Liver Function and Pathology

Flashcards created from lecture notes on liver function, pathology, and related conditions.

Main blood supplies to the liver

Portal vein (60–70%) and hepatic artery (30–40%).

Portal triad

Consists of portal vein, hepatic artery, and bile duct.

Acinar zone most susceptible to ischemia

Zone 3 (centrilobular zone).

Acinar zone exposed to bloodborne toxins

Zone 1 (periportal zone).

Ballooning degeneration of hepatocytes

Reversible swelling of hepatocytes due to cellular edema.

Conditions with ballooning degeneration

Alcoholic hepatitis and nonalcoholic steatohepatitis.

Feathery degeneration

Reversible hepatocyte swelling due to retained bile in cholestasis.

Hepatic steatosis

Accumulation of fat within hepatocytes.

Mallory hyaline

Aggregates of damaged intermediate filaments within hepatocytes.

Chronic condition associated with Mallory hyaline

Chronic alcohol use.

Cell death mechanisms in irreversible liver injury

Necrosis and apoptosis.

Councilman bodies

Apoptotic hepatocytes seen in viral hepatitis.

Typical necrosis for ischemic liver injury

Centrilobular coagulative necrosis.

Bridging necrosis

Necrosis connecting portal tracts to central veins or other portal tracts.

Massive hepatic necrosis

Widespread loss of hepatocytes with collapse of the reticulin framework.

Hepatitis

Inflammation of the liver.

Interface (piecemeal) hepatitis

Inflammatory destruction of hepatocytes at the limiting plate.

Irreversible liver injury response

Fibrosis.

Cells responsible for liver fibrosis

Hepatic stellate cells.

Storage of hepatic stellate cells

Vitamin A.

Activated stellate cells

Become myofibroblasts.

Cirrhosis

Diffuse fibrosis with regenerative nodules and architectural distortion.

Regenerative nodules

Proliferating hepatocyte clusters surrounded by fibrous septa.

Micronodular vs macronodular cirrhosis

Micronodular nodules are

Common causes of cirrhosis

Chronic hepatitis B, chronic hepatitis C, alcohol use, nonalcoholic fatty liver disease.

Functional liver mass loss before failure

About 80–90%.

Acute liver failure definition

Encephalopathy and coagulopathy developing within weeks of liver injury.

Most common cause of acute liver failure in the US

Acetaminophen toxicity.

Causes of hepatic encephalopathy

Accumulation of ammonia and other neurotoxins.

Classic neurologic sign in hepatic encephalopathy

Asterixis (a flapping tremor).

Cause of coagulopathy in liver failure

Decreased synthesis of clotting factors.

Edema and ascites in liver failure

Hypoalbuminemia.

Fetor hepaticus

Musty breath odor due to mercaptans.

Causes of spider angiomas and palmar erythema

Hyperestrogenemia.

Portal hypertension

Increased pressure within the portal venous system.

Most common cause of portal hypertension

Cirrhosis.

Esophageal varices

Dilated submucosal veins due to portal hypertension.

Caput medusae

Dilated periumbilical veins from portal–systemic shunting.

Congestive splenomegaly

Splenic enlargement due to portal hypertension.

Hematologic abnormality from hypersplenism

Thrombocytopenia.

Viruses causing viral hepatitis

HAV, HBV, HCV, HDV, HEV.

Hepatitis viruses causing chronic infection

Hepatitis B, C, and D.

Hepatitis A transmission and chronic disease

Transmitted fecal-orally and does not cause chronic disease.

Serologic marker for acute hepatitis A infection

IgM anti-HAV.

Hepatitis virus with high mortality in pregnancy

Hepatitis E.

Hepatitis virus requiring hepatitis B for replication

Hepatitis D.

Liver injury in hepatitis B

Determined by host immune response, not direct viral toxicity.

First serologic marker in hepatitis B infection

HBsAg.

Antibody indicating immunity to hepatitis B

Anti-HBs.

Marker during hepatitis B window period

IgM anti-HBc.

Hepatitis virus leading to chronic hepatitis

Hepatitis C.

Difficulty in eradicating hepatitis C

High genetic variability and antigenic mutation.

Histologic feature of chronic hepatitis C

Lymphoid aggregates in portal tracts.

Ground-glass hepatocytes association

Chronic hepatitis B.

Autoimmune hepatitis

Immune-mediated chronic hepatitis with autoantibodies and elevated IgG.

Population most affected by autoimmune hepatitis

Females.

Autoantibodies in type 1 autoimmune hepatitis

ANA and anti-smooth muscle antibodies.

Bilirubin origin

Breakdown of heme from senescent red blood cells.

Enzyme conjugating bilirubin in hepatocytes

UDP-glucuronyl transferase (UGT).

Water soluble bilirubin

Conjugated (direct) bilirubin.

Causes of unconjugated hyperbilirubinemia

Increased production, decreased uptake, impaired conjugation.

Gilbert syndrome

Benign decreased bilirubin conjugation due to reduced UGT activity.

Crigler–Najjar syndrome type I

Complete absence of bilirubin conjugation; fatal without transplant.

Kernicterus cause

Unconjugated bilirubin crossing the blood–brain barrier in neonates.

Conjugated hyperbilirubinemia cause

Impaired bile excretion or bile duct obstruction.

Syndrome with black liver and conjugated hyperbilirubinemia

Dubin–Johnson syndrome.

Lab markers suggesting cholestasis

Elevated alkaline phosphatase and GGT.