Viral and Non-Viral Liver Disease Flashcards
The liver has a high _____________ reserve.
functional (meaning that you have to destroy a large proportion of the liver to see functional deficits)
What does the story of Prometheus reveal?
That the liver has a good regenerative capacity –his liver was destroyed every morning by a bird, but always regrew before the next day
The lobules are divided into three zones. Which is closest to the central vein?
3 (think of C as the third letter in the alphabet)
What are some clinical signs of liver failure?
- Icterus, both scleral and otherwise
- Spider telangiectasia
- Palmar erythema
- Coagulopathy (and related signs)
- Ascites
- Gynecomastia
What pathologic appearance does cirrhosis present with?
Fibrotic scarring with regenerative nodules separated by fibrous septation
After massive necrosis, the ___________ areas are alive and the ____________ areas are dead.
yellow; gray/brown
Cirrhosis of the liver leads to _____________.
portal hypertension
Why does liver disease lead to splenomegaly?
Portal hypertension leads to blood congestion in the spleen.
The most common cause of chronic liver disease in the U.S. is _______________.
Viral hepatitis C (more than half)
Alcohol-induced liver disease is second (at roughly 1/3)
There are four different leukocytes that can be found in a liver with hepatitis. List them and give the type of disease in which they are most commonly found.
- Lymphocytes: viral
- Neutrophils: steatohepatitis
- Plasma cells: autoimmune hepatitis
- Eosinophils: drug reactions
Describe the histologic presentations of acute and chronic hepatitis.
Acute: widespread lobular disarray
Chronic: patchy necrosis and fibrosis
What time frame is associated with chronic and acute hepatitis?
Less than 6 months = acute
Greater than 6 months = chronic
What is steatosis?
Fat accumulation in hepatocytes
Cholestasis is ____________.
bile accumulation in hepatocytes
What liver pathology presents with ground-glass inclusions?
Viral infection
What overall pattern can you notice in the progression of fibrosis?
Fibrosis (that is, collagen deposition) proceeds from a basic circular stage to bridging, with the “islands of regeneration” being the final state.
How are grades and stages different in terms of liver diagnosis?
Grade: amount of inflammation and injury
Stage: amount of fibrosis
All of the hepatitis viruses are _______ viruses with the exception of _________.
RNA; HBV, which is DNA
Give the method of transmission for each of the hepatitis viruses.
A and E: fecal-oral
B, C, and D: parenteral (B can also be transmitted sexually)
Think of this: A and E are on the opposite ends of the alphabetically arranged list, just like the mouth and butt are on the opposite ends of the body.
True or false: all of the hepatitis viruses can cause chronic liver disease.
False. A and E never cause chronic liver disease.
Which hepatitis strain most frequently causes chronic liver disease?
C
Multiple things increase risk for HCV: _______________.
IV drug use, promiscuity, and recent surgery
Chronic hepatitis presents with ________ aggregates.
lymphoid
Which hepatitis has the most likelihood to increase risk for hepatocellular carcinoma?
B, because it is a DNA virus and can integrate into the genome
______________ is completely dependent on hepatitis B for replication.
Hepatitis D
It also potentiates the effects of HBV, leading to greater hepatic damage.
_____________ and ____________ cause acute hepatitis only.
Hepatitis A; hepatitis E
Autoimmune hepatitis presents with what autoantibodies?
ANA, ASMA, anti-LKMB
Anti-mitochondrial antibodies are present in what autoimmune disease?
Primary biliary cirrhosis
What specific structure is attacked in primary biliary cirrhosis?
Intrahepatic small-caliber bile ducts
Uniquely, __________ are more commonly affected by primary sclerosing cholangitis.
men
Primary sclerosing cholangitis mainly affects the ____________ bile ducts.
larger caliber
What disorder presents with periductal onion-skin fibrosis?
Primary sclerosing cholangitis; this can ultimately turn into fibrous obliteration.
True or false: the liver normally has fat deposition along the bile duct epithelium.
False. Healthy livers do not store fat.
What can cause steatohepatitis?
Alcohol abuse
Metabolic syndrome
Drug injury
Wilson disease results from _______________ and presents with ______________.
autosomal recessive defect in the ATP7B protein, which pumps copper into the bile duct; psychiatric and liver dysfunction
There are two main alleles for the alpha-1 antitrypsin gene: PiZZ and PiMM. Which is the harmful one?
PiZZ
Most adenomas have a non-negligible risk of transitioning to adenocarcinoma. _____________ is unique in this regard, because it carries an extremely low risk of transition.
Hepatocellular adenoma
Bile can accumulate in which parts of the liver?
Hepatocytes
Bile canaliculi
Bile ducts
Kupffer cells
Cytoplasmic bile leads to what kind of cell death?
Ballooning degeneration
Hepatocyte disarray with infiltrate, but without fibrosis is characteristic of _____________.
acute viral hepatitis
The staging of liver fibrosis goes from ______ to ________.
0 (no fibrosis) to 4 (cirrhosis)
Elevated IgG indicates ____________.
autoimmune hepatitis
The histology of autoimmune hepatitis is almost indistinguishable from ___________.
viral hepatitis
Often ______________ is the only sign or symptom of primary sclerosing cholangitis.
elevated alkaline phosphatase
What disease should you think of when you hear “onion-skin fibrosis”?
Primary sclerosing cholangitis
Excess acetaminophen causes ___________ necrosis.
coagulative
Chicken-wire fibrosis is a characteristic of ______________.
steatohepatitis
What is the triad of steatohepatitis findings?
Lobular inflammation
Ballooning degeneration
Steatosis
HFE is found on chromosome ____.
6 (you need two copies knocked out: HFE + HFE = six letters)
Histologically, how can you differentiate between primary and secondary hemochromatosis?
In primary hemochromatosis, the iron accumulates in hepatocytes, while in secondary hemochromatosis, the iron accumulates in Kupffer cells.
True or false: the majority of people with alpha-1-antitrypsin deficiency have liver disease.
False. Only about 10%
______________ is usually asymptomatic and is thought to arise from a vascular anomaly.
Focal nodular hyperplasia
Chronic hepatitis leads to inflammation and fibrosis centered around the ________________.
portal tracts
The DNA hepatitis virus results in chronic disease in what percent of cases?
5%
What happens to the nuclei of those with HBV infection?
It can become “sanded,” meaning it gets washed out.
