Liver Path. - Patterns of Injury Flashcards Preview

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Flashcards in Liver Path. - Patterns of Injury Deck (31)
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1
Q

What is cirrhosis?

A

Disruption of hepatic architecture by fibrosis.

Regenerative nodules form.

2
Q

What cells lay down the collage in cirrhosis?

A

Stellate cells and portal fibroblasts.

3
Q

What are 4 patterns of liver injury?

A

Vascular
Hepatitic
Infiltrative
Cholestatic

4
Q

Which LFT enzyme is liver predominant?

A

ALT

5
Q

Which LFT enzyme is associated with biliary injury?

A

GGT

6
Q

Which LFT enzyme is present in, but not specific to the liver?

A

AST

7
Q

Is LDH prevalent in the liver?

A

No.

8
Q

What process actually releases enzymes from the injured hepatocyte?

A

Cytoplasmic blebbing.

9
Q

What kind of injury causes more AST release?

Examples of things that cause this?

A

Mitochondrial injury.

EtOH, Wilson’s disease

10
Q

What’s special about the caudate lobe of the liver?

A

It has independent venous drainage to the IVC.

11
Q

What happens when venous outflow from the liver is blocked, initially? Symptoms?

A

Congestion of liver (‘nutmeg liver”)

Pain from liver capsule expanding, hepatomegaly ascites.

12
Q

Which zone of the liver is first affected by congestion?

A

Zone 3

13
Q

What happens to the liver when there’s chronic venous outflow obstruction?

A

“Cardiac Type Fibrosis”
… perhaps to resist increased forces.
Hepatocyte atrophy.

14
Q

What’s Budd-Chiari?

Why is this bad?

A

Venous outflow obstruction that spares caudate:
Liver atrophies except for caudate, which hypertrophies.
This is bad because hypertrophy of the caudate can compress the IVC once large enough.

15
Q

2 ways to get liver ischemia?

A

Infarct

Hypotension

16
Q

Can a liver survive a completely occluded portal vein? What happens?

A

Yes, initially.
Thrombis remodeling can lead to portal tract venopathy - lots of blockages of portal veins throughout the liver.
(also portal hypertension still happens)

17
Q

Will blockage of the hepatic portal vein cause ascites?

A

Nope.

18
Q

What will die if the hepatic artery gets occluded?

A

Bile ducts - as these are mainly supplied by hepatic artery bloodflow.

19
Q

What does a bile duct infarction look like grossly?

A

“Biloma” with bile contents spewing out.

20
Q

2 main divisions of hepatitis?

A

Acute vs. chronic

21
Q

2 main histological features of a chronic hepatitic pattern of injury?

A

Lymphocytes

Apoptotic hepatocytes

22
Q

Biochemical features of a hepatitic pattern of injury?

A

High AST and ALT.

23
Q

What does “activity” refer to in chronic hepatitis?

A

Degree of inflammation and hepatocellular death.

24
Q

What zone does acetaminophen damage? Why?

A

Zone 3- because the damage is caused by a toxic metabolite made by P450 metabolism - and Zone 3 has the most P450 activity.

25
Q

What’s the toxic metabolite of acetominophen called?

A

NAPQI (more on this later)

26
Q

What can increase resistance in the liver without fibrosis?

A

Amyloid

27
Q

In what zone is most of the fat deposited in alcoholic and non-alcoholic steatosis?

A

Zone 3

HCV related steatosis is more in Zone 1

28
Q

What’s cholestasis?

A

Any impediment of bile flow.

29
Q

What can you see in histology of cholestasis? (2 things)

A

Bile plugs

“Feathery degeneration”

30
Q

In what patterns of liver damage do you see elevated GGT?

A

Cholestatic

Infiltrative

31
Q

What’s elevated in a cholestatic pattern of liver disease?

A

GGT and conjugated / direct bilirubin.