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70 Cards in this Set
- Front
- Back
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What is the largest visceral organ?
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the liver
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What is unique about the blood supply to the liver?
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dual
60-70% portal vein 30-40% hepatic artery |
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What makes up the portal triad?
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portal v, hepatic artery, bile duct
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What is a classic liver lobule?
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Hexagon with porta a at apices and a central v centrally
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What is a portal lobule?
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Triangle with central v centrally and portals at apices
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What is a liver acinus?
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football shape with short axis btwn 2 portal triads & long axis btwn 2 central v
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What is unique about a liver acinus?
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it has 3 zones
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Which zone is most vulnerable to an ischemic attack?
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zone 3
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What is a kupffer cell?
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phagocytic cell which lines the hepatic sinuses
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What is a stellate cell?
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stores vitamin A and located in the space of Disse
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What are some metabolic functions of the liver?
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central organ of glucose homeostatis
makes glycogen from glucose or pyruvate synth FA & cholesterol degrades fat |
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What does the liver synthesize?
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albumin, clotting factors, acute phase reactants, bile acids
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What does the liver store?
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glycogen, triglycerides, iron, copper & lipid soluble vitamins
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What are 3 primary diseases of the liver?
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viral hepatitis
alcoholic liver disease hepatocellular carcinoma |
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What are 3 secondary liver diseases?
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cardiac decompensation
metastatic cancer extrahepatic infections |
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What do you see with fulminant hepatic necrosis?
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flacid liver with wrinkled capsule and central necrosis
it appears greenish due to increase in bile |
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What is a mallory body?
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alcoholic hylaine
accumulation of eosinophils |
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What is a councilman body?
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necrotic hepatocyte
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What do you see in a liver with chronic passive congestion?
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nutmeg liver
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What is cardiac problem that causes the back up of venous blood into the liver?
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right sided heart failure
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The backing up of blood in the liver causes what?
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hypoperfusion & retrograde congestion
can lead to cardiac sclerosis (cirrhosis) |
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What do you see histologically with chronic passive congestion of the liver?
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centrilobular necrosis
nutmeg liver |
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What is the mech of centrilobular necrosis in chronic passive congestion?
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this zone recieves the most deoxygenated blood and so necrosis occurs
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What enzymes are increased with cell wall damage?
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AST, ALT, LDH
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What enzymes are elevated with damage to the mitochondria?
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AST
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What enzymes are elevated with bile duct obstruction?
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ALK, GGT, 5'NT
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What enzymes are increased with ingestion of microsomal enzyme inducing agents?
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GGT
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Where do you find AST?
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cytoplasm and mitochondria
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What enzyme do you find in the cytoplasm only?
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ALT & LDH
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What are the enzymes of the canalicular membrane?
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GGT, ALK, 5'NT
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Where do you find GGT?
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canalicular membrane & microsomes
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What are some examples of hepatic dysfunction without overt necrosis?
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-Reye syndrome
-Tetracycline toxicity -acute fatty liver of pregnancy |
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How much of the liver must be dysfunctional before the liver fails?
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80-90%
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What are some clinical features of chronic liver failure?
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jaundice, scleral icterus, hypoalbuminemia (pitting edema), hyperammonemia (encephalopathy), asterixis, gynomastia, hypgonadism, spider angiomas
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What is seen with acute liver failure?
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multi-organ sys failure
coagulopathy hepatorenal syndrome |
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What do you see histologically with hepatic cirrhosis?
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bridging septae, nodules, architectural destruction
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What are some causes of hepatic cirrhosis?
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alcoholic liver disease
viral hepatitis biliary disease primary hemochromatosis wilsons disease a1 antitrypsin deficiency cryptogenic cirrhosis |
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What are some life threatening complications of cirrhosis?
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portal hypertension
hepatocellular carcinoma |
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What si the cellular pathology in cirrhosis?
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activation of stellate and kupffer cells to proliferate & make collegen & hepatocellular distruction
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What are some pre-hepatic causes of portal hypertension?
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obstructive thrombosis
narrowing of portal vein |
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What are some hepatic causes of portal hypertension?
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cirrhosis
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What are some post-hepatic causes of portal hypertension?
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right-sided heart failure
constrictive pericarditis |
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What are some consequences of portal hypertension?
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hepatic encephalopathy
splenomegaly esophageal varicies ascites |
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What is an esophageal varice?
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dilitation of esophageal veins at junction of stomach an dLES in lower 1/3 of esophagus that may rupture
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Extrahepatic bilirubin is?
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bound to serum & deliver to the liver
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Unconjugated bilirubin is?
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lipid soluble
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Glucuronidation occurs where?
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in the ER catalyzed by UDP glycouronlytransferase
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conjugated bilirubin is?
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water soluble & excreted in bile
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What deconjugates bilirubin?
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gut bacteria
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What are some causes of pre-hepatic jaundice?
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1. hereditary hemolytic processes
2. aquired hemolytic processes 3. inffective erythropoiesis 4. newborns 5. impaired deliver to the liver |
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What are some examples of hereditary processes that cause pre-hepatic jaundice?
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sickle cell
G6PD deficiency thalassemia |
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What are some aquired hemolytic processes that cause pre-hepatic jaundice?
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HDN
hemolytic transfusion rxn |
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What are some examples of ineffective erythropoesis that causes pre-hepatic jaundice?
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megoblastic anemia
lead posioning |
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What are some causes of impaird deliver to the liver that causes pre-hepatic jaundice?
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congestive heart failure
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What are some causes of post-hepatic jaundice?
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Gilbert's disease
criggler Najjar syndrome Dubin-Johnson & Rotor syndromes |
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What is Gilbert's syndrome?
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inability of the hepatoceytes to take up bilirubin from the blood
benign mildly symptomatic |
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What is the result of Gilbert Syndrome?
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unconjugated bilirubin
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What is Crigler Najjar Syndrome?
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conjugation is impaired causing and increas in unconjugated bilirubin
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What is Dubin-Johnson Syndrome?
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inability of the hepatocyte to secrete conjugated bilirubin into the bile caniculi once it has been formed
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What is the result of Dubin-Johnson syndrome?
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conjugated bilirubin returns to the blood
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What are some causes of post-hepatic jaundice?
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bile duct stone
cancer of bile duct or pancreas bile duct stricture sclerosising cholangitis choledochal cysts |
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What are some causes of unconjugated hyperbilirubinemia?
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excess production of bilirubin
reduced hepatic uptake of bilirubin impaired bilirubin conjucation |
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What are some causes of conjugated hyperbilirubinemia?
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cholestatic jaundice (impaired bile flow)
deficiency of canalicular membrane transporters hepatocellular disease |
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What is kernicterus?
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accumulation of unconjugated bilirubin in neonatal brain due to heomlysis
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What is cholestasis?
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blockage of bile secretion
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What is cholestais a result of?
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hepatocellular dysfunction or biliary obstruction
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What do you get with cholestatis?
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jaundice, pruritis, skin xanthomas
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What enzymes do you see in serum with cholestatis?
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elevated ALK, GGT, 5'NT
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What deficiency do you get with cholestatis?
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fat soluble vitamins (DAKE)
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What can unrelieved obstruction lead to?
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cirrhosis
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