Liver Pathology 2 Flashcards
Fibrous deposition in alcoholic steatosis begins where in hepatocyte
around central vein
Non-alcoholic fatty liver disease/hepatic steatosis is most often due to
metabolic diseases
DM, hyperlipidemia, obesity
insulin resistance –> steatosis
Primary biliary cirrhosis
autoimmune destruction of intrahepatic bile ducts (extrahepatic bile ducts are spared)
AMA + disease
anti-mitochondrial antibody
primary biliary cirrhosis
Secondary biliary cirrhosis
etiologies
prolonged extrahepatic bile duct obstruction
Primary sclerosing cholangitis
association
ulcerative colitis
Primary sclerosing cholangitis
pathology
autoimmune fibroinflammatory destruction of intrahepatic AND extrahepatic bile ducts
fibrous plugs in place of bile ducts in portal canal
Complications of primary sclerosing cholangitis
strictures of bile ducts at different locations
Hemochromatosis
pathology
mutation of HFE gene
hepcidin not produced when iron is high
ferroportin not degraded on apical surface of intestinal epithelium
excess iron absorbed
Skin in hemochromatosis
slate gray skin
hemosiderin and malnin buildup in dermal macrophages
Where does Fe build up in hemochromatosis
1˚: periportal hemosiderin
2˚: in Kuppfer cells
Bronze diabetes
hemochromatosis DM + skin pigmentation
also cirrhosis
Screening for hemochromatosis
fasting transferrin saturation
diagnostic: liver Bx w/ quantitative Fe
Wilson’s disease mutation
ATP7B mutation
cannot get Cu into bile
so cannot excrete
Test results in Wilson’s
decreased ceruloplasmin
increased urinary Cu
Liver disease in A1AT deficiency
not in null-null: no A1AT produced, so does not build up
mutated protein –> builds up (ZZ and MM homozygotes)
Mechanisms of drug-induced hepatotoxicity
direct hepatotoxicity (dose-dependent) unpredictable/idiosycratic: unpredictable
Budd-Chiari syndrome
hepatic vein thrombosis
hepatomegaly, ascites, abdominal pain
Granulomatous hepatitis
possible etiology
sarcoid
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
in pre-eclampsia
BM transplants and liver
graft vs host
sinusoidal obstructive syndrome
ALT and AST
information
hepatocyte damage
ALT > AST more specific for liver damage
Alkaline phosphatase
information
cholestasis/damage to bile duct epithelium
also due to bone pathologies
GGT
information
when alkaline phosphatase may be due to bone disease
