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GI Week 5 > Liver Path- Nelson > Flashcards

Liver Path- Nelson Flashcards

1
Q

Define jaundice

A

Yellow discoloration of the skin due to retention of bilirubin

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2
Q

Defice icterus

A

Yellow discoloration of the sclera due to retention of billirubin

*earliest sign of jaundice

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3
Q

Define cholestasis

A

Impaired secretion of bile

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4
Q

What cells are responsible for taking RBCs out of circulation to break them down? Then what happens?

A

Reticuloendothelial cells (macrophages)

Many located in spleen

Break down hemoglobin into: heme + globin

Globin = protein, so broken down to amino acids

Heme = broken down into Fe and protoporphyrin

Fe = recycled

Protoporphyrin is converted to unconjugated bilirubin

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5
Q

What protein transports bilirubin to the liver?

A

Albumin

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6
Q

What gets conjugated to bilirubin in the liver?

A

Glucuronic Acid

*makes CONJUGATED BILIRUBIN

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7
Q

What enzyme is responsible for conjugating bilirubin?

A

UDP-glucuronyl-transferase

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8
Q

Is unconjugated bilirubin able to be excreted in the urine?

A

NO!!!! it is water INSOLBULE so it cannot get excreted

It is bound to albumin
Toxic to tissues

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9
Q

How is conjugated bilirubin excreted? Is it soluble?

A

It is SOLUBLE
-Conjugated in hepatocytes

  • Canicular transport protein transfers it to bile caniculi
  • Goes into bile ducts, and released into duodenum
  • Intestinal flora convert it to urobilinogen
  • 80% is excreted in feces = WHY YOUR POOP IS BROWN!!
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10
Q

How much total serum bilirubin is needed to produce jaundice?

A

2-3 mg/dL

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11
Q

Which form of bilirubin is toxic to tissues?

A

Unconjugated bilirubin

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12
Q

Potential causes of unconjugated hyperbilirubinemia?

A
  • Extravascular hemolysis
  • Jaundice of newborn
  • Gilbert Syndrome
  • Crigler-Najjar Syndrome
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13
Q

Potential causes of conjugated hyperbilirubinemia?

A
  • Dubin-Johnson Syndrome

- Obstructive jaundice

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14
Q

What would cause an increase in BOTH conjugated and unconjugated bilirubin?

A

Viral hepatitis!

Inflammation disrupts hepatocytes and small bile ductules

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15
Q

Why do newborns sometimes get jaundice?

A

Newborn liver has transiently low UGT activity

Leads to high unconjugated bilirubin

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16
Q

What is a severe complication of jaundice in a neonate?

A

UCB is fat soluble and can deposit in the basal ganglia = KERNICTERUS

Leads to neurological damage and death

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17
Q

What is treatment for neonatal jaundice?

A

Phototherapy

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18
Q

Does phototherapy conjugate bilirubin???

A

NO!!!!!!!!!!!!!!!!!!!!
It transforms unconjugated bilirubin to a water soluble form so it can be excreted in the urine….. BUT IT DOES NOT CONJUGATE IT!

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19
Q

What is Gilbert’s Syndrome?

A

Mildly low UGT activity

Leads to increased unconjugated bilirubin (

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20
Q

What is Crigler-Najjar Syndrome?

A

ABSENCE of UGT in fetus

Leads to increased unconjugated bilirubin

Kernicterus = usually fatal

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21
Q

What is Dubin-Johnson Syndrome?

A

Deficiency of bilirubin canalicular transport protein

Increased CONJUGATED bilirubin

Liver is DARK, otherwise not clinically significant

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22
Q

What syndrome produces a DARK LIVER and no other clinically significant consequences?

A

Dubin-Johnson Syndrome = deficiency of bilirubin canalicular transport protein

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23
Q

Morphological findings in hepatocellular cholestasis

A
  • Bile with-in hepatocytes
  • Canalicular bile stasis
  • Feathery degeneration of hepatocytes
24
Q

What is ascending cholangitis?

A

Secondary bacterial infection of the biliary tree due to extrahepatic biliary obstruction

25
Q

Morphologic findings in canalicular cholestasis?

A
  • Canaicular bile stasis
  • Feathery hepatocytes
  • Bile with-in distended bile ducts
  • Bile duct proliferation with in portal tracts
26
Q

Which 2 hepatitis viruses are transmitted fecal-oral?

A

Hep A
Hep E

The vowels hit your bowels

27
Q

What does carrier state mean in regards to hepatitis?

A

Persistent hepatitis infection without significant ongoing necroinflammatory disease

Typically occurs as a result of exposure at childbirth (perinatal transmission)

28
Q

What hepatitis virus must be encapsulated by HBV to be infective?

A

Hep D

-defective ssRNA virus

29
Q

Difference between superinfection and coinfection?

A

Superinfection = HDV infects individual with chronic HBV infection

Co-infection= Hep D is transmitted simultaneously with Hep B (infected at same time)

30
Q

Which is worse, superinfection or coinfection?

A

Superinfection!

31
Q

What causes hepatocellular injury in hepatitis infeciton?

A

Patient’s cellular immune response

CD8+ T cells

Subsequent lysis of infected cells

32
Q

Which hepatitis viruses can cause chronic disease?

A

Hep B
Hep C
Hep D (with Hep B infection)

consonants can cause chronic hepatitis!

33
Q

What viruses can cause viral hepatitis?

A

Hepatitis Viruses (A, B, C, D, E)
EBV
CMV

34
Q

When is acute viral hepatitis defined as chronic viral hepatitis

A

When symptoms last > 6 months

35
Q 
Jaundice
Dark urine
Fever
Malaise
Nausea
Elevated liver enzymes
ALT>AST

What do you think it is?

A

Acute Hepatitis!

Jaundice- increased CB and UCB!

Dark urine- increased CB

36
Q

Is acute viral hepatitis frequently biopsied?

A

Nope!

37
Q

Pathological findings associated with acute viral hepatitis?

A

Lobular hepatits:

  • Diffuse liver cell degeneration w/ necrosis & apoptosis
  • Kupffer cell hyperplasia
  • Mononuclear (predominately lymphocytes) with in portal tracts and lobules
38
Q

Why is it sometimes necessary to perform a liver biopsy in chronic viral hepatitis?

A

Often required for assessing the degree of liver damage

-clinical findings of chronic viral hepatitis are highly variable

39
Q

Pathologic findings in chronic viral hepatitis?

A

Periportal hepatits with piecemeal necrosis

Bridging necrosis

Progressive fibrosis leading cirrhosis

40
Q

What pathologic clue can be seen on liver biopsy that would suggest chronic HBV infection?

A

Ground glass hepatocytes

41
Q

Do patients with acute massive hepatic necrosis always get cirrhosis?

A

Nope!

Clinically suffer acute liver failure- acute toxic agent causes no fibrosis

Reticulin framework is intact, liver can regenerate without much architectural distortion

42
Q

How is perinatal HBV prevented?

A

Treat with Hep B immune globulin (HBIG) and Hep B vaccine 2-12 hours after birth

85-95% effective in preventing development of HBB chronic carrier state

43
Q

Define autoimmune hepatitis

A

Liver injury due to a T-cell mediated autoimmune pathogenesis

44
Q

Treatment for autoimmune hepatitis?

A

Immunosuppressive agents (steroids)

45
Q

Define cirrhosis

A

End stage liver damage characterized by disruption of the normal hepatic parenchyma by bands of fibrous and regenerative nodules of hepatocytes.

46
Q

Most common cause of cirrhosis?

A

Alcoholic liver disease (60-70%)

47
Q

3 complications associated with cirrhosis?

A

Hepatic Failure
Portal Hypertension
Hepatocellular carcinoma

48
Q

Most common cause of acute liver failure?

A

Acetaminophen overdose (50% of cases)

49
Q

Most common cause of chronic liver failure?

A

Chronic liver disease associated with cirrhosis

50
Q

Who gets reye’s syndrome?

A

Children and teenagers following a viral infection that was treated with aspirin

51
Q

What is reye’s syndrome?

A

Rare, often fatal childhood hepatic encephalopathy

52
Q

What is found on liver biopsy for Reye’s syndrome?

A

Microvesicular steatosis

Widespread mitochondrial injury

53
Q

Most common cause of portal hypertension?

A

Liver cirrhosis

54
Q

Four main complications of portal hypertension

A
  1. Ascites
  2. Portosystemic shunts (anastamoses- esophageal varices)
  3. Splenomegaly (congestive)
  4. Hepatic Encephalopathy
55
Q

Complication of portal vein thrombosis?

A

Portal hypertension

But as obstruction is often before the liver, ascites does not typically occur

56
Q

Which two Hepatitis viruses are non-enveloped?

A

A and E

GI Week 5 (12 decks)

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