PATH - Liver Disease

Question 1

Hepatic steatosis

Answer 1

Alcoholic liver disease

*Macrovesicular fatty change that may be *reversible with alcohol cessation

Question 2

Alcoholic hepatitis

Answer 2

Alcoholic liver disease

Requires sustained, long-term consumption

Swollen and necrotic hepatocytes with
neutrophilic infiltration.

*Mallory bodies

Make a toAST with alcohol:
*AST>ALT (ratio usually > 2:1).

Question 3

Alcoholic cirrhosis

Answer 3

Final and irreversible form.

Micronodular, irregularly shrunken liver with *“hobnail”
appearance.

Sclerosis around central vein (zone III)

Manifestations of chronic liver disease (eg, jaundice,
hypoalbuminemia).

Question 4

Non-alcoholic fatty liver disease

Answer 4

Metabolic syndrome (insulin resistance)

obesity–>fatty infiltration of hepatocytes–>cellular “ballooning” and eventual necrosis.

*ALT > AST (Lipids)

May cause cirrhosis and HCC.

Independent of alcohol use

Question 5

Hepatic encephalopathy

Answer 5

Cirrhosis–>portosystemic shunts–>DEC NH3 metabolism–>neuropsychiatric dysfunction

SX: Spectrum from disorientation/asterixis (mild) to difficult arousal or coma (severe)

TX: lactulose (NH4+ generation) and rifaximin or neomycin (NH4+ producing gut bacteria).