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78 Cards in this Set
- Front
- Back
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The liver arises from what?
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As the hepatic diverticulum from the endodermal lining of the foregut in the 3rd/4th week of gestation
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Where is the youngest portion of the liver?
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Outside, because grows inside out
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Processes which interfere with post natal bile duct development will have their largest effect in what area of the liver?
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Outside
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What gives rise to the hepatocytes and bile ducts?
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Common stem cell (vascular system from different process)
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What process is normal in the fetal liver and continues until 34 weeks of gestation?
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Extramedullary hematopoeisis
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What is a bile duct hamartoma?
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Benign solitary tumor of the liver, get multiple smaller veins in that triad
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What is a congenital hepatic fibrosis?
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Abnormality where EVERY portal tract has a bile duct hamartoma
Get increased portal hypertension due to increased resistance |
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What is caroli's disease and polycystic liver disease?
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Abnormality with a dilation in bile duct
Causes bile to become static in these areas and stones may arise |
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What is the blood supply to the hepatocytes?
To the bile ducts? |
Hepatocytes: DUAL supply, hepatic artery and portal vein
Bile ducts: SINGLE supply, hepatic artery |
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What is the clinical significant of the vascular supplies?
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Easier to get ischemia to bile ducts because only one blood supply
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Stellate cells in the space of disse store what?
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Vitamin A
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what are the macrophages associated with the fenestrated endothelium in the liver?
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Kupffer cells
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What is the overall purpose of the space of disse?
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Hepatocytes need something to give structure.
Serves as framework/guide for hepatocyte regeneration But still just a MATRIX/GEL so allows for EXCHANGE |
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Hepatic stellate cells (Ito cells) in the space of diss store Vitamin A and can transform into what?
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Tranform into myofibroblasts and lay down mature collagen resulting in FIBROSIS
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What does acute venous outflow obstruction cause in the liver?
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Blood cannot leave liver, therefore get CONGESTION, especially in zone 3
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What 2 conditions can cause ACUTE venous outflow obstruction?
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1. Budd-Chiari
2. Cardiac Issues (ie congestive heart failure) |
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What is a budd-chiari?
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Blockage of ALL left, middle, and right hepatic veins
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What are the 2 main causes of a budd-chaiai?
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1. Hypercoaguability
2. Tumor invasion |
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Grossly, what will a liver with acute outflow obstruction look like?
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Nut-meg liver
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Budd-chairi is more common in which sex?
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Females
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What is veno occlusive disease?
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a condition in which central veins in the liver are obstructed due to central vein laying down collagen in response to prolonged injury
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veno occlusive disease is a result of what?
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Toxic injury - ex: CHEMO before a bone marrow transplant
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If the injury in veno occlusive disease is chronic, what will be seen?
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"Cardiac type fibrosis" - collagen layed down, space between hepatice cords decreased
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Which lobe is NOT affected in budd-chiari?
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Caudate because it has it's independent venous drainage into the IVC
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What will become hypertrophied in chronic budd-chiari?
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The caudate lobe due to its independent venous drainage into the IVC
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What is pressure atrophy?
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Hepatocyte degeneration in venous occlusion due to the decreased nutrients from decreased blood inflow
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What can happen due to Vitamin A toxicity?
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Stellate cells become swollen / have hyperplasia
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What is the result of stellate cell swelling?
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They can literally block or clog up the sinusoids
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Overtime, Vit. A causes what?
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Causes stellate cells to lay down collagen and may eventually lead to cirrhosis
cause increase portal hypertension eventually |
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Is hepatic infarction common?
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NO, due to the dual blood supply to the liver
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What is seen histologically in a liver infarction?
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Coagulative necrosis surrounded by a hyperemic ring
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Does ischemia lead to fibrosis?
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NO
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When you see coagulative necrosis, what should you think?
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ISCHEMIC INJURY!!
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What is the effect of thrombosis of the portal vein?
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NO acute effect
Overtime though, hypertension may occur and regeneration may be hurt due to decreased growth factors |
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What happens to the portal vein in a portal triad in resonspe to chronic injury?
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Collagen is laid down, Lumen becomes remodeled and made smaller (so almost can't see it)
Ex: Veno-occlusive disease |
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What infection can cause chronic damage and portal tract venopathy?
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Schistosoiasis
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What are the 4 types of non-cirrhotic portal hypertension?
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1. Portal vein thrombosis
2. Portal tract veinopathy / hepato-portal sclerosis 3. Nodular Regenerative hyperplasia 4. Infiltrative (Vit A, amyloid, fat) |
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In nodular generative hyperplasia, what is seen wrt hepatocyte size?
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Hepatocytes get smaller toward zone 3 due to nutrient and oxygen deprivation
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The differential size of hepatocytes in response to different nutrient/oxygen supply gives what?
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The impression of nodularity in "Nodular regenerative hyperplasia"
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Is fibrosis seen in nodular regenerative hyperplasia?
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NO
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Are all endothelial cell in the liver the same, do they all respond the same way to different toxins?
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NO
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Are abnormal tests common in liver enzymes?
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YES (however 1% prevelance of significant liver disease in all patients screened)
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How could LFT's be elevated even in the liver is absolutely fine?
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Could be indirect reaction to a systemic disease (ex: celiacs, hypothyroidism)
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Which 2 enzymes are the "transaminases"?
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AST and ALT
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What type of enzyme is ALT?
It's elevation signifies what? |
Liver restricted enzyme, thus its elevation is indicative of a HEPATIC process
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Where is AST found?
What does it's elevation mean? |
AST found is many tissues, thus its elevation may NOT be indicative of a hepatic process
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What do the transaminases NOT reflect?
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The synthetic function of the liver
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What 2 proteins do give some correlation with synthetic ability?
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Albumin and coagulation factors
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Overal increase ALT usually means what?
Increased GGT? |
ALT = hepatic
GGT = infiltrative / blockage |
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Generally, wrt to ALT, Alk Phos, and Bilirubin, what is seen in a hepatic cause?
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Increased ALT, normal Alk Phos and Bilirubin
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What is seen in cholestatic?
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Normal ALT, increased Alk Phos, and somewhat increased Bili
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What is seen in infiltrative?
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Normal ALT, increased Alk Phos, and normal Bili
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In the cell, where is AST located?
ALT? GGT? |
AST = mitochondria / and some cytoplasm
ALT = cytoplasm GGT = bile canaliculus membrane |
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Hepatic forms of injury such as Hep C cause what?
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Cause leakage of ALT and AST from hepatocytes
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Usually, which is higher, ALT or AST?
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ALT due to the relative subcellular distribution
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Processes that hurt the mitchondira (ex: alcohol, some drugs, wilson's disease) cause what levels of AST?
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More AST's in the blood than other hapatic injuries
ex: 2:1 ratio AST:ALT in alcoholic damage |
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Why did the fish get kicked out of school?
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Cause he was caught with seaweed.
Almost there!! Good job! |
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GGT is elevated in what?
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Cholestatic conditions
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What causes increased Alk Phos?
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Bile duct obstruction / irritation
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What are the 4 main patterns of liver injury?
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1. Hepatic
2. Steatotic 3. Cholestatic/Obstructive 4. Infiltrative |
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What are the histologic features of hepatic pattern liver injury?
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1. Lymphocytes in portal tracts
2. Apoptotic hepatocytes |
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What are some common causes of hepatic damage?
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HCV, auto-immune hepatitis
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What is steatosis?
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Injury in which the hepatocytes become engulfed in lipids
"Fatty Liver" |
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What are some common causes of steatosis?
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Obestiy, Diabetes, Alcohol Use
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What are the enzyme levels in steatosis?
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May have mild elevation of Alk Phos/GGT and/or mild elevation in AST/ALT
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What is the main histologic sign of cholestatic damage?
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Bile plugs - bilirubin "trapped" in the space between the hepatocytes
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What enzyme levels are seen in cholestatic?
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Extremely elevated Alk Phos/GGT
Elevated Bilirubin Minimally elevated AST/ALT |
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What are some common causes of cholestatic damage?
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Blockage of common bile duct by gall stone or tumor
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Bilirubin is derived from what?
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From hemaglobin in RBCs
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Bilirubin is bound to what in the blood?
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Albumin
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Bilirubin is actively taken up by hepatocytes and conjugated with glucoronide to do what?
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make it water soluble
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What happens to the conjugated bilirubin?
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Actively secreted out of the hepatocyte into the "bile"
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What are the 3 types of bilirubin?
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1. Conjugated
2. Unconjugated 3. Delta bilirubin (measured indirectly) |
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What is cholestasis?
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any condition in which the flow of bile from the liver is blocked.
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What is normal bilirubin?
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<1.1, 70% unconjugated
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The accumulation of bile salts in cholestatic injury leads to what type of hepatocyte degeneration?
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"Feathery Degeneration"
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If the liver is seen to have "pink infiltrate" in the space of diss, but no elevation of LFT's, what could be the cause?
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Amyloidosis
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What do you call a woman with one leg?
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- Ilene
BOOM BABY! YOUR DONE! |
