Pathology- Acute Liver Injury 2 Flashcards
What is the most common cause of acute liver injury?
alcohol
who gets alcoholic hepatitis and how do they present?
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
microscopic findings of acute liver injury?
1) ballooning degeneration
2) steatosis
3) mallory bodies
4) feathery degeneration
5) apoptosis
6) acute inflammation
what are some other common manifestations of alcoholic hepatitis?
1) bleeding tendency– diagnosied by prolonged PT or INR
2) confusion or worse hepatic encephalopathy
3) fever
what is the ratio of AST/ALT normally? how is it different in alcohol?
- 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
what is ballooning degenration?
- 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
what is steatosis?
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
macrovesicular steatosis is d/t what?
- 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
what causes microvesicular steatosis?
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
is microvesicular steatosis reversible?
- microvesicular steatosisi is less common and less reversible than macrovesicular.
* dont get aspirin to children!
greatly enlarged defective mega mitochondria associated with
microvesicular steatosis
what are mallory bodies?
causes of it?
- 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
microscopic triad of alcoholic hepatitis
-steatosis, mallory bodies, and neutrophils
feathery degeneraiton what is it and what does it indicate?
- 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
what causes NASH and how does it differ from nonalcoholic steatohepatitis?
- obesity causes liver disease almost identical to alcohol called NASH
- NASH tends to be milder than alcoholic hepatitis and to lack cholestasis
what is feathery degeneration associaed with?
- biliary obstruction by stones, tumors, or granulomas
which hepatocytes get more feathery degeneration?
- periportal hepatocytes more so than centrolobular and midzonal hepatocytes
- when is GGT elevated?
- ggt is elevated by both biliary and hepatocellular disease so it is less helpful in differentiating them than with alk phos
what is the most common form of cell death in hepatic viral infections?
- apoptosis
finding hepatocyte injury and necrosis in alcoholic steatohepatitis is msot common in what type of hepatocytes?
centrolobular zone
