Liver Path III Flashcards
consequences of cirrhosis, male
hepatic encephalopathy
esophageal varices
splenomegaly
consequences of cirrhosis, females
oligomenorrhea, amenorrhea, sterility, hypogonadism
jaundice
yellow staining of membranes by bilirubin
cholestasis
inability to excrete bile
bile salts
can lead to pruritis - itching
also malabsorption of fats - no Vit K dependent clot factors
cholesterol retention
eruptive xanthomas - periorbital or tendinous
canal of hering
travel of bile - to portal tract
small ductule cholangioncytes
canal of hering
imflammation/proliferation
large ductule cholangiocytes
volume/alkalinity
cholestasis and parenchyma
enlarged hepatocytes, dilated canalicular spaces, apoptotic cells, kupffer cells present
portal tract and cholestasis
edema, bile pigment retention, neutro inflammation
UDP
uridine diphosphatase - conjugates bilirubin with glucuronic acid
unconjugated bilirubin
binds albumin
-not excreted in kidney
conjugated bilirubin
does not bind albumin - lost in urine
urobilinogen
brown color of stool and yellow color of urine
choluria
dark urine
pale stool
in cholestasis
-no bilirubin to darken stool - stercobilinogen
unconjugated hyperbilirubinemia
hemolysis
gilbert
crigler najjar
mixed hyperbilirubinemia
look at AST, ALT, alk phos, and GGT
high AST, ALT - hepatic
high alk phos and GGT - cholestatic
AST < ALT
viral serology
AST > ALT
alcoholic liver disease
20-30yo with black liver
dubin johnson
high conjugated bilirubin
dubin johnson
rotor syndrome
gilbert
shortage of enzyme
-jaundice under stress
unconjugate bilirubin high
crigler najjar type 1
no enzyme
-kerniceterus - levels >20
bad
unconjugated bilirubin high
crigler najjar type 2
some enzyme
bilirubin 6-20
unconjugated bilirubin high
bilirubin in urine
always pathological - detected on dipstick
delta-bilirubin
in plasma bound to albumin
not measured
longer half life
this is why after hepatitis starts to resolve or obstruction treated - conjugated levels take some time to return to normal
neonatal jaundice
cannot conjugate 2 weeks old
physiologic jaundice of newborn that goes away
-unconjugated
worse with breast feeding deconjugating enzymes in milk
alpha1 antitrypsin deficiency
can cause neonatal jaundice
neonatal jaundice causes
biliary atresia - require surgery
non-biliary disorders - alpha1 antitrypsin deficiency
idiopathic
panlobular giant cell transformation of hepatocytes
neonatal hepatitis
biliary atresia
jaundice before 8 weeks old in neonate
-elevated conjugated**
two forms - fetal and perinatal
fetal biliary atresia
aberrant intrauterine development of biliary tree - situs inversus, congenital heart disease
perinatal biliary atresia
most common**
bile ducts destroyed after birth - unknown etiology
type 1 - common duct
type 2 - right or left hepatic bile duct
type 3 - common - above porta hepatis - not correctable**
cholestasis histo
zone 3 bilirubin in hepatocytes and bile canaliculi
zone 1 ductule proliferation and fibrosis
large bile duct injury
classically obliterative cholangitis
immunohisto stain IgG4 positive plasma cells surrounding bile duct
ampulla of vater
bile ducts dump into duodenum
acute jaundice
flu-like, RUQ pain, acholic stool, choluria, pruritis, eruptive jaundice, encephalopathy
chronic jaundice
cirrhosis
portal HTN, ascites, variceal hemorrhage
spider angiomata
chronic jaundice - estrogenic
ALT/AST measure of hepatocyte integrity
viral infection - destroy hepatocyte
cirrhosis - can have normal levels
most common cause of elevated AST/ALT
NASH
AST:ALT greater than 1
more likely alcohol
and never >500
greater than 300 - consider infection, toxic insult
more specific indicator
ALT
GGT
specific to liver
can isolate liver as source of problem
mild increase in GGT
more than 3 drinks/day
alk phos and GGT
induced enzymes
albumin
measure of hepatocyte function
-half life 20 day - slow changes
protime
measure of hepatocyte function
must rule absorption of vit K factors**
IgA
alcoholic liver disease
IgM
primary biliary cirrhosis
IgG
autoimmune hepatitis
liver biopsy
gold standard
cholestasis - ultrasound
hepatitis - lab tests
child pugh score
used in chronic liver disease - cirrhosis
class determines one and 3 year survival - based on looking at bilirubin, albumin, PT, ascites, and hepatic encephalopathy
