systemic pathology Flashcards
The ___ lobule is composed of:
portal triads
hepatic sinuses,
terminal hepatic venule (central vein) and associated plates of hepatocytes
classic
the terminal hepatic vein (CV) is at the center of a “lobule,” while the portal tracts (PV) are at the periphery
Lobular Model
Pathologists refer to the regions of the parenchyma as “__ and ___.”
periportal
centrilobular
Relies on the basis of blood flow, three zones can be defined, zone 1 being the closest to the blood supply and zone 3 being the farthest
Acinar Model
The two models of the liver
hepatic lobular model and acinar model
Functionally, the liver can be divided into three zones, based upon oxygen supply:
zone 1
zone 2
zone 3
this zone encircles the portal tracts where the oxygenated blood from hepatic arteries enters
zone 1
this zone is located around central veins, where oxygenation is poor
Zone 3
these cells:
Line the sinusoids
Fenestrated, w/o tight junctions, w/o basement membrane
Endothelial Cells
these cells are Bone marrow derived phagocytes
Immune and cytokine release functions.
Kupfer Cells
these cells are Beneath endothelial cells In the space of Disse
Specialized storage capacities
Secrete ECM components
Stellate Cells
Hepatocytes have three specialized surfaces
Sinusoidal
Lateral
Canalicular
functions of the liver: (5)
metabolic synthetic storage catabolic Excretory
this function of the liver maintaining glucose homostasis; Free Fatty acid oxidation and conversion to triglycerides and secretion as lipoproteins
Metabolic
the liver synthesizes ___ proteins
serum
the liver is storage point for :
glycogen triglycerides iron copper lipid-soluble vitamin
in the liver, Endogenous substances are catabolized to maintain balance; detoxification of ___.
xenobiotics
the liver excretes ___
bile
the end stage of chronic liver disease
Cirrhosis
The central pathogenic processes in cirrhosis are:
Injury/death of hepatocytes
Extracellular Matrix deposition
Vascular reorganization
Cirrhosis is defined by three main morphologic characteristics:
Bridging fibrous septa
Parenchymal nodules.
Disruption of the architecture of the entire liver
Major Causes of Cirrhosis: (6)
Alcoholic Liver Disease Chronic Hepatitis Biliary Disease Nonalcoholic Fatty Liver Disease (NAFLD) Metaboloic Disease Cryptogenic
types of chronic hepatitis: (3)
Chronic Viral Hepatitis
Autoimmune Hepatitis
Drugs
types of Biliary Disease
3
Extrahepatic Biliary Obstruction
Primary Biliary Cirrhosis Sclerosing Cholangitis
examples of metabolic diseases are (8)
Hemochromatosis
Wilson Disease Hereditary Fructose Intolerance
Glycogen Storage Disease
Tyrosinemia Glactosemia
α1-Antitrypsin Deficiency
Hereditary Storage Diseases
contains small, regenerative nodules of parenchyma and fatty change.
Micronodular Cirrhosis
in this situation the liver is misshapen, and the cut surface reveals irregular nodules and connective tissue septa of varying width.
Macronodular Cirrhosis
The major clinical consequences in the setting of cirrhosis, shown for the male is
portal hypertension
In women, oligomenorrhea, amenorrhea, and sterility are frequent, as a result of ___.
hypogonadism
A daily intake of more than __ gm of alcohol in men and __ gm in women significantly increases the risk of cirrhosis
60
20
Alcoholic liver disease spans three major morphologic and clinical entities:
Fatty liver (Hepatic Steatosis) Alcoholic Hepatitis (Alcoholic Steatohepatitis) Cirrhosis
___ is the accumulation of intrahepatocyte fat and it is directly dependent on the intake of alcohol, since it is fully and rapidly reversible on discontinuation of alcohol ingestion. Virtually all chronic alcoholics have this
Steatosis
Signs and Symptoms of Alcoholic Fatty Liver (Hepatic Steatosis)
few symptoms of liver disease, and does not by itself progress to more severe disease
Treatment/Prognosis of Alcoholic Fatty Liver (Hepatic Steatosis)
The fatty change is completely reversible if there is abstention from further consumption of alcohol
acute necrotizing lesion
Alcoholic Hepatitis
Alcoholic Hepatitis is characterized by: (4)
Necrosis of hepatocytes
Mallory bodies
Neutrophilic inflammatory response
Perivenular fibrosis.
Signs & Symptoms
Presents with:
malaise, anorexia, fever, right upper quadrant abdominal pain, and jaundice
mild leukocytosis
Serum aminotransferase activities are ___ elevated and Serum Alkaline Phosphatase activity is usually ___ in alcoholic hepatitis
moderately
increased
treatment for alcohol hepatitis
no specific treatment
__% of alcoholics develop cirrhosis
15
continued exposure to alcohol can result in steatosis and eventually ____
cirrhosis
____ and ___ can result in abstinence. in other words they are reversible
steatosis
hepatitis
repeated attacks of hepatitis can lead to ___
cirrhosis
severe exposure when having steatosis can lead to _____
hepatitis
close resemblance to Alcoholic Liver Disease.
the risk factors which appear to be the apparent triggers for the initiation of the liver disease (e.g., obesity, Type 2 Diabetes, and hyperlipidemia).
Nonalcoholic Fatty Liver Disease (NAFLD)
The observed pathology of Alcoholic Liver Disease and ___ Liver Disease are mirrow images
The treatment and the prognosis are different because they are driven by the different risk factors
Non-Alcoholic
In ____ disease, signs and symptoms are asymptomatic with only moderate increases in serum liver enzymes
Nonalcoholic Fatty Liver Disease (NAFLD)
About one-half of the people with both severe __ and ___ have Nonacoholic Steatohepatitis (NASH)
obesity
diabetes
Two major categories to describe the patterns by which drugs cause injury:
Predictable pattern
Unpredictable pattern
Drugs that cause injury in a dose-dependent manner refers to:
Predictable pattern
Drugs that cause injury with low frequency, irrespective of dose and without obvious predisposition (idiosyncratic reaction)
Unpredictable pattern
The main treatment for DILI is withdrawal of the offending ___
However, some types of liver injury can be associated with a progressive course, possibly leading to fibrosis or cirrhosis, despite discontinuation of the ___
drug
drug
____ for treatment of tuberculosis, after 3 weeks, elevated the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in a patient.
isoniazid
in alcoholic cirrhosis, the greenish tint of some nodules is due to __ ___
bile stasis
In severe cases of __ the venules and perivenule sinusoids are obliterated and surrounded by dense fibrous tissue
Central Hyaline Sclerosis
The sudden onset of alcoholic hepatitis suggests an ___ or physiologic co-factor, but none have been identified to date
environmental
daily intake of more than 60 gm of alcohol in men significantly increases the risk of cirrhosis. this corresponds to __ oz. (180 ml) of 86 (__%) proof alcohol, three 8 oz. glasses of wine, or four-and-one-half 12 oz. bottles of bear.
6
43
A daily intake of 20 gm of alcohol in women significantly increases the risk of cirrhosis. This corresponds to:
2 oz. (60 ml) of 86 (43%) proof alcohol, __ 8 oz. glasses of wine, or one-and-one-half __ oz. bottles of bear
one
12
In general, more than __ years of alcoholism is required to produce cirrhosis. Only __% of alcoholics develop cirrhosis
10
15
