Pathology- Acute Liver Injury 2

Question 1

What is the most common cause of acute liver injury?

Answer 1

alcohol

Question 2

who gets alcoholic hepatitis and how do they present?

Answer 2

40-60yo w/ rapid onset of jaundice, moderately elevated AST <300 and mildly elevated ALT.

tender enlarged liver with moderately elevated bilirubin, alk phosphate, and AST

• leukocytosis

Question 3

microscopic findings of acute liver injury?

Answer 3

1) ballooning degeneration
2) steatosis
3) mallory bodies
4) feathery degeneration
5) apoptosis
6) acute inflammation

Question 4

what are some other common manifestations of alcoholic hepatitis?

Answer 4

1) bleeding tendency– diagnosied by prolonged PT or INR
2) confusion or worse hepatic encephalopathy
3) fever

Question 5

what is the ratio of AST/ALT normally? how is it different in alcohol?

Answer 5

• normally the ratio is around 1.15

most causes of acute liver injury release more ALT than ast so you have a ratio <1

• w/ alcohol there is more ast than alt so ration is >2

Question 6

what is ballooning degenration?

Answer 6

• hepatocytes become swollen with almost clear cytoplasm from from any injury that depletes ATP causing the Na/K pump to fail w/ influx of Na and h20 into the cells

** it is reversible

Question 7

what is steatosis?

Answer 7

fatty change - fat accumulation in hepatocyte cytoplasm seen in many liver disease

1) macrovesicular - single cytoplasmic lipid droplet pushing nucleus to the side
2) micro-vesicular

Question 8

macrovesicular steatosis is d/t what?

Answer 8

• decreased lipoprotein synthesis w/ impaired secretion of lipids

* more common form of steatosis and seen in alcoholic liver disease, nonalcoholic steatohepatitis, and with glucocorticoids

*Reversible

Question 9

what causes microvesicular steatosis?

Answer 9

d/t impaired mitochondiral beta oxidation of FA for ATP synthesis

* seen in acute fatty liver of pregnancy, reye’s syndrome (aspirin toxicity), w/ multiple hornet stings, and mixed with macro-vesicular steatosis in alcoholic hepatitis

Question 10

is microvesicular steatosis reversible?

Answer 10

• microvesicular steatosisi is less common and less reversible than macrovesicular.

* dont get aspirin to children!

Question 11

greatly enlarged defective mega mitochondria associated with

Answer 11

microvesicular steatosis

Question 12

what are mallory bodies?

causes of it?

Answer 12

• aggregates of intermediate filament (cytokeratins). they are granular or ropy, darkly eosinophilic or amphophilic deposits often in a perinuclear location
• alcohol and obesity are the most common causes of it

***hepatocytes with mallory bodies often have ballooning degeneration and are surrounded by neutrophils

Question 13

microscopic triad of alcoholic hepatitis

Answer 13

-steatosis, mallory bodies, and neutrophils

Question 14

feathery degeneraiton what is it and what does it indicate?

Answer 14

• w/ severe intracellular cholestasis, hepatocytes swell and teh cytoplasm become wispy = feathery degenration
• indicates severe hepatocyte damage and many of the hepatocytes with it will die

Question 15

what causes NASH and how does it differ from nonalcoholic steatohepatitis?

Answer 15

• obesity causes liver disease almost identical to alcohol called NASH
• NASH tends to be milder than alcoholic hepatitis and to lack cholestasis

Question 16

what is feathery degeneration associaed with?

Answer 16

• biliary obstruction by stones, tumors, or granulomas

Question 17

which hepatocytes get more feathery degeneration?

Answer 17

• periportal hepatocytes more so than centrolobular and midzonal hepatocytes

Question 18

• when is GGT elevated?

Answer 18

• ggt is elevated by both biliary and hepatocellular disease so it is less helpful in differentiating them than with alk phos

Question 19

what is the most common form of cell death in hepatic viral infections?

Answer 19

• apoptosis

Question 20

finding hepatocyte injury and necrosis in alcoholic steatohepatitis is msot common in what type of hepatocytes?

Answer 20

centrolobular zone