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62 Cards in this Set
- Front
- Back
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What are the 5 main etiologies of liver injury?
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1. jaundice
2. Viral hepatitis 3. Toxic 4. Inborn errors of metabolism 5. Immunologic |
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What are the 4 main patterns of liver injury?
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1. Hepatic
2. Vascular 3. Cholestatic 4. Infiltrative |
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What is cirrhosis?
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Disruption of hepatic architecture by fibrosis
Represents the end stage of chronic liver damage |
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What grossly forms in the liver in response to cirrhosis?
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Regenerative nodules
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What is the gold standard for the diagnosis of cirrhosis?
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The liver biopsy
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What is hepatitis?
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Primary directed hepatocellular injury
(note: inflammation usually, but not always seen) |
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What are the 2 broad categories of hepatitis?
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1. Acute
2. Chronic |
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What are the 3 broad etiologies of hepatitis?
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1. Viral
2. Autoimmune 3. Toxins |
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What is acute hepatitis?
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Hepatitis (primary directed hepatocellular injury) which last for less than 6 months.
Fibrosis is NOT seen |
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What is chronic hepatitis?
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Hepatitis which persists for >6 months
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What are the 5 main categories of CHRONIC hepatitis?
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1. Viral
2. Biliary 3. Metabolic 4. Autoimmine 5. Drug |
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While mechanisms of damage are diverse in hepatitis, how do the cells usually die?
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Via apoptosis
Recall: from previous lecture in patterns of liver damage |
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What is the BEST definition of chronic hepatitis?
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Injuries that reside in the liver for a sufficient period of time that they have the ability to invoke a fibrogenetic repsonse
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What is the limiting plate?
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Hapatocytes at the junction of the portal tract and parenchyma
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What is the "Activity" of CH?
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Degree of inflammation and hepatocellular death
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What is the "stage" of CH?
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Degree of fibrosis
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What is ballooning degeneration?
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A form of hepatocyte death where swelling is seen, ie "hydropic change"
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What are the stages of activity in CH?
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1 = mild
2 = moderate 3 = severe |
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What are the 4 stage of fibrosis?
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0 = none
1 = mild expansion 2 = Septa 3 = Bridging 4 = cirrhosis |
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What describes a 2 stage fibrosis?
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Fibrosis with beginning septa
Portal fibrosis now extends into the parenchyma but has not yet joined with another septa |
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What describes stage 3 fibrosis?
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Bridging Fibrosis
When at least 2 septa join, causing "bridging" |
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What describes stage 4 fibrosis?
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Cirrhosis
When numerous areas of bridging have occurred leading to the disruption of hepatic architecture |
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Portal to portal bridging fibrosis is characteristic of what type of injury?
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Hepatic injuries
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Central to central vein bridging is seen in what type of injury?
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Those that primaryily affect zone 3:
Venous outflow blockage and EtOH damage |
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What % of people infected with Hep C go on to chronic hep?
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85%
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What may follow chronic Hep C infeciton?
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Cirrhosis
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Why is HCV so bad?
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Bodies antibodies are relatively ineffective
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What, inconjuction with Hep C, causes worse symptoms/effects?
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Alcohol
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What region in the HCV has a high rate of mutation, allowing it to escape the immune system?
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E2
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How long does it take Hep C infection to progress to cirrhosis?
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A long time, >30 years in a non-alcoholic (<20 years in a booze hound)
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What type of virus is Hep B?
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DNA (unlike C which is RNA)
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What can Hep B cause?
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Chronic Hepatitis with ensuing cirrhosis
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Are antibodies effective in Hep B?
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YES
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What are the 2 histologic characteristics of Hep B?
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1. Hepatitis
2. Ground Glass Hepatocytes |
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What do ground glass hepatocytes represent?
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Surface antigen --> HBV has integrated into host genome
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Where within the cell is Hep B surface antigen usually found?
Core antigen? |
Surface antigen: Cytoplasm (ground glass)
Core antigen: Nucleus |
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What is the most important feature of Hep A?
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NEVER leads to Chronicity, fibrosis, or cirrhosis!!!!!
A = ACUTE!! Wow i'm good, i should write review books |
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What are the 3 main histologic characterisitics of Hep A?
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1. Hepatitis
2. Lobular disarray 3. Cholestasis |
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What non-infectious condition can lead to acute/chronic hepatitis and may lead to cirrhosis?
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autoimmune hepatitis
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In which zone will the negative effects of toxins usually be seen in the liver?
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Zone 3 because that is where p450 is that is degrading the toxin
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What are the 2 main drugs that can cause liver damage?
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1. Dilantin
2. Acetaminophen |
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How does acetaminophen cause liver damage?
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The drug, if present at high doses, get converted by p450 to NAPQ1 which is toxic
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What type of damage does acetaminophen cause?
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Zone 3 hemorrhagic necrosis
NOT Chronic, fibrotic, cirrhosis --> it's an acute process |
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Is most acetaminophen detoxified via p450?
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NO, because p450 causes toxic metabolite to form
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What is steatosis?
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Accumulation of neutral lipids (TG's, cholesterol) in the cytoplasm of hepatocytes
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What are the 2 types of steatosis and steato-hepatitis?
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1. Macro
2. Micro |
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Steatosis as a result of obesity, diabetes, and EtOH usually shows up where in the liver?
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Zone 3
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Where does steatosis occur in Hep C?
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Zone 1
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What is steatohepatitis?
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fatty liver which has cellular death due to fat
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What are 3 main histologic signs of steato-hepatitis?
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1. Ballooning degeneration
2. Mallory's Hyaline 3. "Chicken Wire" - collagenization of space of disse |
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What are the 3 main metabolic injuries to the liver?
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1. Hemachromatosis - too much Fe absorption
2. Wilson's Disease - Not enough copper secretion 3. Alpha-1 Anti-Trypsin - biliary cirrhosis |
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In which zone with hemosiderin (in Hemochromatosis) be seen first?
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Zone 1
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What is the main pathogenesis of hemochromatosis?
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1. Enterocytes regulate iron uptake from gut lumen by sensing its own iron stores
2. Errors in HFE cause the pool to be musjudges and too much Fe to be absorbed |
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What is the mutation is HFE normally?
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C282Y
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Hemachromatosis, if left untreated will cause what?
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Cirrhosis
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What is wilson's disease?
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Genetic disorder of copper metabolism
Cannot EXCRETE copper |
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What are the 4 main presentations of wilson's?
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1. Chronic Hepatitis
2. Steato-hepatitis 3. Acute liver failure and necrosis 4. Neurologic Manifestation |
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What is the role of a1-AT?
Where is it produced? |
protease inhibitor important in the lung
Produced in the liver |
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What are the clinical manifestations of A1-AT defiency?
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1. Emphysema
2. Neonatal jaundice and hapatitis |
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What histologic signs are seen in a1-at def?
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Cirrhosis with a biliary pattern
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What is seen histologcially, cellulary in a1-at def?
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Accumulation of a1-at which appear as pink, round, smooth, globules in the hepatocytes
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What do you call a fish with no eyes?
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A fsh
WOO HOO, you're done!! |
