Wk5 Liver Pathology Flashcards
Yellow discoloration of skin due to retention of bilirubin:
Jaundice
Yellow discoloration of sclera due to retention of bilirubin:
Icterus
Site of heme conversion to bilirubun:
reticuloendothelial cells
lymph nodes and spleen
bilirubin is transported to liver complexed with ?
albumin
Location of bilirubin conjugation?
What is it conjugated with?
Where does is go next?
Hepatocytes
glucuronic acid
bile –> feces
Type of bilirubin that is:
water insoluble
bound to albumin
TOXIC to tissues
not excreted in urine
Unconjugated
Type of bilirubin that is:
water soluble
not bound to albumin is serum
NOT TOXIC
excreted in urine when serum levels are high
conjugated
Impaired secretion of bile:
cholestasis
Danger of neonatal jaundice:
kernicterus
**long term neurologic sequelae of hyperbilirubinemia
How does phototherapy treat neonatal jaundice?
makes unconjugated bilirubin soluble
**does not conjugate it
Liver enzyme that conjugates bilirubin:
UGT1A1
Autosomal recessive or dominant
decrease in UGT1A1 activity
usually benign unless stressed
Gilbert’s syndrome
Inherited absence of UGT
kernicterus
usually fatal
Crigler-Najjar syndrome
Direct hyperbilirubinemia = ?
increased Conjugated bilirubin
Indirect hyperbilirubinemia = ?
increased Unconjugated bilirubin
Review cholestasis (Intrahepatic vs extrahepatic)
slides 16-24
hepatitis virus
acute NOT chronic
usually asymptomatic
vaccine available
Hep A
HAV
hepatitis virus present in body fluids
sexual/close contact
potential for chronic disease
vaccine available
Hep B
HBV
Define “carrier state” for HBV:
persistent HBV infx without significant ongoing necroinflammatory disease
usually a result of exposure at childbirth
Defective SS RNA virus
only pathogenic in presence of HBV
increases severity of HBV infx
mostly IVD use in USA
Delta hepatitis virus (HDV)
80% of infx proceed to chronic hepatitis
20-30% untreated –> cirrhosis
no vaccine
high mutation rate
Hep C
Tests for HCV:
antibody screen
if positive:
active infection detected by:
RNA PCR
Rare form of hepatitis virus in USA
not chronic or carrier state
high mortality in pregnancy
Hep E (HEV)
Two hep viruses that cannot cause chronic hepatitis:
A and E
Pathological findings of ACUTE viral hepatitis:
lobular disarray, including:
hepatocyte degeneration
Kupffer cell hyperplasia
lymphocytic infiltration of portal tracts
“Ground glass” hepatocytes
Hep B
Massive hepatic necrosis:
focal/random
inflammatory infiltrate
likely causes?
viral
autoimmune
Massive hepatic necrosis:
zonal
non-inflammatory
likely causes?
drugs
ischemia
middle age female
ANA
SMA (anti-smooth muscle actin)
anti-SLA/LP
HLA-DR3
Type 1
Autoimmune Hepatitis
child or adolescent
anti-ALKM-1
ALC-1
Type 2
Autoimmune hepatitis
Dx of AIH:
Dx of exclusion
**Tx: immunosuppressives
Pathology of AIH:
increased plasma cells in periportal lymphocytic infiltrate
lobular inflammation
Mech of disease in cirrhosis:
stellate cells in space of Disse become fibrogenic due to injury
Three main complications of cirrhosis:
- hepatic failure from decrease hepatic perfusion
- portal hypertension
- Hepatocellular carcinoma
Encephalopathy and/or liver failure in children taking ASA for viral fever:
Reye’s syndrome
Four manifestations of portal hypertension:
Ascites
Esophageal varices
Splenomegaly
Hepatic encephalopathy
Basic extrahepatic cause of portal hypertension:
portal vein thrombosis
sepsis (acute appendicitis, diverticulitis)
hypercoag states
trauma
pancreatic etiologies
Intrahepatic causes of portal HTN:
cirrhosis
hepatocellular carcinoma
