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GI II Exam 1 > Liver Path II > Flashcards

Liver Path II Flashcards

1
Q

centrilobular

A

zone 3

necrosis - with right heart failure

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2
Q

periportal

A

zone 1

necrosis with phosphorus, eclampsia, mushroom toxicity

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3
Q

fulminant masive necrosis of liver

A

usually fatal

amanita mushroom

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4
Q

bridging fibrosis

A

portal to portal

seen with trichrome stain

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5
Q

fulminant liver failure

A

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

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6
Q

chronic liver failure

A

loss of 80-90% liver function

jaundice, edema, forgetful (hyperammonia)

fetor hepatis - smelly breath

parotid gland enlargement

PT time - factor VII

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7
Q

hepatic encephalopathy

A

hyper ammonia

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8
Q

PT time

A

increased bc of factor VII decrease in chronic liver failure

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9
Q

nodules of liver

A

can be palpable

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10
Q

12th leading cause of death

A

cirrhosis

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11
Q

cirrhosis characteristics

A

bridging fibrosis
parenchymal nodules
disruption of enter liver - diffuse

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12
Q

nodularity of cirrhosis

A

from regeneration of hepatocytes

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13
Q

cirrhosis

A

irreversible
-rarely - regression can occur

but do still have risk of hepatocellular carcinoma

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14
Q

diagnosis of cirrhosis

A

see regenerating hepatocytes

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15
Q

etiology of cirrhosis

A

hep C - alcohol - cryptogenic

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16
Q

stellate cells

A

to myofibroblasts - by PDGFR and TNF
-induce ECM deposition and cirrhosis**

kupffer cells - cytokines stimulate fibrogenesis in stellate cells

collagen in space of disse

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17
Q

biliary channels

A

rate limiting step in bilirubin excretion - lost in cirrhosis

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18
Q

anorexia, weight loss, fatigue, weakness

A

cirrhosis

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19
Q

PDGF and TNF

A

activate stellate cells

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20
Q

endothelin 1

A

stimulate contraction of stellate cells

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21
Q

TGF-beta

A

stimulate fibrogenesis

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22
Q

canonical principle

A

necrosis of hepatocytes
to myofibroblasts

leads to liver fibrosis

23
Q

NO

A

vascular relaxation and stellate cell apoptosis

24
Q

angiogenesis in cirrhosis

A

increased sinusoid vessls with cirrhosis
-micro and macronodules form

could theoretically serve as portal pressure reducing shunts

25
Q

acute liver injury

A

apoptosis of hepatocytes

minor - can regenerate

major - loss of hepatocytes

canals of hering - liver progeneritor cells

genesis signaling - hedgehog, Wnt, hedgehog

26
Q

portal HTN

A

with fibrosis and sinusoid remodeling

also low NO, increased vasoconstrictors, and endothelial dysfunction

27
Q

micronodular

A

less than 3mm

28
Q

macronodular

A

greater than 3mm

29
Q

nodules

A

regenerating hepatocytes

30
Q

bridging fibrosis

A

connect portal triads and centrilobular hepatocytes

-create islands of regeneration

31
Q

liver cords two cells thick

A

presumptive of regeneration

32
Q

portal HTN

A

increase portal venous pressure 8-10mmHg or hepatic vein/portal vein gradient >5mmHg

see collaterals open - esophageal varices, hemorrhoids, caput medusa

33
Q

portal HTN path

A

2/3 structural - sinusoid resistance

1/3 dynamic - increased portal venous flow
-uncleared got bacteria - produce NO

34
Q

result of portal HTN

A

ascites
portosystemic shunts
congestive splenomegaly
hepatic encephalopathy

35
Q

pre-hepatic portal HTN

A

portal or splenic vein occlusion

36
Q

intra-hepatic portal HTN

A

pre-sinusoid - schistosomiasis, sarcoidosis
sinusoidal - cirrhosis, alcoholi hepatitis
post-sinusoid - veno-occlusive disease, pyyrolizidine

37
Q

pyrollizidine

A

ca lead to post-sinusoid intrahepatic portal HTN

38
Q

post -hepatic portal HTN

A

right side HF
constrictive pericarditis
hepatic vein outflow obstruction - budd chiari - 2 veins needed**

39
Q

most common cause of portal HTN

A

cirrhosis

40
Q

falciform ligament with abdominal wall collaterals

A

caput medusa

41
Q

most problematic shunt

A

esophageal varices

42
Q

esophageal and azygous veins

A

esophageal varices

43
Q

between superior rectal vein and lower rectal veins

A

hemorrhoids

44
Q

between paraumbilical veins and abdominal epigastric veins

A

caput medusa

45
Q

between colic veins and retroperitoneal veins

A

portosystemic shunt

46
Q

splenomegaly

A

can occur in splenomegaly
-hypersplenism

leads to pancytopenia

47
Q

gamna gandy bodies

A

microscopic foci of fibrotic iron laden nodules in splenic parenchyma

-with splenomegaly due to portal HTN

48
Q

ascites

A

excess fluid in abdomen

commonly due to cirrhosis

49
Q

path of ascites

A

sinusoid HTN

sodium and water retention

vasodilation of splanchnic circulation - RAAS system - increased ADH

50
Q

peritoneal ascites

A

carcinoma - tuberculosis

see high protein

51
Q

non-peritoneal ascites

A

cirrhosis and heart failure

see low protein (but albumin still in ascitic fluid

52
Q

spontaneous bacterial peritonitis

A

ascites pt with fever, abdominal pain

E. coli and s. pneumonia

53
Q

hydrothorax

A

more common on right - right pleural effusion

can occur with ascites

GI II Exam 1 (29 decks)

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