Pathoma 11.3 Liver Flashcards
The fibrosis found in cirrhosis is mediated by:
TGF-beta from stellate cells
Where are stellate cells found in the liver?
Beneath the endothelial cells that line the sinusoids
What are Mallory bodies and when are they seen?
Mallory bodies are damaged IFs within the hepatocytes and they are seen in alcoholic hepatitis
What lab values are commonly seen in alcoholic hepatitis?
AST > ALT
What lab values are commonly seen in nonalcoholic fatty liver disease?
ALT > AST
Dx: Excess body iron leads to deposition in the tissues and organ damage; Damage is mediated by generation of free radicals
Hemochomatosis May be primary or secondary Increased risk of hepatocellular carcinomina
What is the most common genetic mutation associated with Primary Hemochromatosis?
HFE gene - C282Y
Dx: Cirrhosis Secondary DM Bronze skin
Hemochromatosis
Dx: Cirrhosis Neurological manifestations Kayser-Fleisher rings on cornea; Increased risk of hepatocellular carcinoma
Wilson disease
What is the treatment for Wilson disease?
D-penicillamine
Dx: Autoimmune, granulomatous destruction of the intrahepatic bile ducts; Antimitochondrial antibody seen in labwork
Primary Biliary Cirrhosis
Decreased serum ceruloplasmin suggests what diagnosis?
Wilson disease
Dx: Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts; Periductal fibrosis with an onion-skin appearance; Beaded appearance on imaging
Primary Sclerosing Cholangitis Patients present with obstructive jaundice
Primary Sclerosing Cholangitis is associated with what other autoimmune disorder?
Ulcerative colitis
What lab test is often seen in Primary Sclerosing Cholangitis?
Positive p-ANCA
Dx: Fulminant liver failure and encephalopathy; Children; Previous viral infection treated with aspirin
Reye Syndrome
Primary Sclerosing Cholangitis carries increased risk for what cancer?
Cholangiocarcinoma (bile ducts)
How do children with Reye syndrome present?
Hypoglycemia; Elevated liver enzymes; Nausea and vomiting
Dx: Hepatic tumor of hepatocytes; Associated with oral contraceptive use - regresses when drug is stopped; Risk of rupture and intraperitoneal hemorrhage, especially during pregnancy
Hepatic adenoma
Aflatoxins from Aspergillus raise the risk for:
Hepatocellular carcinoma Aflatoxins induce p53 mutations
Dx: Liver infarction due to hepatic vein obstruction; Painful hepatomegaly and ascites
Budd-Chiari syndrome
What is a common cause of Budd-Chiari syndrome?
Hepatocellular carcinoma
What is the serum tumor marker for hepatocellular carcinoma?
Alpha fetoprotein
