Primer 27 - Liver Pathology Flashcards
What is the etiology if AST is greater or equal to ALT?
That a virus might be responsible for the liver pathology.
What does GGT stand for and when is it elevated?
Gamma Glutamil Transpeptidase. Elevated in liver pathologies, excess alcohol consumption, and disease that affect the biliary tract.
When is alkaline phosphatase elevated?
Elevated in biliary obstruction (gallstones, cancer). Relatively nonspecific, because it is elevated in active bone formation (children), cancer of the bone and Paget’s disease.
What is Nutmeg liver?
Occurs when there is a backup of blood into the liver commonly due to right sided heart failure. Can also be caused by Budd-Chiary syndrome.
What can long term congestion of the liver lead to?
Centralobular congestion and necrosis. Can also lead to fibrosis. This is sometimes called cardiac cirrhosis from the right sided heart failure.
What is Budd-Chiary syndrome?
It is a syndrome caused by the obstruction of either Inferior vena cava or hepatic veins. Clinical manifestations are hepatomegaly, ascities, abdominal pain, and eventual liver failure. Good change to develop portal hypertension, leading to esophageal varices and caput medusa.
What is a clinical manifestation difference between Budd-Chiary syndrome and Right sided heart failure?
In Budd-Chiari syndrome there is no jugular vein distention (JVD) unlike right-sided heart failure.
What is Reye’s syndrome?
Idiopathic but associated with children using aspirin and/or viral infections (varicella or influenza). Can happen without aspirin. The main pathology it causes is hepatoencephalopathy (of the liver and brain). It is thought to be caused by damage to mitochondria and the aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzymes.
What is Wilson’s disease?
An autosomal recessive (defect in enzyme ATP-7B), causes inadequate copper excretion in the bile, which is the main mechanism of how we excrete excess copper. There is also a defect of copper transportation in the serum in the form of ceruloplasmin. Ceruloplasmin is going to be low, which is one of the diagnostic criteria.
Where organs does Wilson disease affect?
There is copper accumulation in liver (Hepatocellular carcinoma), brain (Basal ganglia degeneration and Parkinsonian symtoms), cornea (Kayser-Fleischer ring), kidney (hepatocellular carcinoma) and joints. Can also cause hemolytic anemia.
If AST is greater than ALT, what does it suggest?
[A Scotch and Tonic: AST > ALT]
That it might be an alcohol induced liver pathology.
What are the symptoms of Wilson disease?
Hepaticencephalopathy, dementia, Fancoi’s syndrome (Proximal tubule dysfunction).
What is the treatment for Wilson disease?
Penicillamine. [Pennies are made of copper]
What is hemochromatosis and what is elevated in lab findings?
Excess iron deposition in the body. Ferretin levels are increased. Increased total iron, decreased total iron-binding capacity (TIBC), increased transferrin saturation.
What is the classic triad of hemochromatosis?
AKA bronze diabetes: it is cirrhosis, diabetes mellitus, and skin pigmentation. It also cause congestive heart failure, testicular atrophy and increase risk of hepatocellular carcinoma.
What are the causes of hemochromatosis?
- Primary hemochromatosis: Autosomal recessive disorder.
2. Secondary hemochromatosis: Transfusion (chronic).
What is the treatment for hemochromatosis?
Phlebotomy and deferoxamine.
What does alpha 1 antitrypsin do?
Alpha 1 antitrypsin protects the cells from the proteolytic enzyme elastase.
