cirrhosis
anorexia, weight loss, fatigue, weakness
cirrhosis
PDGF and TNF
activate stellate cells
endothelin 1
stimulate contraction of stellate cells
TGF-beta
stimulate fibrogenesis
canonical principle
necrosis of hepatocytes
to myofibroblasts
leads to liver fibrosis
NO
vascular relaxation and stellate cell apoptosis
angiogenesis in cirrhosis
increased sinusoid vessls with cirrhosis
-micro and macronodules form
could theoretically serve as portal pressure reducing shunts
acute liver injury
apoptosis of hepatocytes
minor - can regenerate
major - loss of hepatocytes
canals of hering - liver progeneritor cells
genesis signaling - hedgehog, Wnt, hedgehog
portal HTN
with fibrosis and sinusoid remodeling
also low NO, increased vasoconstrictors, and endothelial dysfunction
micronodular
less than 3mm
macronodular
greater than 3mm
nodules
regenerating hepatocytes
bridging fibrosis
connect portal triads and centrilobular hepatocytes
-create islands of regeneration
liver cords two cells thick
presumptive of regeneration
portal HTN
increase portal venous pressure 8-10mmHg or hepatic vein/portal vein gradient >5mmHg
see collaterals open - esophageal varices, hemorrhoids, caput medusa
portal HTN path
2/3 structural - sinusoid resistance
1/3 dynamic - increased portal venous flow
-uncleared got bacteria - produce NO
result of portal HTN
ascites
portosystemic shunts
congestive splenomegaly
hepatic encephalopathy
pre-hepatic portal HTN
portal or splenic vein occlusion
intra-hepatic portal HTN
pre-sinusoid - schistosomiasis, sarcoidosis
sinusoidal - cirrhosis, alcoholi hepatitis
post-sinusoid - veno-occlusive disease, pyyrolizidine
pyrollizidine
ca lead to post-sinusoid intrahepatic portal HTN
post -hepatic portal HTN
right side HF
constrictive pericarditis
hepatic vein outflow obstruction - budd chiari - 2 veins needed**
most common cause of portal HTN
cirrhosis
falciform ligament with abdominal wall collaterals
caput medusa
most problematic shunt
esophageal varices
esophageal and azygous veins
esophageal varices
between superior rectal vein and lower rectal veins
hemorrhoids
between paraumbilical veins and abdominal epigastric veins
caput medusa
between colic veins and retroperitoneal veins
portosystemic shunt
splenomegaly
can occur in splenomegaly
-hypersplenism
leads to pancytopenia
gamna gandy bodies
microscopic foci of fibrotic iron laden nodules in splenic parenchyma
-with splenomegaly due to portal HTN
ascites
excess fluid in abdomen
commonly due to cirrhosis
path of ascites
sinusoid HTN
sodium and water retention
vasodilation of splanchnic circulation - RAAS system - increased ADH
peritoneal ascites
carcinoma - tuberculosis
see high protein
non-peritoneal ascites
cirrhosis and heart failure
see low protein (but albumin still in ascitic fluid
spontaneous bacterial peritonitis
ascites pt with fever, abdominal pain
E. coli and s. pneumonia
hydrothorax
more common on right - right pleural effusion
can occur with ascites