Pathology 1 Flashcards
What are the normal roles of the liver?
protein synthesis
bilirubin metabolism and excretion
metabolism of lipids, carbs, AAs, and vitamins
storage of vitamins, glycogen, etc.
What is normally contained in the Space of Disse?
small amounts of collagen type IV, basement membrane proteins, minimal amounts of interstitial or fibril forming collagens
stellate cells - storage, can respond to stimuli to proliferate and become myofibroblast-like
What are ballooning and feathering/foamy?
hepatocellular degeneration - look similar but feathery only in cholestasis
What are the roles of lipofuscin pigment and metals (iron and copper) in liver injury?
can accumulate - Prussian blue stains for hemosiderin or iron, Rhodanine stains for copper
What are the different forms of inflammation or hepatitis?
mononuclear
acute
mixed
granulomatous
How does the process of regeneration begin?
oval cells in canals of Hering are reserve cell compartment for this and metaplastic ductular proliferation
What can cause hepatocellular degeneration?
hypoxia, ROS, NO, bile acids, toxins, TNFalpha, immune processes and inflammation
When does jaundice ensue?
when bilirubin levels exceed 2-3 mg/dl
What are hereditary disorders associated with primarily conjugated hyperbilirubinemia?
Dubin-Johnson and Rotor syndrome
What syndromes present with unconjugated hyperbilirubinemia?
Crigler-Najjar, Gilbert
What is Gilbert syndrome?
mild fluctuating unconjugated hyperbilirubinemia due to decreased hepatocyte, bilirubin UDP-glucoronyl transferase activity
unremarkable clinical course
What changes are seen in cirrhosis?
loss of material exchange between blood and hepatocytes, loss of microvilli, sinusoids become vascular channels, vascular shunts between hepatic arterial, portal venous, and hepatic venous circulations
Which two types of cirrhosis look different than the others?
biliary tract diseases - nodules not as uniform and round
cardiac - starts as central vein associated, then bridging between central veins
What are the major causes of cirrhosis?
chronic viral hepatitis
alcoholic or nonalcoholic steatohepatitis
autoimmune diseases
iron overload
What are the features of portal HTN?
portal-systemic vascular shunts
ascites
congestive splenomegaly
What are the four places that portal-systemic vascular shunts happen?
intrahepatic
gastroesophageal - varices and portal gastropathy
periumbilical - caput medusae
hemorrhoids
What are the outcomes of viral hepatitis?
asymptomatic inf
symptomatic acute inf - anicteric or icteric dz, fulminant hepatitis
resolution and recovery
chronic hepatitis with or without progressive liver dz
What happens during acute symptomatic hepatitis?
inflammation - portal and interface between portal tracts and parenchyma Kupffer activation and proliferation cell degeneration +/- cholestasis lobular disarray regeneration
What causes the symptoms and pathology of viral hepatitis?
immune response - cytotoxic t cells destroy virally infected liver cells
What are liver biopsies used for in chronic hepatitis?
confirm histologic features of viral hepatitis
evaluate grade of inflammation and cell injury
evaluate stage of fibrosis present
can help guide treatment
