Acute Liver Injury Part 2

Front 1

What is the most common cause of acute liver injury?

Alcoholic hepatitis:

Age

Presentation (speed) of jaundice

AST

ALT

AST/ALT ratio

Back 1

Front 2

What can cause all the these?

Back 2

Alcohol can cause all of these

All of these can be seen in acute liver injury

Front 3

Back 3

Front 4

What are three other common manifestations of alcoholic hepatitis? (blood, brain, heat)

Back 4

Front 5

AST/ALT ratio of >2 suggests what?

What is a common exception to this exception?

Back 5

Front 6

What type of generation is common with all sorts of acute liver diseases?

What is the mechanism? Is it reversible?

Back 6

Front 7

Which hepatocytes have ballooning degeneration?

Back 7

Front 8

What type of degeneration is shown?

Back 8

Ballooning => empty cytoplasm

Front 9

Can alcoholic hepatitis cause SIRS (like pancreatic)?

Back 9

Front 10

Fatty change or fatty degeneration, the accumulation of lipid in hepatocyte cytoplasm.

What is this?

What are the two types?

Back 10

Front 11

Which type of steatosis in each?

Back 11

Front 12

Macro-vesicular steatosis
is due to _____ lipoprotein synthesis with resultant impaired secretion of lipids.

It is the more common form of _____, and is seen in
alcoholic liver disease,
non-alcoholic steatohepatitis, and with ______.

It is _____.

Back 12

Macro-vesicular steatosis
is due to decreased lipoprotein synthesis with resultant impaired secretion of lipids.

It is the more common form of steatosis, and is seen in
alcoholic liver disease,
non-alcoholic steatohepatitis, and with glucocorticoids.

It is reversible.

Front 13

What type of steatosis?

Back 13

Macrovesicular

Front 14

Which type of steatosis is due to impaired mitochondria beta-oxidation of fatty acids for ATP synthesis?

In which to situations is it seen?

Back 14

Front 15

Is micro vesicular more or less common than macro vesicular? Reversible?

Back 15

Front 16

What type of steatosis is associated with greatly enlarged defectives mega-mitochondria?

Back 16

Front 17

Back 17

Front 18

What type of degeneration do they have and what are they surrounded by?

Back 18

Front 19

What three things are shown?

Back 19

Malloy bodies, ballooning degeneration, and neutrophils.

Front 20

Identify steatosis, Mallory bodies, and neutrophils.

Back 20

Front 21

With severe intracellular
cholestasis, hepatocytes swell
and the cytoplasm becomes
wispy, referred to as _____
degeneration.

_____ degeneration indicates
severe hepatocyte damage
and many of the hepatocytes
with it will die.

Back 21

With severe intracellular
cholestasis, hepatocytes swell
and the cytoplasm becomes
wispy, referred to as feathery
degeneration.

Feathery degeneration indicates
severe hepatocyte damage
and many of the hepatocytes
with it will die.

Front 22

_____ causes a liver disease
almost identical to alcohol
called non-alcoholic
steatohepatitis (NASH).

_____ tends to be milder than
alcoholic hepatitis and to lack
cholestasis.

Back 22

Obesity causes a liver disease
almost identical to alcohol
called non-alcoholic
steatohepatitis (NASH).

NASH tends to be milder than
alcoholic hepatitis and to lack
cholestasis.

Front 23

What type of degeneration?

Back 23

Feathery

Front 24

Feathery degeneration is
associated with ____ _____ by stones, tumor
or granulomas.

Because bile transport is
central to portal, rich periportal
hepatocytes see more _____ and
get more _____ degeneration
than their poor centrolobular
and midzonal colleagues.

Back 24

Feathery degeneration is
associated with biliary
obstruction by stones, tumor
or granulomas.

Because bile transport is
central to portal, rich periportal
hepatocytes see more bile and
get more feathery degeneration
than their poor centrolobular
and midzonal colleagues.

Front 25

Biliary obstruction by ____,
tumor or granulomas causes
higher levels of ___ ___ than hepato-
cellular diseases.

___ is elevated by both biliary
and hepatocellular disease,
making it less helpful in
differentiating them.

Back 25

Biliary obstruction by stones,
tumor or granulomas causes
higher levels of alkaline
phosphatase than hepato-
cellular diseases.

Gamma-glutamyl-transferase
(GGT) is elevated by both biliary
and hepatocellular disease,
making it less helpful in
differentiating them.

Front 26

_____ is the most common form of cell death in hepatic viral infections.

Apoptotic bodies of dead hepatocytes were first
described by Dr. Councilman
in yellow fever

(and are often referred to as
_____ bodies).

Back 26

Apoptosis is the most common form of cell death in hepatic
viral infections.

Apoptotic bodies of
dead hepatocytes were first
described by Dr. Councilman
in yellow fever

(and are often referred to as
Councilman bodies).

Front 27

Three names for apoptotic cells.

Back 27

Front 28

What causes a shrunken cell with condensed cytoplasm + nucleus follow by nuclear breakup?

Back 28

Front 29

What is shown here?

Back 29

Front 30

Both apoptosis and garden
variety coagulative necrosis
of hepatocytes are common
microscopic features of
______ _______.
Findings of hepatocyte injury
and necrosis in alcoholic
steatohepatitis are most
prevalent in the _______
zone, following the metabolic
gradient.

Back 30

Both apoptosis and garden
variety coagulative necrosis
of hepatocytes are common
microscopic features of
alcoholic steatohepatitis.
Findings of hepatocyte injury
and necrosis in alcoholic
steatohepatitis are most
prevalent in the centrolobular
zone, following the metabolic
gradient.

Front 31

Back 31

Front 32

The lobular gradient is reflected in multiple
diseases.

For instance, in _____-sided heart failure,
increased pressure in right atrium is transmitted
to ___ ___ ___ and in turn to hepatic
veins and eventually centrolobular veins.

The increased _____ pressure results in
sinusoidal congestion, dilation and slower blood
flow. The slower the flow the longer periportal
and midzonal hepatocytes have to extract oxygen
and nutrients so that, by the time the blood
reaches the centrolobular zone, it has less.

As a result, ______ hepatocytes become
hypoxic, atrophic and, if starved, necrotic.

Back 32

The lobular gradient is reflected in multiple
diseases.

For instance, in right-sided heart failure,
increased pressure in right atrium is transmitted
to inferior vena cava and in turn to hepatic
veins and eventually centrolobular veins.

The increased centrolobular pressure results in
sinusoidal congestion, dilation and slower blood
flow. The slower the flow the longer periportal
and midzonal hepatocytes have to extract oxygen
and nutrients so that, by the time the blood
reaches the centrolobular zone, it has less.

As a result, centrolobular hepatocytes become
hypoxic, atrophic and, if starved, necrotic.

Front 33

Back 33

Front 34

In ___-sided heart failure
or combined left and right
heart failure, the liver is
enlarged and passively
congested.
Sometimes, there is a network
of dark ___ (color) areas in a
background of pale steatotic
or normal areas that resembles
the cut surface of a _____.

Back 34

In right-sided heart failure
or combined left and right
heart failure, the liver is
enlarged and passively
congested.
Sometimes, there is a network
of dark red areas in a
background of pale steatotic
or normal areas that resembles
the cut surface of a nutmeg.

Front 35

What are two components of the liver in heart failure?

Back 35

Passive congestion of the liver

Nutmeg

Front 36

Severe heart failure causes
_____ of centrolobular
hepatocytes in a pattern
similar to other processes
like septic shock,
Tylenol overdose, etc.

Back 36

Severe heart failure causes
necrosis of centrolobular
hepatocytes in a pattern
similar to other processes
like septic shock,
Tylenol overdose, etc.