Pathology Block 7 Vascular disease
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Created by:
MedSchoolAce on January 19, 2010
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37 terms
Terms | Definitions |
|---|---|
 Block blood flow into the liver | What do hepatic a.compromise, acquired disease of the portal vein and idiopathic hypertension all have in common |
| Block blood flow through the liver | Cirrhosis, Passive congestion, peliosis hepatitis all: |
| Block blood flow out of the liver | Budd-chiari sydrome, hepatic, v. thrombosis, veno-occlusive disease, and shistosomiasis all: |
| Hepatic artery compromise | Etiology: Thrombosis/artery coompression - embolism; neoplasm, polyarteritis nodosa; sepsis (block blood flow into the liver) |
| Hepatic artery compromise | Compromise of this vessel leads to esophageal varices, splenomegaly and intestinal congestion |
| Hepatic artery compromise | Pathology: THrombosis/artery compression -> possible infarct; Portal venous supply and accessory vessels may sustain the liver |
| Thrombosis | In transplanted livers, presence of _______ can lead to infarction |
| Acquired disease of portal vein | Etiology: Obliteration of small portal veins can lead to impeded flow into the liver; conditions include PBC, PSC, sarcoidiosis, RA, SLE; polyarteritis nodosa; myeloproliferative disorders; exposure to vasotoxic chemicals (aresenic, vinyl chloride |
| Intrahepatic portal vein blockage | Pathology: No ischemic infarction; pseudoinfarct | Gross: Infarct of Zahn - no necrosis; severe hepatic atrophy | Histology: marked hemostasis in distended sinusoids |
| Extrahepatic portal vein blockage | Etiology: Banti syndrome, intra-abdominal sepsis (appendicitis, diverticulitis), thrombotic disorders, trauma, pancreatitis |
| Banti syndrome | - subclinical extrahepatic portal vein occlusion |
| Infarct of Zahn | Infarct commonly found with intrahepatic portal vein blockage, tno necrosis; severe hepatic atrophy |
| Extrahepatic portal vein blockage | Manifestations: May be insidious + well-tolerated or catastrophic and fatal; abdominal pain; portal HTN - ascites; esopahageal varices |
| Banti syndrome | Manifestation: This syndrome presents with variceal bleeding and ascites in the later years |
| Idiopathic portal hypertension | Etiology: Associated iwth hypercoagulability, myeloproliferative disorders, peritonitis, and arsenic exposure; There is impaired portal vein inflow nad non-cirrhotic portal HTN | Histology: hepatoportal sclerosis, dense fibrosis of intrahepatic portal tracts |
| Cirrhosis | Manifestation: this blockage of flow through the liver leads to ascites, esophagela varices, hepatomegaly, and increased transaminases |
| Passive congestion | Etiology: RHF, LHF |
| RSHF | Nutmeg liver; centrilobular hepatocyte atrophy |
| Passive congestion | Gross: nutmeg liver and fibrosis |
| LSHF | Nutmeg liver; ischemic coagulative necrosis |
| Combined congestion | Nutmeg liver with centrolobular hemorrhagic necrosis |
| Peliosis hepatis | Etiology: anabolic steroids, oral contraceptives (rare), associated iwth cnacer; tb; aids; post-transplant immunodeficiency |
| Peliosis hepatis | Manifestations: Rupture may occur spontaneously or following trauma |
| Peliosis hepatis | Gross: multiple, dark cavities, in capsule | Histo: sinusoidal dilation; large blood-filled cavities lined or unlined by sinusoidal endothelium; absence of fibrous wall |
| Budd-Chiari Syndrome | Obstruction of 2+ major hepatic veins |
| Budd-Chiari Syndrome | Obstruction of 2+ major hepatic veins; presents with ascites, hepatomegaly, abdominal pain, and increased transaminases, jaundice |
| Budd-Chiari Syndrome | Increased intrahepatic BP becuase blood cannot be shunted around the blocked outflow tract, this is obstruction of 2+ major hepatic veins |
| Hepatic vein thrombosis | Etiology: Hypercoagulable states, Stasis or small lesion, or vascular injury |
| Hypercoagulable states | Polycythemia vera; factor V leiden; myeloproliferative states, deficiency of protein C or protein S, oral contraceptives; antithrombin III deficiency |
| Stasis or small lesion | These can cause Hepatic vein thrombosis: Cirrhosis; CHF, sickle cell anemia, HCC, hepatic abcess |
| Sickle cell anemia | May be associated with hepatic vein thrombosis | present with dilated sinusoids filled with sickled RBCs, erythrophagocytosis, increased tranaminases, chronic cholestasis, and progressive hepatic failure (rare) |
| Veno-occlusive disease | Etiology: jamaican drinkers of bush tea, immediate weeks after BM transplant |
| Veno-occlusive disease | Manifestations: Mortality > 30%, tender hepatomegaly, ascites, weight gain, jaundice, this is a condition that blocks outflow of blood from the liver |
| Veno-occlusive disesae | Pathology: Obliteration of hepatic vein radicals by subendothelial swelling nad fine reitculated collagen |
| Veno-occlusive disease | this condition must be diagnosed clinically since a biopsy is too risky (highly increased risk of bleeding due to blockage of outflow of blood from the liver) |
| Schistosomiasis | Etiology: most common cause of portal HTN in the world; acute form - snail fever, cutaneous form - swimmer's itch: s. mansoni, S. japonicum; can cause blockage of outflow of blood from the liver |
| Schistosomiasis | Histology: Hepatic perisinusoidal egg granulomas, symmer's pipe stem periportal fibrosis, embolic egg granulomas in brain and spinal cord |
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