Path: Liver Flashcards
What are the 2 main complications from fibrosis of the liver?
(1) Impedes the synthetic and clearing functions of the liver.
(2) Increases resistance in the liver leading to portal hypertension.
What are the stages of fibrosis that lead to cirrhosis?
(1) expansion
(2) formation of septae
(3) bridging of septae
(4) cirrhosis
What is AST?
Aspartate aminotransferase.
What is ALT?
Alanine aminotransferase.
What is GGT?
Gamma-glutamyl transpeptidase.
Where is ALT produced?
The liver predominantly.
Where is AST produced?
Liver, muscle, kidney, heart.
Where is AST most present in the hepatocyte?
The cytoplasm and mitochondria.
Where is ALT most present in the hepatocyte?
The cytoplasm.
What enzyme is most aberrantly elevated in hepatitis?
ALT.
What enzyme is most aberrantly elevated in alcohol-induced liver disease?
AST.
J: This process is responsible for elevated LFTs after hepatocyte injury.
What is cytoplasmic blebbing?
What is unique about the caudate lobe as compared to the other lobes of the liver?
It has direct venous drainage into the inferior vena cava.
In the event of venous outflow obstruction in the liver, which zone will show the earliest signs of congestion?
Zone 3.
What is the course of chronic Budd-Chiari?
(1) The hepatic veins become obstructed.
(2) The non-caudate lobes of the liver become congested and enlarged.
(3) These lobes eventually become fibrotic and atrophy.
(4) To compensate for this functional loss, the caudate lobe undergoes hypertrophy.
What are the initial effects of a hepatic portal vein thrombosis?
Likely nothing. (The spleen may become enlarged.)
What are the long-term effects of a hepatic portal vein thrombosis?
Remodeling and fibrosis may lead to an obliteration of the portal vein and portal hypertension.
What is the most common cause of portal hypertension worldwide?
Schistosomiasis.
What are consequences of obstruction of the hepatic artery?
Bile duct infarction followed by a biloma, a large lesion consisting of spreading biliary contents and necrotic material.
Why is the hepatic bile duct more prone to infarction?
It only receives blood from the hepatic artery.
What is a hepatitic pattern of liver injury?
(1) The portal tracts become infiltrated by lymphocytes and plasma cells.
(2) This infiltrate can spill over into neighboring hepatocytes leading to a sparse lymphocytic infiltrate in the lobules.
(3) ALT and AST become elevated, whereas alkaline phosphatase, GGT, and bilirubin are normal.
(4) Hepatocytes may undergo Fas-mediated apoptosis.
In the liver, what is a limiting plate?
The hepatocytes at the junction of the portal tract and the parenchyma.
Is hepatitis C a DNA or RNA virus?
RNA.
What percentage of individuals with hepatitis C develop chronic hepatitis?
85%.
Which zone in the liver is most likely to be damaged in acetaminophen toxicity? Why?
Zone 3. The metabolic product, NAPQI, is the toxic element and P450 metabolism occurs predominantly in this zone.
What is the pattern of injury in acetaminophen toxicity?
An acute, hepatitic pattern of injury.
What is steatohepatitis?
A fatty liver with hepatocellular death due to the fat. It is usually associated with alcohol abuse.
What is the LFT profile of steatohepatitis?
(1) Elevated ALT and AST
(2) Slightly elevated ALK and GGT
(3) Normal bilirubin
J: This refers to ubiquitinated intermediate filaments in hepatocytes, often associated with steatohepatitis.
What is Mallory’s hyaline?
J: This term describes the character of hepatocellular injury in steatohepatitis.
What is ballooning degeneration?
How does amyloidosis cause portal hypertension?
There is no fibrosis, rather it lines the sinusoids increasing resistance.
What is the LFT profile of amyloidosis?
Normal.
What is the LFT profile of cholestasis?
(1) slightly elevated ALT and AST
(2) extremely elevated ALK and GGT
(3) elevated bilirubin
What is cholestasis?
Bile plugs composed of bilirubin become trapped in the bile canaliculi, reducing bile flow from the liver.
J: This refers to the character of hepatocellular injury in cholestasis.
What is feathering degeneration?
What is suspected when fibrosis of the liver begins in zone 3?
Venous outflow obstruction.
What are complications of cirrhosis?
(1) decreased synthetic and clearing function
(2) portal hypertension
(3) increased risk of hepatocellular carcinoma
What are complications of choledochal cysts?
(1) obstruction of the bile duct through twisting
(2) formation of gallstones
(3) rarely, adenocarcinoma
Is a choledochal cyst a true or pseudo diverticulum?
True.
J: This refers to a cholangiocarcinoma that occurs at the junction of the left and right hepatic ducts.
What is a Klatskin tumor?
What disorders are associated with cholangiocarcinoma?
(1) ulcerative colitis
(2) PSC
What should you look into in the event of intrahepatic choledocholithiasis?
Low-level gram negative bacterial infection in the liver.
What are causes of small-duct biliary disease in an adult?
(1) PBC
(2) PSC
(3) sarcoidosis
(4) graft vs host
(5) drug-induced ductopenia
What is the pathogenesis of PBC?
(1) Abnormal expression and/or antigenic mimicry of the E2 component of pyruvate dehydrogenase on the apical surface of biliary epithelial cells.
(2) Cellular immunologic attack.
(3) Biliary epithelial cell death.
What are the most common associated diseases with PBC?
(1) sicca syndrome
(2) thyroid disease
(3) arthralgia
(4) Raynaud’s syndrome
(5) sclerodactyly
(6) fibrosing alveolitis
Which ducts are at risk in PSC?
Large biliary ducts.
How does PSC appear on ERCP?
Beads on a string.
What is the most common source of metastatic tumors in the liver?
GI.
Is hepatic adenoma a precursor lesion of hepatocellular carcinoma? Bile duct adenoma for cholangiocarcinoma? Hemangioma for angiosarcoma?
No. No. No.
What are the 3 most common liver tumors?
(1) hepatocellular carcinoma
(2) cholangiocarcinoma
(3) hepatoblastoma
