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GI Final > Pathology of Acute and Chronic Liver Failure and Cirrhosis (Quiz 3) > Flashcards

Pathology of Acute and Chronic Liver Failure and Cirrhosis (Quiz 3) Flashcards

1
Q

what’s the most common cause of acute liver failure

A
  • Tylenol (acetaminophen) overdose
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2
Q

cirrhotic causes of chronic liver failure

A
  • alcohol
  • viral hepatitis
  • steatohepatitis
  • autoimmune/bilary
  • genetic/metabolic
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3
Q

two types of hepatotoxic drugs

A
  • intrinsic (acetaminophen)

- idiosyncratic

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4
Q

how can acetaminophen be toxic

A
  • metabolism by cyto P450 produces NAPQI (toxic)
  • generally conjugated with glutathione but in high doses will deplete glutathione stores and cause cell death in the hepatocyte
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5
Q

how to treat Tylenol overdose

MOA

A
  • N-acetylcysteine (NAC)

- replenishes depleted glutathione stores

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6
Q

effect on chronic alcoholism with taking tylenol

A
  • induces cytochrome P450
  • creates more toxic metabolite
  • chronic alcoholics suffer liver injury at a lower toxic dose
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7
Q

the hepatocytes nearest the ______ are perfused by blood having the highest level of oxygen and nutrients

A
  • nearest the portal area

- Zone 1

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8
Q

which zone of hepatocytes are relatively hypoxic and malnourished and more sensitive to hepatotoxic injury

A
  • zone 3
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9
Q

which zone of hepatocytes are damaged during moderate acetaminophen overdose

what about with severe acetaminophen toxicity

A
  • zone 3

- all zones

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10
Q

why could PT/INR be high when albumin is normal

A
  • albumin has a much longer half life than coagulation factors
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11
Q

what do dead hepatocytes due to acetaminophen toxicity look like

A
  • bright pink (eosinophilic)
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12
Q

threshold for acetominophen toxicity in adults is how much

A

10-15 g

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13
Q

pathologic findings for cirrhosis

A
  • thick fibrous bands

- regenerative nodules

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14
Q

why might you have splenomegaly with cirrhosis

A
  • increased portal venous back pressure transmitted to splenic veins
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15
Q

what size is the liver with cirrhosis

A
  • smaller
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16
Q

what helps facilitate rapid exchange of nutrients between hepatocytes and sinusoids

A
  • pores in endothelial cytoplasm of sinusoid

- absence of sub endothelial basement membrane

17
Q

what happens to the hepatocytes and sinusoids during cirrhosis

A
  • loss of pores in sinusoid endothelium
  • sub endothelial basement membrane develops
  • stellate cells develop myofibroblastic phenotype that forms collagen in space of Disse
18
Q

why do varices form

A
  • shunt from the obstructed portal circulation to the systemic circulation
19
Q

prehepatic non-cirrhotic causes of chronic liver failure

A
  • portal vein thrombosis

- blockage in an inflow vein

20
Q

what symptoms of portal vein thrombosis do you see

A
  • signs of portal hypertension
  • esophageal varices
  • splenomegaly
21
Q

what else can cause portal vein thrombosis

A
  • sluggish blood flow in a patient with cirrhosis
22
Q

intrahepatic non-cirrhotic causes of chronic liver failure

A
  • amyloidosis
23
Q

what do you see on histology with amyloidosis

best way to check for amyloidosis

A
  • amyloid proteins
  • atrophic hepatocytes
  • stain with Congo red
24
Q

splenic enlargement in amyloidosis is caused by

A
  • protein deposition
25
Q

post hepatic non-cirrhotic causes of chronic liver failure

A
  • hepatic vein/IVC thrombosis (Budd-Chiari)
  • constrictive pericarditis
  • right heart failure
26
Q

what is Budd-Chiari

what happens

A
  • thrombotic occlusion of hepatic vein or IVC
  • blocked exit of blood from liver
  • back pressure of blood damages the liver
27
Q

difference between hepatic vein thrombosis and hepatic portal vein thrombosis

A
  • hepatic vein thrombosis causes liver injury
28
Q

how can constrictive pericarditis and right heart failure causes posthepatic portal hypertension

A
  • heart can’t handle blood returning form the liver

- increase in hepatic venous back pressure

29
Q

what do you see histologically with Budd-Chiari syndrome

A
  • centrilobular congestion with red blood cell lesions
30
Q

what effect on the liver size does Budd-Chiari have

what about the spleen

A
  • hypertrophy of the caudate lobe

- splenomegaly from portal hypertension

31
Q

another name for right sided heart failure causing portal hypertension

A
  • congestive hepatopathy
32
Q

what do you see on gross findings with congestive hepatopathy

A
  • nutmeg liver

GI Final (27 decks)

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