Robbin's Tables Flashcards
Normal values of bilirubin: conjugated and unconjugated
conjugated - .1 - .3
unconjugated - .2 - 9
Dasabuvir
NS5B
CYP3A4
N, pruritus, insomnia
Preeclampsia
maternal HTN
proteinuria
peripheral edema
coag abnormalities
+ hyperreflexia and convulsions = eclampsia
HNF1-alpha hepatocellular adenoma
inactivating HNF1alpha mutation
fatty and devoid of cellular architectural atypic
LFABP is NOT expressed (typically always is)
What levels are elevated in:
a. Steatosis
b. Steatohepatitis
c, Steatofibrosis/cirrhosis
a. alk phos, ggt
b. AST, ALT, alk phos, bilirubin
c. coag probs hypoprotein
Elbasvir
fatigue, HA, N when combined with Grazoprevir
When is infarct of hepatic artery a problem?
in liver transplantation –> leads to infarction of major ducts of biliary tree
Simeprevir
NS 3/4 protease inhibitor
must be taken with food
Ledipasvir
fatigue, HA, asthenia when combined with sofobuvir
Pattern of Injury: Cholestatic Hepatitis
antibiotics
statins
Glasgow alcoholic hepatits score
predicts mortality based on
- age
- serum bilirubin
- BUN
- PT time
- peripheral WBC count
greater than/equal to 9 –> better survival is received glucocorticoids
What is cholestasis?
impaired bile formation and bile flow that leads to bile pigmentation in the haptic parenchyma
Grazoprevir
NS 3/4 protease inhibitor
fatigue, HA, N
Classic Tetrad of Hemochromatosis
- Cirrhosis with hepatoemegaly
- Abnormal skin pigmentation
- DM
- Cardiac dysfunction
Mallor Denk bodies
accumulations of intermediate filaments found within hepatocytes
- Alc Liver disease (main one)
- NAFLD
- Wilson Disease
- Chronic biliary obstruction
- PBC
Pattern of Injury: Hepatocellualr necrosis
acetaminophen
PBC Morphology Highlights
- patchy distribution
- bile accumulation is periportal
- feathery degeneration and ballooned, bile-stained hepatocytes
- Mallory Denk Bodies
- Marked hepatomegaly
End stage livers have a green pigmentation!!
some pts develop portal HTN rather than severe cholestasis
Pattern of Injury: Fatty liver disease
ethanol
aspirin (reye)
corticosteroids
Dagnosis for
- HNF1-alpha hepatocellular adenoma
- Beta catenin hepatocellular adenoma
- Inflammatory hepatocellular adenoma
- stain for LFABP –> will be absent
- beta catenin nuclear translocation; glutamine synthetase is positive
- inc CRP and serum amyloid in serum; areas of fibrotic storm, mononuclear inflammation, ductular reactions, dilated sinusoids, telangiectatic vessels
Pattern of Injury: Neoplasms
vinyl chloride
alcohol
oral contraceptives
thorotrast
Velpatasvir
with sofosbuvir = first once daily single tablet regime
HA, fatigue
Pattern of Injury: Fibrosis and cirrhosis
alcohol
vitamin A
Pattern of Injury: Granulomas
amiodarone
allopurinol
Sofosbuvir
NS5B
prodrug, nucleotide analog
What cytokines activate stellate cells?
proliferation - PDGF, TNF
contraction - ET-1
chemotaxis - MCP-1, PDGF
422,
Ombitasvir
nausea, purities, insomnia
CYP3A4
Why are women more susceptible to alc liver disease?
estrogen increases gut permeability to endotoxins –>
increases expression of LPS receptor CD14 in Kupffer cells –> increased production of pro inflammatory cytokines and chemokine
What can a PPI due in hemochromatosis?
reduces intestinal iron absorption and decreases maintenance phlebotomy blood volume requirement
Paritaprevir
NS 3/4 protease inhibitor
CYP3A4
N, pruritus, insomnia
What levels are raised in hepatic steatosis? alcoholic hepatitis?
a. serum bilirubin, alk phos
b. AST > ALT, hyperbilirubinemia, alk phos
Mxns of liver injury due to iron
- lipid per oxidation via iron catalyzed free radicals
- stimulations of collagen formation by activation of hepatic stellate cells
- Interaction of reactive oxygen species and iron with DNA leading to cell death and possibly HCC
Three ways Cu is toxic to liver
- promotes formation of free radicals
- binds to sulfhydryl groups of cellular proteins
- displaces other metals from hepatic metal-enzymes
What is unique about aflatoxin in HCC?
leaves molecular signature - mutation in codon 249 of p53 gene
Criteria for Metabolic Syndrome
- DM or insulin resistance or impaired glucose tolerance or impaired fasting glucose
- BP (140/90), microalbuminuria, central obesity, dyslipidemia
Stupid high liver enzyme levels
ischemic hepatitis
acetaminophen OD
acute viral hep
Pattern of Injury: Cholestatic
contraceptives
anabolic steroids
What are the three types of hepatic adenomas?
- HNF1-alpha: no risk of malignant transformation
- Beta catenin Activated: very high risk (cut out even if asx); associated with OCs and anabolic steroids
- Inflammatory: small, but definite risk (cut out even if asx)
Pattern of Injury: Vascular lesions
oral contraceptives
high dose chemo
anabolic steroids
Maddrey Discriminant Function
if at or above 32, have high risk of mortality and may benefit from glucocorticoids
*alcoholic hepatitis
Associated Conditions with Wilson Disease
renal calculi infertility hemolytic anemia subQ lipomas RTA
What is the histo hallmark of ascending cholangitis?
influx of periductular neutrophils directly into bile duct epithelium and lumen
