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Year 2 Gastrointestinal > Pathology of the liver I > Flashcards

Pathology of the liver I Flashcards

1
Q

hepatocyte integrity refers to what structure specifically?

A

membrane

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2
Q

why is LDH not as specific for liver damage?

A

RBCs also use LDH

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3
Q

what is the role of albumin?

A

transporter of heme and FAs

maintains blood osmolarity

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4
Q

what enzymes are elevated in response to bile flow blockage?

A

alkaline phosphatase
5-NT
GGT

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5
Q

where are 5-NT and GGT located?

A

bile duct epithelium

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6
Q

which type of bilirubin has conjugated sugars? is it more or less soluble?

A

direct (measured directly in the lab)

more soluble

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7
Q

why is unconjugated bilirubin referred to as indirect?

A

because the value is obtained by subtracting direct from total bilirubin

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8
Q

at what bilirubin levels do you start getting symptoms of jaundice?

A

above 2 mg / dL

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9
Q

what is the normal range for bilirubin?

A

0.1 - 1.0 mg / dL

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10
Q

what are the general mechanisms of jaundice and cholestasis?

A
  1. isolated disorders
  2. liver disease
  3. bile duct obstruction
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11
Q

prehepatic hyperbilirubinemia will involve what type of bilirubin? what is the main cause? what is the mechanism?

A

unconjugated

RBCs

heme gets into macrophages - heme - biliverdin - bilirubin-albumin

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12
Q

where does conjugation of bilirubin occur, specifically?

A

hepatocyte ER

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13
Q

hepatic hyperbilirubinemia will involve what type of bilirubin?

A

unconjugated

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14
Q

posthepatic hyperbilirubinemia will involve what type of bilirubin?

A

conjugated

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15
Q

what enzyme is responsible for conjugation of bilirubin?

A

UGT1A1

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16
Q

which form of bilirubin can be excreted?

A

bilirubin monoglucuronide

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17
Q

what type of bilirubin metabolism errors will result in elevation of unconjugated bilirubin?

A

overproduction
reduced uptake
defective conjugation

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18
Q

what type of bilirubin metabolism errors will result in elevation of conjugated bilirubin?

A

defective excretion

defective secretion

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19
Q

gilbert syndrome and crigler-najjar syndrome involve which general dysfunction in bilirubin metabolism?

A

reduced glucuronyl transferase activity

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20
Q

what is the only autosomal dominant disorder of bilirubin metabolism?

A

crigler-najjar syndrome type II

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21
Q

how is bilirubin metabolism affected by crigler-najjar syndrome type I?

A

absent

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22
Q

how is bilirubin metabolism affected by crigler-najjar syndrome type II?

A

decreased UGT1A1 activity

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23
Q

how is bilirubin metabolism affected by gilbert syndrome?

A

decreased

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24
Q

how is bilirubin metabolism affected by dubin johnson syndrome?

A

impaired biliary excretion of bilirubin glucuronides due to mutation in canalicular multidrug resistance protein 2

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25
Q

what is the liver pathology associated with dubin johnson syndrome?

A

pigmented cytoplasmic globules

BLACK LIVER

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26
Q

which syndrome of bilirubin metabolism is associated with kernicterus?

A

crigler-najjar syndrome type I

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27
Q

what is the liver histology appearance for crigler-najjar syndrome type I?

A

normal

28
Q

when do the crigler-najjar syndromes present?

A

birth

29
Q

what is the liver histology appearance for crigler-najjar syndrome type II?

A

normal

30
Q

what is the most serious consequence of crigler-najjar syndrome type I?

A

kernicterus - unconjugated bilirubin in brain

31
Q

what is the protein defect in dubin johnson syndrome?

A

multidrug resistant protein 2

32
Q

patients with dubin johnson syndrome have an increase in which isomer of urinary coproporphyrins?

A

isomer 1

33
Q

which bilirubin metabolism syndrome is associated with asymptomatic jaundice?

A

rotor syndrome

34
Q

what is the main dysfunction in progressive familial intrahepatic cholestasis (PFIC)? what are the symptoms?

A

biliary epithelial transporters

failure to thrive, hepatic failure, need for liver transplant

35
Q

what are the components of normal bile?

A 
cholic 
chenodeoxycholic acid 
taurine / glycine salts 
cholesterol 
lecithin 
bilirubin 
bicarbonate
36
Q

what is the role of lecithin in bile?

A

protects epithelium

37
Q

which gene is mutated in PFIC-1? which protein does it encode for? what is the result?

A

ATP8B1

canalicular ATPase

problem shunting substance into canalicular system

38
Q

which gene is mutated in PFIC-2? which protein does it encode for? what is the result?

A

ABC11

bile salt export pump

cannot expore bile

39
Q

which gene is mutated in PFIC-3? which protein does it encode for? what is the result?

A

ABC4

MDR3

phosphatidyl choline transfer - phospholipids cannot get into cell

40
Q

what are the sequalae of progressive familial intrahepatic cholestasis?

A 
cholestasis 
fat malabsorption 
fat soluble vitamin deficiency 
osteopenia 
liver failure
41
Q

what are the diffuse infiltrative diseases leading to hepatic disorders with cholestasis? will the bile be conjugated or unconjugated?

A

granulomatous disorders
malignancy

conjugated

42
Q

what are the two most common causes of posthepatic jaundice?

A

gall stones

cancer of head of pancreas

43
Q

what are the physical symptoms of cholestasis?

A 
pruritis 
jaundice 
clay colored stool 
dark urine 
bleeding diathesis 
xanthomas 
osteoporosis
44
Q

what are the clinical values for cholestasis?

A

increased alkaline phosphatase
increased GGT
increased 5-NT

hyperbilirubinemia above 1.2
hyperlipidemia

45
Q

what is the cause of feathery degeneration in cholestasis?

A

swollen hepatocytes (check)

46
Q

what is the cause of ascending cholangitis?

A

infection due to cholestasis over time

47
Q

what is bridging fibrosis as seen in cirrhosis?

A

bridging between microscopic structures of the liver

48
Q

what are the steps in the pathogenesis of cirrhosis?

A

hepatocyte necrosis
progressive fibrosis
regenerative hepatocyte nodules

altered vascular flow
disruption of hepatocyte function

49
Q

what cell drives much of the fibrosis in cirrhosis? why?

A

kupffer cell - induces stellate cell to become myofibroblast

50
Q

what cytokine is responsible for much of the collagen elaboration in cirrhosis?

A

TGF-B

51
Q

what is found in between the micronodules in micronodular cirrhosis?

A

fibrosis

lymphocytes (check)

52
Q

what are the lab values associated with decompensated cirrhosis / portal hypertension?

A 
decreased albumin 
increased serum albumin 
increased transaminases 
increased GGT 
increased prothrombin time
53
Q

why are estrogen levels higher decompensated cirrhosis / portal hypertension?

A

cannot be broken down in liver

54
Q

what is the equation for serum ascites albumin gradient (SAAG)?

A

(albumin concentration of serum) - (albumin concentration of ascitic fluid)

55
Q

what is the SAAG value for portal hypertension? non portal hypertension?

A

portal HTN - over 1.1

non portal HTN - less than 1.1

56
Q

hepatic failure indicates what % loss of function?

A

80%

57
Q

what are the clinical signs of hepatic failure?

A

encephalopathy
coagulopathy
jaundice
multiple organ failure

58
Q

chronic liver failure occurs in the context of what disorder?

A

decompensated cirrhosis

59
Q

what is hepatorenal syndrome? what is the cause?

A

renal failure that occurs in the setting of cirrhosis or fulminant liver failure - sometimes in context of HTN, usually without other kidney diseases

alteration in blood flow

60
Q

what are the clinical signs of hepatorenal syndrome?

A

normal kidney
oliguria / anuria
increased BUN, creatinine
low urinary sodium concentration

61
Q

what is the hallmark of hepatorenal syndrome?

A

intense renal vasoconstriction with predominant arterial vasodilation

62
Q

is tubular function preserved in hepatorenal syndrome?

A

yes

63
Q

what is hepatopulmonary syndrome?

A

triad of

chronic liver disease
hypoxemia
intrapulmonary vascular dilations

64
Q

what is the cause of hepatopulmonary syndrome?

A

ventilation perfusion mismatch - limited oxygen diffusion due to rapid blood flow through vessels

65
Q

what is the cause of hepatic encephalopathy?

A

increased ammonia brain diffusion with edema

66
Q

asterixis, abnormal EEG, lethargy, and decerebrate posture indicate what condition?

A

hepatic encephalopathy

Year 2 Gastrointestinal (38 decks)

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