P27 - Hepatobiliary and Exocrine Pancreas Flashcards
functional subunit of liver parenchyma
- hepatic lobule
space of Disse
- perisinusoidal space between sinusoid and hepatic plate
- hepatic stellate cells present
function of hepatic stellate cells (2)
- storage for Vit A
- response to hepatic injury by producing collagen (hepatic fibrosis)
kupffer cells function
- remove infectious agents, endotoxins, immune complexes, senescent cells, particulate debris, and other substance from portal blood that drains GI tract
how do kupffer cells function immunologically
- antigen-presenting cells and initiators of cytokine signaling
bile flows in what direction compared to blood
- opposite
what part of the hepatocyte has the least oxygenated blood and what is it susceptible to
- surrounding central veins (zone 3)
- hypoxic injury
bilirubin comes from the breakdown of what
- heme
bile acid metabolism (synthesis and excretion)
- synthesized in liver and excreted into gallbladder
portals of entry into hepatocytes (4)
- direct extension (penetrating trauma)
- hematogenous spread
- retrograde biliary infection
- retrograde pancreatic ductular infection
describe random pattern of hepatocellular degeneration and necrosis
- multifocal areas of degeneration and necrosis scattered randomly throughout the liver with no predictable lobular pattern
- hematogenous route of entry
- embolic pattern
describe zonal pattern of hepatocellular degeneration and necrosis
- specific areas of degeneration and necrosis that are restricted to particular portion of hepatic lobule
zones of hepatic lobule (3)
- zone 1 - periportal
- zone 2 - mid-zonal
- zone 3 - centrilobular
cause of random pattern of hepatocellular degeneration and necrosis
- blood-borne infectious agents (viruses, bacteria, protozoa)
cause of zonal pattern of hepatocellular degeneration and necrosis (3)
- hypoxic injury
- zonal hepatitis
- hepatotoxicities
cytochrome P450 enzyme converts drugs or chemicals into what
- toxic metabolites
three causes of hyperbilirubinemia
- hemolytic disease (prehepatic)
- liver failure (hepatic)
- cholestatic disease (posthepatic)
how does hemolytic disease lead to hyperbilirubinemia
- hemolysis leads to accumulation of bilirubin in blood
- exceeds liver capacity to remove bilirubin from blood
how does liver failure lead to hyperbilirubinemia
- hepatic dysfunction leads to failure of hepatocytes to uptake bilirubin from blood
cholestasis is the reduced…
- outflow of bile
cholestatic disease can occur in what 2 ways
- extrahepatic
- intrahepatic
what causes acholic feces
- complete obstruction of outflow of bile leads to maldigestion of fats and clay-colored feces
response of liver to injury (3)
- regeneration
- fibrosis
- biliary hyperplasia
what components of the liver can regenerate
- all components
chronic and sever in jury of liver many lead to
- end-stage liver (cirrhosis)
hepatic fibrosis occurs in response to
- chronic injury and repeated injury or chronic inflammation
biliary hyperplasia predominantly occurs with what
- disease that causes biliary inflammation, obstruction and cholestasis
pathophysiology of end stage liver (Cirrhosis)
- diffuse process in liver characterized by severe fibrosis and replacement of normal hepatic lobules with nodular regeneration and abnormal vasculature
what percentage of hepatic parenchyma can be removed without significant impairment of function
- 75%
congenital abnormalities of the liver (3)
- biliary cysts
- ductal plate malformations
- portosystemic shunts
predisposed breeds to congenital polycystic disease
- cairn terriers
- west highland white terriers
- bull terriers
- persian cats
ductal plate malformations also known as
- congenital hepatic fibrosis
clinical signs of ductal plate malformations
- young dog with chronic progressive liver failure
- portal hypertension, ascites, icterus, end-stage liver disease
breeds predisposed to ductal plate malformations
- young dogs
- boxers
acute hepatitis results in what liver lesion
- embolic pattern which is randomly multifocal
liver disorder that is most common in vet med
- chronic hepatitis
chronic hepatitis characterized by
- fibrosis, mononuclear inflammatory cells, hepatocellular loss, nodular regeneration and structural remodeling of hepatic lobule and vasculature
chronic hepatitis occurs with
- chronic persistent antigenic stimulus (infections, immune mediated disease, metabolic disease, toxins, drugs)
nonspecific reactive hepatitis is due to
- livers response to systemic inflammation, most likely from GI disease
cholangitis definition
- inflammation of biliary ducts
neutrophilic cholangitis caused by
- infectious
- caused by ascending bacterial infection
lymphocytic cholangitis caused by
- chronic, immune-mediated biliary disease of cats
cholangiohepatitis caused by
- extension of bacterial cholangitis into surrounding periportal parenchyma
cholangiohepatitis is inflammation of
- biliary ducts and extension of inflammation into surrounding liver parenchmya
which of the following causes greater elevation of serum ALT:
- acute hepatitis
- chronic hepatits
- nonspecific reactive hepatitis
- cholangitis
- cholangiohepatitis
- cholangiohepatitis
which of the following may cause mild elevation of serum ALT and ALP:
- acute hepatitis
- chronic hepatits
- nonspecific reactive hepatitis
- cholangitis
- cholangiohepatitis
- nonspecific reactive hepatitis