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Jaundice - Hemochromatosis (63)
Terms in this set (79)
Review clinical features of non-neoplastic disorders of the liver.
Review signs of liver disease
Review liver laboratory investigations.
Liver function test shows that elevated ALT is higher than elevated AST.
primary hepatic damage
AST/ALT > 2
Liver function test shows that elevated AST is higher than elevated ALT.
toxic damage to hepatocytes
alcoholic liver disease
Liver function test shows increased ALP and GGT.
disruption to the flow of bile
ALP increased in obstructive liver disease (cholestasis)
GGT rises in cholestasis and with alcohol use
List 2 tests used to assess the liver's synthetic function.
serum albumin: decreased in chronic liver diseases.
prothrombin time: increased in acute and chronic liver diseases.
What oncofetal protein is increased in hepatocellular carcinoma?
Describe why ammonia levels increase in hepatic failure.
The liver is responsible for breaking down ammonia into urea. If there is hepatic failure, this process cannot occur.
*increased ammonia levels can ultimately lead to encephalopathy.
What disorder is associated with low ceruloplasmin levels?
*ceruloplasmin is a carrier of copper.
What type of endoscopic examination can assess the status of the biliary tree?
Endoscopic retrograde cholangiopancreatography
*magnetic retrograde cholangiopancreatography
Describe ballooning degeneration of hepatocytes.
Hepatocytes have irregularly clumped cytoplasms, become bigger, and have degenerate nuclei. It is one of the features of steatohepatitis.
Describe feathery degeneration of hepatocytes.
Hepatocytes have fine foamy cytoplasm because of the detergent action of bile salts.
List 2 causes of macrovesicular steatosis.
non-alcoholic fatty liver disease --> malnutrition (protein-energy malnutrition)
List 2 causes of microvesicular steatosis.
acute fatty liver of pregnancy
Reye's syndrome (aspirin)
What inclusion bodies are indicative of a hepatocyte that is undergoing apoptosis?
Review formation of bilirubin.
List 3 causes of pre-hepatic jaundice
List 2 causes of post-hepatic jaundice.
List 3 causes of hepatic jaundice.
Does increased indirect serum bilirubin suggest liver cell damage or primary biliary duct disease?
liver cell damage
List the 3 characteristics that define cirrhosis.
bridging fibrous septa in the form of delicate bands or broad scars around multiple adjacent lobules
parenchyma nodules created by regeneration
Describe the difference in size between micronodular and macronodular cirrhosis.
micronodular < 3mm nodules
macronodular > 3mm nodules
Is hepatitis B cirrhosis micronodular or macronodular?
*note the green caused by bilirubin.
Which zone of the liver is affected by viral hepatitis?
Which zone of the liver is affected by congestive heart failure?
Cirrhosis clinical presentation
Where are Ito cells found?
between hepatocytes in the sinusoids
*also important in vitamin A metabolism
Review consequences of portal hypertension.
hepatic encephalopathy: occurrence of confusion, altered level of consciousness and coma caused by accumulation in the bloodstream of toxic substances that are normally removed by the liver.
Review causes of portal hypertension.
Thrombosis of the hepatic vein resulting in features similar to right heart failure
What is the most common infective disease of the liver?
Hepatitis A nucleic acid
Hepatitis A incubation period
Hepatitis A age group and transmission
Hepatitis A diagnosis
look for IgM at the onset of signs and symptoms
Hepatitis B nucleic acid
enveloped partially dsDNA
Hepatitis B incubation period
Hepatitis B transmission
What are the chronic hepatitis conditions?
primary sclerosing cholangitis
primary biliary cirrhosis
What are the 2 hallmarks of chronic hepatitis?
inflammation of the portal tract
interface activity: lymphocytes will attack the limiting plates of the liver.
Hepatocytes show sanded-nuclei
hepatitis B core antigen
Ground glass hepatocyte
hepatitis B surface antigen
A ground glass hepatocyte is a liver parenchymal cell with a flat hazy and uniformly dull appearing cytoplasm on light microscopy. The cytoplasm's granular homogenous eosinophilic staining is caused by the presence of HbsAg.
What is the most important cause of transfusion-associated hepatitis and chronic liver disease?
Hepatitis C incubation period
Hepatitis C nucleic acid
Review hepatitis C histology.
Hepatitis C has a propensity to damage the biliary tract.
Hepatitis E envelope and nucleic acid
Clinical hepatic insufficiency that progresses rapidly to hepatic encephalopathy within 2-3 weeks
*viral hepatitis is the most import ant cause (60-70%)
Autoimmune hepatitis gender
more common in females
Autoimmune hepatitis Rx
What type of antibodies are seen in autoimmune hepatitis?
high titers of IgG --> anti-nuclear and anti-smooth muscle antibodies
*anti-LKM (liver kidney microsomal type) antibodies
Describe the histology of autoimmune hepatitis.
Feathery change occurs due to influx of bilirubin. In addition inflammation brings in lymphocytes and plasma cells.
What type of inclusion bodies are associated with alcoholic liver disease?
*tangled skeins of intermediate filaments (keratin)
*seen as eosinophilic cytoplasmic inclusions
Describe the 3 patterns of liver disease.
alcoholic hepatitis (inflammation and steatohepatitis)
variable amount of fibrosis to cirrhosis
Is alcoholic liver disease micro- or macronodular?
mainly micronodular, but maronodules may be formed at a later stage
What type of hepatocyte degeneration is associated with alcoholic liver disease?
What liver disease is associated with metabolic syndrome?
non-alcoholic fatty liver disease
*diabetes, hypertension, hypertriglyceridemia
Non-alcoholic fatty liver disease risk factors (3)
What are the 2 mutations on the HFE gene associated with hemochromatosis?
What mutation causes primary hemochromatosis?
HFE gene on chromosome 6
Primary hemochromatosis gender
common in males
*rarely manifests before 40
Does hemochromatosis cause micronodular or macronodular cirrhosis?
What metabolic disorder is associated with hemochromatosis?
What type of cancer is associated with hemochromatosis?
*200x increased risk
Causes of secondary iron overload --> hemochromatosis
Hemochromatosis gross specimen
Review involvement of other organs in hemochromatosis.
What cardiac disorder is associated with hemochromatosis?
Wilson's disease pattern of inheritance
What 3 organs are most common affected by Wilson's disease?
brain: basal ganglia
How does Wilson's disease present in the eye?
How does Wilson's disease present in the blood?
acute intravascular hemolysis
Review Wilson's disease morphology
Is ALT or AST more specific for liver injury?