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77 Cards in this Set
- Front
- Back
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List some conditions that you see microvesicular steatosis.
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- acute fatty liver of pregnancy
- valporic acid toxicity |
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List some conditions that you see macrovesicular steatosis.
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- obesity/DM type II
- HCV (in scattered hepatocytes) |
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Pathogenesis of acute fatty liver of pregnancy.
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- mother and father are both heterozygous deficient in mitochondrial 3-hydroxyacyl CoA dehydrogenase.
- fetus is homozyous deficient in the enzyme. - maternal circulation is flooded with 3-hydroxyacyl metabolite |
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Treatment for acute fatty liver of pregnancy.
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Termination of pregnancy.
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Which condition exhibit both macro- and micro-vesicular steatosis?
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alcoholic fatty liver
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Which condition would you think of if you see periportal necrosis?
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eclampsia
- periportal sinusoids contain fibrin deposits with hemorrhage into space of Disse |
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How to treat eclampsia?
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Termination of pregnancy
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Pathologic criteria for cirrhosis.
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- diffusely disrupted architecture
- bridging fibrosis: bypass functional hepatocytes - neonodules: micro- and macro- |
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Top 4 causes of cirrhosis.
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- alcoholic liver disease
- chronic viral hepatitis - biliary tract disease - hemachromatosis |
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How does cirrhosis cause portal HTN?
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- compression of sinusoids by increased collagen
- compression of central vein by perivenular fibrosis - anastomosis between hepatic arterial and portal venous system impose pressure on veins. |
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Pre-hepatic causes of portal HTN.
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- portal vein thrombosis
- obstruction by tumor mass - splenomegaly: increased venous drainage from spleen |
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Hepatic causes of portal HTN.
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- cirrhosis: fibrosis
- schistosomiasis, massive fatty change - diffuse fibrosing granulomatous disease: sarcoid, miliary TB, nodular regenerative hyperplasia |
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Post-hepatic causes of HTN.
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- hepatic vein outflow obstruction
- RHF - constrictive pericarditis |
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Consequences of portal HTN.
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- ascites (lymphatic capacity overload): >500ml
- portalsystemic veous shunts: hemorrhoids, esophageal varices, caput medusae - congestive splenomegaly - hepatic encephalopathy |
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What percentage liver cells must be non-functional in hepatic failure?
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80-90%
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Major causes of liver failure.
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- chronic liver disease: hepatitis, alcohol, liver decompensation of intercurrent diseases
- sudden massive hepatic necrosis: drugs, toxins, chemicals, mushroom poisoning, HAV, HBV - acute hepatic dysfunction without necrosis: Reye, tetracyclin, pregnancy |
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These are signs of what condition?
- palmar erythema - spider angioma - gynecomastia, testicular atrophy - fetor hepaticus - jaundice |
liver failure
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What are some complications of liver failure?
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- hepatic encephalopathy
- hepatorenal syndrome |
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What is this complication of liver failure?
- rigidity, hyperreflexia, confusion, asterixis |
hepatic encephalopathy
- increased serum ammonia -> impair neuron, brain edema |
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What is this complication of liver failure?
- hyperosmolar urine - no protein, normal sediment, low Na |
hepatorenal syndrome
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Unconjugated or conjugated bilirubin?
- insoluble in water - toixic in tissue - tightly binds albumin - no excretion in urine |
unconjugated bilirubin
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Unconjugated or conjugated bilirubin?
- soluble in water - non-toixic - loosely binds albumin - freely excretion in urine |
conjugated bilirubin
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At what level of serum bilirubin level would you see jaundice?
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> 2mg/dl
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Pre-hepatic causes of jaundice (unconjugated).
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- hemolysis: hemolytic anemia, internal hemorrhage, ineffective, ineffective erythropoiesis (thalassemia)
- muscle (myoglobin) breakdown |
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Hepatic causes of jaundice.
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1. reduced uptake
- drug interference with membrane transporter - Glibert syndrome 2. reduced conjugation - C-N I, II - Gilbert syndrome - breat milk jaundice: glucuronidase - diffuse hepatocellular disease: hepatitis, cirrhosis 3. reduced excretion - Dubin-Johnson syndrome (absence of MRP2 carrier) - Rotor syndrome - diffuse hepatocellular disease |
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Post-hepatic causes of jaundice.
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- bile duct obstruction
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What is this liver condition?
- pruritis - xanthoma - high serum ALP, GGT - vit A, D, E, K deficiency |
Cholestasis
- bile deposition in liver |
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What is this liver condition?
Morphology - dilated canaliculi and bile ducts - degeneration of limiting plates - intracytoplasmic bile pigments in hepatocytes and Kupffer cells - extramedullary hematopoiesis |
Cholestasis
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Name this viral hepatitis:
- enveloped ds DNA |
HBV
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Name this viral hepatitis:
- fecal-oral transmission |
HAV
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Name this viral hepatitis:
- water borne |
HEV
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Name this viral hepatitis:
- long incubation period |
HCV
HBV |
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Name this viral hepatitis:
- no carrier state |
HAV
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Name this viral hepatitis:
- no chronic hepatitis |
HAV
HEV |
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Which phase of viral hepatitis is this? (prodrome, jaundice, recovery)
- fever, painful hepatomegaly - increase serum transaminase - atypical lymphocytosis |
prodrome
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Which phase of viral hepatitis is this? (prodrome, jaundice, recovery)
- increased urine bilirubin and urobiliniogen - IgM antibodies |
jaundice
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Which phase of viral hepatitis is this? (prodrome, jaundice, recovery)
- IgG antibodies |
recovery
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Which viral hepatitis is this?
- DNA polymerase with reverse transcriptase activity |
HBV
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Major causes of fulminant hepatitis.
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- drugs: acetominophen, isoniazid, MAOI, halothane, methyldopa
- toxins: mushroom - HBV |
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What is the most important prognostic factor of chronic hepatitis?
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etiology
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Which is more common in the U.S.?
parasitic infection or pyogenic liver abscess |
pyogenic liver abscess
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What is the most sensitive test for recent alcohol intake and is used to monitor those in treatment for abuse?
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GGT
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What is this liver condition?
Morphology - fatty change: micro and macrovesicular - fibrosis - mallory body |
alcoholic liver disease
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What is this liver condition?
- micronodular cirrhosis - DM - slate gray skin - hepatomegaly - arrhythmias - atypical arthritis - hypogonadism |
hemachromatosis
- destruction of pancreatic islet cell (DM) - iron deposit in myocardium, pituitary gland, adrenal gland, thyroid, parathyroid, joints, skin. |
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What is the treatment for Wilson's disease?
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Cu chelator (D-penicillamine)
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What is this disease?
- behavioral change - psychosis - parkinson like syndrome - Kayser Fleischer ring |
Wilson's disease
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What is this disease?
- decreased serum ceruloplasmin - increase hepatic Cu - increased urinary Cu secretion - mutated ATP7B gene (CH13) |
Wilson's disease
- mutated transmembrane Cu transporting ATPase on canaliculi membrane - Cu spill over around age 5 |
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What is this condition?
- cause neonatal hepatitis with cholestatic jaundice - PAS positive cytoplasmic globular inclusions - emphysema |
alpha-1-AT deficiency (CH14)
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What is this condition?
- neonates with jaundice, dark urine, light and acholic stool - panlobular giant cell transformation (rossettes) |
neonatal cholestasis
- 50% idiopathic - 20% biliary atresia - 15% alpha-1-AT deficiency |
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Pathogenesis of secondary biliary cirrhosis.
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biliary obstruction -> secondary infection -> periportal fibrosis -> hepatic scarring, nodular formation -> bridging fibrosis -> cirrhosis
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Pathogenesis of primary biliary cirrhosis.
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- aberrant MHCII on bile duct epithelial cells -> autoreactive T cells -> hyperagammaglobulinemia with complication activation and circulating immune complexes (IgM)
- anti-mitochondrial antibodies |
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Etiology of secondary biliary cirrhosis.
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- gallstones
- tumors of biliary tree and head of pancreas - stricture - in children: biliary atresia, CF, choledochal cysts, paucity of bile duct |
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What is this disease?
- gross: fine granular appearance - micro: portal edema with neutrophils, periductal fibrosis, mononuclear infiltrate |
secondary biliary cirrhosis
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Name a complication of secondary biliary cirrhosis.
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ascending cholangitis
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What is the strongest indicator for prognosis in primary biliary cirrhosis?
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degree of fibrosis
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What is this disease?
- hyperagammaglobulinemia - increased circualting immune complex (IgM) Morphology - early: portal mononuclear inflammation with granulomatous response - late: fibrosis |
primary biliary cirrhosis
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What is this disease?
Morphology - bile duct with onion skin periductal fibrosis and mononuclear infiltrate Cholangiography: - beaded bile ducts with strictures |
Primary sclerosing cholangitis
- chronic disease with inflammation, obliterative fibrosis, segmental constriction of intra- and extra- hepatic bile ducts |
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What intrahepatic biliary architectual anomaly is associated with AD PKD?
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polycystic liver disease
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What intrahepatic biliary architectual anomaly is associated with AR PKD?
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congenital hepatic fibrosis
- abdominal pain on stooping |
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What is this intrahepatic biliary architectual anomaly?
- clusters of dilated bile ducts in/near portal tract - no clinical significance |
von meyenburg complexes
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What is this intrahepatic biliary architectual anomaly?
- multiple diffuse cysts detached drom biliary tree - abdominal pain on stooping - associated with AD PKD |
polycystic liver disease
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What is this intrahepatic biliary architectual anomaly?
- extensive fibrosis with abnormally shaped bile ducts - associated with AR PKD - complication: portal HTN, bleeding varices |
congenital hepatic fibrosis
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What is this intrahepatic biliary architectual anomaly?
- larger bile ducts segmentally dilated with inspissated bile - often seen with congenital hepatic fibrosis - complication: gallstones, cholangitis, hepatic abscess, portal HTN |
Caroli disease
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Which circulatory disorder of the liver is this?
- portal HTN with esophageal varices - splenomegaly - ascites - infarction of intestines |
portal vein thrombosis
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Causes of portal vein thrombosis.
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- perintoneal inflammation
- metastatic neoplasm in hylar lymph nodes - pancreatitis -> splenic vein thrombosis -> progression into portal vein - post surgery |
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Causes of impaired blood flow through liver.
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- cirrhosis
- occlusion of sinusoids: sickle cell anemia, DIC, eclampsia - RHF: nutmeg liver - LHF - peliosis hepatis: dilated sinusoid with blood |
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Causes of Budd-Chiari syndrome.
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- polythyssemia vera
- pregnancy - cancer - paroxysmal nocturnal hemoglobulinemia |
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Pathogenesis of hepatocellular carcinoma.
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repeated cycle of liver cell death and regeneration -> more opportunity for gene mutation
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Name some organisms that cause hepatocellular carcinoma.
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- HBV
- Aflatoxin from food spoilage mold |
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Which of the following class of hepatocellular carcinoma has the best prognosis?
- well differentiated - moderately differentiated - poorly differentiated - fibrolamellar variant |
- fibrolamellar variant
well differentiated cell separated by dense collagen |
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Which liver infection have a high risk of bile duct adenocarcinomas?
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opithorchis sinensis (chinese liver fluke)
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What is this malignancy?
- moderately differentiated adenocarcinoma - distorted ducts with prominent sclerotic stroma - primary mass with numerous intrahepatic satellite tumors |
bile duct carcinoma
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Complication of liver adenoma.
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rupture of subcapsular tumor (especially pregnancy) -> intraperitoneal hemorrhage
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What is this neoplasm?
- highly vascular - well circumscribed - can't see bile ducts, central vein - thickened plates (1-2 cell layers) |
liver adenoma
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What is this neoplasm?
gross - yellow nodule with a central scarr micro - central fibrous scar |
focal nodular hyperplasia
- 85% female |
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What is this neoplasm?
- gross: spongy, red-purple mass with hemorrhage and fibrosis - micro: dialted vessels lined by single layer endothelial cells. |
hemangioma
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What is this neoplasm?
- diffuse spherical nodules of regenerating hepatocytes, arising in non-cirrhotic liver - nodules not separated by fibrous septae |
nodular regenerative hyperplasia
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