• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/83

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

83 Cards in this Set

  • Front
  • Back
zone of liver that has poorest oxygenation
centrolobular
portal triad
portal vein, hepatic artery, bile duct
most common liver disease in the US
nonalcoholic fatty liver disease
most common primary cancer of the liver
hepatocellular carcinoma
cirrhosis characteristics (3)
fibrous septa

perenchymal nodules (regenerating hapatocytes)

disruption of architecture of entire liver
3 main causes of cirrhosis in the US
alcohol

viral

nonalcoholic steatohepatitis

other causes: biliary tract disease, hemochromatosis
active cirrhosis
ongoing hepatic damage

peacemeal necrosis - slow infiltration and eating away of liver cells
inactive cirrhosis
will not reverse damage - but no further damage occurs
pathogenesis of cirrhosis
cirrhosis is hepatic fibrosis

inflam cytokins, toxin, kupffer cells cause damage to hepatocytes

stellate (Ito cells) proliferate and synth ECM component -> fibrosis
Ito cell
stores vitamin A in liver

can be activated to synth collagen and ECM components -> fibrosis
cirrhosis causes of death
liver failure

portal hypertension

hepatocellular carcinoma
portal hypertension types
prehepatic - portal vein thrombosis or stenosis

intrahepatic - cirrhosis

posthepatic - right heart failure, hepatic vein obstruction
clinical consequences of cirrhosis
hepatic encephalopathy

esophageal varicies

splenomegaly


other minor issues: ascities, caput maedusae
jaundice
yellow discoloration of skin
icterus
yellow discoloration of sclerae
hyperbilirubinemia
increased unconjugated form due to excess production (hemolytic anemia), reduced hepatic uptake, or impared conjugation

increased conjugated form due to problem with canalicular transport, or impaired bile flow
cholestasis
impaired bile formation or flow

bile gets backed up - form bile lake/infarct - leads to cirrhosis
liver enzyme tests
AST, ALT
bile canalicular tests
alkaline phosphatase (AP) - also found in bone

gamma-glutamyl transferase (GGT)

GGT will be elevated in liver disease, but normal in bone disease
acute viral hepatitis general morphology
cell swelling

cytolysis

apaptosis -> acidophil - councilman bodies

inflammation - lymphocytes and macrophages

maybe cholestasis
councilman bodies
due to apoptosis of hepatocyte - creates acidophil
acute hep B histological features
ground glass hepatocytes

HBsAg stain

you can tell hep B from other hep viral
acute hep C histological features
steatosis, lymphoid aggregates


can't distinguish from other hep viral
chronic hepatitis definition
persistance of increased serum liver enzymes (transaminases) > 6months
chronic hepatitis morphology
peacmeal necrosis - interface hepatitis

leads to...

bridging necrosis - portal to protal or to central

leads to...

bridging fibrosis (this + regenerative nodules = cirrhosis)
most common blood borne infection in the US
hep C
Causes more chronic hepatitis - Hep B vs Hep C
Hep C - also causes more cirrhosis and more hepatocellular carcinoma
liver abscess
through blood borne infection, ascending biliary, or through direct source

amoebae - anchovie paste
autoimmune hepatitis
females

idiopathic T cell activation - often with concurrent autoimmune disorder

autoantibodies - see increased plasma cells in liver

type1 - antinuclear antibody and smooth muscle autoantibodies (most common in US)

type2- anti-liver/kidney microsome1 antibody (pediatric, rare)

NEGATIVE antimitochondial antibody (AMA) - differentiates from primary biliary cirrhosis
Ethanol induces which of the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
all of them
acetaminophen induces which the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
necrosis
CCl4 induces which the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
necrosis
halothane induces which the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
necrosis
methotrexate induces which the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
macrovesicular steatosis
fibrosis->cirrhosis
tetracycline induces which the following liver changes:

macrovesicular steatosis
microvesicular steatosis
necrosis
fbirosis->cirrhosis
microvesicular steatosis
hepatic steatosis
ethanol metabolism

mitochondrial damage -> fatty acid oxidation - accumuation of fatty acid

microsomal dysfunction - increased lipid biosynth, decreased liporotein

reversible
alcoholic hepatitis
hepatocyte swelling/necrosis

mallory bodies (hyaline change)

neutrophil reaction

fibrosis

steatohepatitis
nonalcoholic fatty liver disease
most common cause of elevated liver enzymes in the US - increased aminotransferases, GGT

looks like alcohol induced disease - nonalcoholic steatohepatitis (NASH)

associated with obesity, diabetes type2, metabolic syndrome

unclear pathogenesis - net retention of lipids within hepatocytes
hemochromatosis
excess total body iron accumulation -> organ damage

hereditary - auto rec - excess absorption

acquired - ineffective erythropoesis stimulates absorption, transfusions, too much oral intake
iron toxicity pathogenesis
free radial production - lipid peroxidation

activates hepatic stellate cells - collagen formation

direct dna effects
hemochromatosis organ effects
liver - cirrhosis, pigmentation

pancreas - diabetes, pigmentation

myocardium/conduction system

endocrine glands

bronze skin

"bronze diabetes"
wilson disease
copper overload - formation of ROS

cirrhosis
basal ganglia atrophy
kayser-fleischer ring
alpha1 antitrypsin deficiency
antiprotease protein made in liver

mutant form is abnormal polymerizes and accumulates in hepatocyte -> hepatitis

in lung -> emphysema

most common diagnosed genetic hepatic disorder in infants and children
secondary biliary cirrhosis
extrahepatic biliary obstruction - cholethiasis, malignancies, strictures

children - biliary atresia, cystic fibrosis

build up of bile acid
primary biliary cirrhosis (PBC)
autoimmune

females, associates with other autoimmune disease

automitochondrial antibodies (AMA)

destruction of intrahepatic bile ducts
primary sclerosing cholangitis (PSC)
unknown cause - autoimmune possible due to autoantibodies

anti-mitochondrial antibody NEGATIVE

male predominance

intra and extrahepatic bile ducts

segmental periductal inflammation - looks like a string of beads

onion skin histology

complication - cholangiocarcinoma
onion skin lesion
seen in primary sclerosing cholangitis
von meyenburg complex
bile duct harmatoma
polycystic liver disease
cysts lined with biliary epithelium

assocated with auto dom polycystic kidney disease
congenital hepatic fibrosis
portal tracts enlarged by fibrous tissue - unusally shaped bile ducts

associated with auto rec polycystic kidney disease
caroli disease
segmental dilation of bile ducts due to stones or abcesses

inc risk of cholangiocarcinoma
portal vein obstruction from thombosis or neoplasia
extrahepatic -> portal hypertension

intrahepatic -> infarct of zahn
infarct of zahn
pseudo-infract caused by obstruction of hepatic artery or portal vein (more common)
most common cause of impaired blood flow through the liver
cirrhosis
right sided heart failure effect on liver
passive congestion of the liver - nutmeg liver
effects of left sided heart failure on the liver
centrilobular necrosis, cardiac sclerosis
budd-chiari syndrome
multiple hepatic vein occulsion -> hepatomegaly, necrosis, fibrosis

triad: abdominal pain, ascites, hepatomegaly
sinusoidal obstruction syndrome
veno occlusive disease due to toxin - sinusoidal obstruction by embolized sloughed endothelial cells

obliterated hepatic veins
liver transplant rejection (acute vs chronic vs hyperacute)
acute - portal tract inflammation, bile duct injury, endotheliitis

chronic - obliterative arteritis

hyperacute rejection is rare
von meyenburg complex
bile duct hamartoma - dilated bile ducts, fibrous stroma

embryoinc bile duct remnants
noneoplastic hepatic masses
von meyenburg complex

solitary biliary cyst

nodular hyperplasia
nodular hyperplasias types (2)
focal nodular hyperplasia

nodular regenerative hyperplasia
focal nodular hyperplasia
lobulated central stellate scar

asymptomatic
nodular regenerative hyperplasia
diffuse, atrophy/hyperplasia

associated with transplants, vasculities, HIV

no cirrhosis, no fibrosis - has regenerative nodules
benign primary hepatic neoplasm
cavernous hemangimoa - most common

hepatic adenoma
hepatic adenoma
young women

associated with oral contraceptives

can rupture -> hemorrhage

if adenoma near to liver capsule - hemorrhage into peritoneum
primary hepatic malignancies
hepatoblastoma - most common primary hepatic malignancy in pediatrics

angiosarcoma
hepatoblastoma
most common primary hepatic malignancy in pediatrics

primative hepatocytes with or w/o mesenchyme (osteoid)
angiosarcoma
adult neoplasm - associated with exposure to vinyl chloride - thorotrast
hepatocellular carcinoma causes
most common primary hepatic malignancy in US

alcohol, HBV, HBC, nonalcoholic steatohepatitis, aflatoxin
hepatocellular carcinoma pathogenesis
due to cycles of cell death/regen -> accumulated mutation

viral integration (e.g. HBx protein from HBV), aflatoxins

cirrhosis is not required for HCC, but certain types of cirrhosis can predispose
types of cirrhosis that increase risk of hepatocellular carcinoma
hemochromatosis
postviral hep
alcoholic
types of cirrhosis that DO NOT increase risk of hepatocellular carcinoma
wilsons disease cirrhosis
autoimmune hepatitis cirrhosis
primary biliary cirrhosis
hepatocellular carcinoma morphology
look for - intracellular bile pigment
fibrolamellar carcinoma
young adults

variant of hepatocellular carcinoma

no known risk factors
tumor marker for hepatocellular carcinoma
alpha-fetoprotein
cholangiocarcinoma
adenocarcinoma with desmoplasia

intrahepatic metastases due to lymphatic and vascular invasion
cholangiocarcinoma vs hepatocellular carcinoma
hepatocellular carcinoma is positive for intracellular bile and alpha fetoprotein stains
cholangiohepatocellular carcinoma
mixed form of hepatocellular carcinoma and cholangiocarcinoma

origin: oval cells
oval cells
progenerator of hepatocytes and duct cells
secondary neoplasms of liver
more common than primary due to volume of blood flow -> increased metastases

look for multifocal involvement

carcinomas usually - breast, colon, lung, pancreas
liver biopsy
never done first - only if can't explain it with other tests or if need confirmation of diagnosis

chronic hep - use for prognosis

not tumors - use fine needle aspiration
fine needle aspiration
good for tumor diagnosis - don't need tissue architecture unless its benign