Liver Pathology Flashcards
Acetaminophen Overdose
What actually causes the liver damage?
Too much acetaminophen cannot be metabolized by your liver (overwhelms the glutathione). Therefore, the drug is made into NAPQI, a toxic metabolite
Acetaminophen Overdose
How should it be treated?
NAC (N-acetylcysteine)
What is the characteristic histologic marker of autoimmune hepatitis?
Plasma cell infiltrate
“Interface hepatitis” almost always indicates the patient has…
Autoimmune hepatitis
Autoimmune hepatitis
Describe the basic pathology and treatment
Presents as acute or chronic hepatitis. Elevated IgG and gamma globulins and auto-antibodies (ANA, anti SMA). T cell mediated autoimmunity
Treat with immunosuppression (steroids)
Alcohol Fatty Liver Disease
Is it reversible? What causes it?
Generally yes
Short term ingestion of alcohol is most common cause
Alcohol Fatty Liver Disease
How do the cells appear histologically?
Macrovesicular cells (nucleus pushed to the side with lots of fat in cells)
May see pericellular fibrosis
What is Mallory Hyaline? What disease does it indicate?
Large proteinaceous debris in cells
Classic for alcoholic hepatitis
Non Alcoholic Fatty Liver Disease
How might it appear histologically?
Could be identical to alcoholic fatty liver disease
Steatosis
Hepatocyte ballooning
Lobular inflammation
Hemochromatosis
What are the causes?
Hereditary- homozygous recessive mutation
Secondary- excess transfusions or hemolysis
Hemochromatosis
Treatment
Phlebotomy
Chelation
Hemochromatosis
What is the pathological issue?
Iron deposition in parenchymal tissues
Elevated serum iron, ferritin
Elevated risk for hepatocellular carcinoma in setting of cirrhosis
Hemochromatosis
What mutations may be present?
HFE gene mutation (chr 6)
C282Y Homozygote
H63D homozygote
Compound heterozygote for C282Y/H63D
Wilson’s Disease
What is the basic pathological issue?
Copper accumulation in the liver and brain
Autosomal recessive disorder
Wilson’s Disease
Symptoms
Low ceruloplasmin
Neuropsychiatric (Cu deposition in brain)
Kayser Fleischer rings (Cu deposition in eye)
Liver failure
Hemolytic anemia
Wilson’s Disease
How would you diagnose it?
Screening - look for low ceruloplasmin
Check urine copper- should be high in Wilson’s
Liver biopsy and stain for copper
Look for KF rings in eyes
Alpha 1 Antitrypsin Deficiency
What is the genetic mutation commonly associated?
PiZZ
Alpha 1 Antitrypsin Deficiency
What is the basic pathological issue?
Errors in coding sequence to prevent its export from hepatocyte, resulting in cell death, inflammation, fibrosis, cirrhosis
Causes pulmonary emphysema
Alpha 1 Antitrypsin Deficiency
How might this be viewed histologically?
PAS stain will be positive for cytoplasmic globules
Budd-Chiari Syndrome
What is the primary pathological problem and symptoms?
Hepatic vein obstruction/thrombosis
Symptoms: Hepatomegaly Ascites Abd pain Hepatic dysfunction
Budd-Chiari Syndrome
Commonly occurs with what disorders?
Myeloproliferative disorders
Inherited disorders of coagulation (Factor V Leiden)
Budd-Chiari Syndrome
How does the liver appear grossly and on histology?
Large, congested liver
Engorged and congested sinusoids
Centrilobular congestion
Veno-Occlusive Disease
Also known as…?
Sinusoidal obstructive syndrome
Veno-Occlusive Disease
What patients most commonly get this disease?
Bone marrow transplant
Chemotherapy pts
Veno-Occlusive Disease
What is the pathological issue? Symptoms?
Injury to sinusoidal endothelium resulting in occlusion of small hepatic veins
Also get fibrosis and obliteration of the central vein
Hepatomegaly
Weight gain
Jaundice
Acute Fatty Liver of Pregnancy
When is is most likely to occur?
3rd trimester
Acute Fatty Liver of Pregnancy
Describe the histology and pathology of the disorder
Microvesicular fatty infiltration of the liver
Leads to acute liver failure and encephalopathy
Acute Fatty Liver of Pregnancy
Treatment
Need to induce labor ASAP
