Liver Diseases - University of Kentucky



Liver Diseases | | | | | | | | |

| |Definition |Pathogenesis |Si/Sx |Pathology |Dx/Tx |Complications |Risk Fctrs. /Misc. |

|Alcoholic Liver |spectrum of disease including | | | | | | |

|Disease |the following pathology in | | | | | | |

| |sequence or together | | | | | | |

|-Fatty liver |reversible deposition of lipids|hepatotoxic effects of ethanol |asymp., malaise, anorexia, |Intracellular fat vacuoles | | | |

|(steatosis) |in hepatocytes |and metabolites? |abdominal discomfort |(macrovesicular); usually no fibrosis| | | |

|-Alcoholic Hepatitis |an acute inflammation of the |hepatotoxic effects of ethanol |Fever, RUQ pain, jaundice, |Necrosis of hepatocytes (central zone| | |Mallory bodies are |

|(steatonecrosis, |liver brought on by alcohol |and metabolites? |malaise, anorexia; |[3]) | | |also seen in NAFLD,|

|steatohepatitis) |consumptoin | |mild leukocytosis, elevated |Neutrophilic inflamm. | | |PBC, Wilson’s |

| | | |AST>ALT |Cytoplasmic hyaline inclusions | | |disease, |

| | | |(usually) |(Mallory bodies) | | |hepatocellular |

| | | | |Perivenular & sinusoidal fibrosis | | |carcinoma, etc. |

|-Alcoholic cirrhosis |diffuse fibrosis with nodular |hepatotoxic effects of ethanol |Chronic liver failure |micronodular; cirr. |“beading” = multifocal |a | |

|:young men (70%) w/ |of all segments of biliary tree| | | |stenosis of extrahepatic | | |

|ulcerative colitis | | | | |biliary tree | | |

| | | | | |Tx: Trpt | | |

|Ascending Cholangitis |Acute inflammation of the wall |results from any lesion |Fever, chills, abd. pain, |Infection is usually w/ GM neg. | | | |

| |of the bile ducts w/ entry of |obstructing bile flow, commonly|jaundice |aerobes (E.coli or Kleb) | | | |

| |neutrophils into the luminal |choledocholithiasis | | | | | |

| |space | | | | | | |

|Extrahepatic Biliary |stenosis of biliary tree |can be congenital; progressive |Dark urine & pale stools; |Periportal ductular proliferation & |Tx: hepatic |death by 1-2 yrs | |

|Atresia | |fibrosis & cirrhosis can |jaundice |fibrosis; no or small extrahepatic |porto-enterostomy (Kasai); |if not corrected | |

|:infants w/ prolonged | |develop | |bile ducts; cholestasis |living relative liver | | |

|cholestasis | | | | |transplant | | |

|Hereditary Hemochromatosis |Inappropriately high iron |iron sensing duodenal crypt |Micronodular cirrhosis |early) increase in hepatocellular |Dx: gene analysis for C282Y |high incidence of |in secondary iron |

|symps show up in |absorption & toxic accum. of |cells become iron-deficient b/c|Diabetes mellitus (75%) |hemosiderin |mutation on HFE gene (c’some|hepatocellular |overload the iron |

|50-60 yo men |iron in parenchyma of various |of HFE gene and upregulate |Skin pigmentation (75%) |late) marked hemosiderin deposition |6); homozygosity (85%); |carcinoma (30%) |is found in the |

| |organs |transport & absorption |cardiac failure, testicular |in hepatocytes & bile duct epith. |can quantitate iron content | |Kuppfer cells |

| | | |atrophy, arthropathy |-fibrosis -> cirrhosis |in liver tissue | |instead of the |

| | | | | |Tx: Phlebotomy | |hepatocytes |

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| |Definition |Pathogenesis |Si/Sx |Pathology |Dx/Tx |Complications |Risk Fctrs. /Misc. |

|Wilson disease |Rare genetic disorder of copper|accum. of toxic levels of |Hepatic disease (hepatitis, |variable |Dx: Increase in hepatic | | |

| |metabolism |copper in liver, brain, eye, |cirrhosis) | |copper content | | |

| | |etc. b/c of defective biliary |Kayser-Fleishcer ring | |Decrease in serum | | |

| | |excretion of copper |Hemolytic anemia (Coombs | |ceruloplasmin | | |

| | | |negative) | |Slit lamp exam for K-F | | |

| | | |Neurological signs (first | |Molecular genetic analysis | | |

| | | |indication – 40% of time) | |(c’some 13 defect = Cu | | |

| | | | | |transporting ATPase) | | |

| | | | | |Tx: chelators, Zinc, Trpt | | |

|Alpha-1-Antitrypsin |most common inborn error of |lack of inhibition of |Lung & liver probs |PAS + diastase-resistant globules in |Dx: Serum A1AT phenotype | | |

|Deficiency – AR |meta. causing cholestatsis or |proteases (sp. elastase) leads | |hepatocytes (not digested by amaylase|determination | | |

| |cirrhosis; involves development|to damage of mito., caspase | |like glycogen is) |Serum quantification = 10% | | |

| |of emphysema & liver disease |activation, release of ROS | | |of normal if genotype is | | |

| | | | | |PiZZ (c’some 14) | | |

| | | | | |Tx: Trpt | | |

|Hepatocellular carcinoma |90% of all primary liver |Cirrhosis (85%), HBV(80%), HCV,| |“Looks like liver” |Dx: elevated serum AFP in | |Strongly linked to |

|*review notes |cancers |Aflatoxin B1 (from | | |90% of cases | |HBV (it integrates |

| | |aspergillus), and EtOH are all | | | | |into host-genome) |

| | |related; possible damage to p53| | | | | |

|Metastatic Cancer |most common malignant neoplasm | | |coming from breast, lung, colon | | | |

| |of the liver | | | | | | |

|Cholangiocarcinoma |bile duct carcinoma |Liver flukes, PSC, UC, | |Adenocarcinoma w/ fibrosis | | | |

| | |anomalies of biliary tree | | | | | |

|Angiosarcoma | |assoc. w/ vinyl chloride, | | | | | |

| | |arsenic, Thorotrast | | | | | |

|Hepatocellular Adenoma | |assoc. w/ oral contraceptives |abd. pain due to hemorrhage, |looks like nrml liver w/ no central | | | |

|: young women | | |rupture |veins or portal areas | | | |

|Focal Nodular Hyperplasia |benign tumor?/liver | | |well demarcated/ poorly encapsulated | | | |

| |regeneration? | | |mass w/ prominent central fibrous | | | |

| | | | |scar | | | |

|Hemangioma |Most common benign tumor of the| | | | | | |

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|Acute Oral Disease | | | | | | | |

| |Definition |Pathogenesis |Si/Sx |Pathology |Dx/Tx |Complications |Risk Fctrs. /Misc. |

|Recurrent Aphthous |most common oral ulcerations |immunological cause | | | | | |

|Ulcerations | | | | | | | |

|-minor apthous ulceration |most common form of RAU |-mostly a rxn of the cell |almost exclusively on non-keratinized | |Tx: Topical steroids: |in severe or |blood dyscrasia, |

|(MiRAU) | |mediated immune response to |movable mocusa; yellow fibrionpurulen | |Decadron, Diprolene, Lidex |resistant cases |nut. defs., |

| | |toxins, food, etc. which act as|membranes w/ erythematous halos; | |Chemical cautery is |one should |Behcet’s, Crohn’s, |

| | |allergens or haptens |2-10 mm | |contraindicated and OTC |evaluate for the |AIDS, & sprue all |

| | | | | |medications are problems |trigger |increase preval. |

|-major apthous ulceration |more morbity than minor (MaRAU)|“ |same as above except significantly | |Tx: more potent local |should be worked | |

|(periadenitis mucosa | | |deeper, larger, and take longer to heal| |steroids: Kenacort, |up to rule out | |

|necrotia recurrens or | | | | |Dexamethasone syrup.; |systemic basis | |

|Sutton’s Disease) | | | | |or systemic steroids | | |

|-herpertiform apthous |similar to MiRAU but generally |“ |lack of painful/erythematous gingiva | |Tx: DOC is topical steroids | | |

|ulceration (HeRAU) |smaller and more numerous | |should distiguish it from primary | |: 2% tetracycline can be | | |

| |(poss. 100 at a time) | |herpetic infection | |effective | | |

|Herpangina |infxn w/ one of numerous |viral infxn |sore throat, fever, headache, sometimes| |Tx: pain relief (motrin or |can have disease | |

|:young children (or |strains of Coxsackie virus | |N/V; | |dyclonine HCL) |several times from| |

|possibly elderly) | | |lesions will resemble RAU but will | |-will heal w/in a week |diff. strains | |

| | | |occur on soft palate, pharyngeal wall,| | | | |

| | | |& tonsillar pillars | | | | |

|Hand, Foot, & Mouth Disease|infxn w/ one of numerous |viral infxn |erythematous maculopapular rash on | |Tx: pain relief (motrin or | | |

|:mostly young children |strains of Coxsackie virus | |hands, feet, legs, arms & buttocks; | |dyclonine HCL) | | |

| | | |annorexia, fever, coryza, | |-will heal w/in a week | | |

| | | |lymphadenopathy, N/V; oral lesions | | | | |

| | | |(90%) on palate, tongue, & buccal | | | | |

|Herpes Simplex Infection |viral infxn mostly w/ Type I |viral infxn |high fever & lymphadnenopathy; gingiva | |Dx: cytologic smear can be |herpes labialis is|herpetic whitlow |

|-primary herpes infxn w/ |but possibly w/ Type II | |is painful & erythematous; involvement | |performed if ? |20 herpes of lips,|occurs if a finger |

|acute herpetic | | |of bound mucosa | |Tx: mostly palliative; |etc. (virus hides |is exposed to |

|gingivostomatitis (some | | | | |Zovirax elixir can reduce |in ganglia of the |infected vesicle |

|people show no signs of | | | | |severity if given before day|area) |fluid |

|primary infxn) | | | | |3 of the ulcerations | | |

|-recurrent herpetic |recurrence of secondary herpes |viral recurrence |in immunocomp. lesions are seen only on| |Tx: systemic antivirals can |not uncommon | |

|stomatits | | |bound mucosa; lesions are pin point | |reduce severity if used |following dental | |

| | | |areas of erythema which develop central| |during prodrome; careful use|procedures | |

| | | |yellow zones (fibrin) | |as prophylaxis | | |

|-above in immsupp. | |viral recurrence |in immsupp. may present w/ herpes | | | | |

| | | |labialis and develop oral lesions w/ a | | | | |

| | | |brown cap (necrotic); they spread | | | | |

| | | |laterally with white-bordered erosions | | | | |

|Herpes Zoster |viral infxn w/ varicella-zoster|virus resides in sensory nerve |upon reactiv. vesicles form unilat. on | |Tx: systemic antivirals |post-herpetic | |

| |virus |ganglia |skin & mucosa | | |neuralgia | |

| |-recurrence of chicken-pox | | | | | | |

|Erythema Multiforme |acute diffuse ulcerative |? |erythematous macules or vescicles, on |(classic macules exhibit |Tx: self-limiting |Stevens-Johnson | |

|:young adult males |condition | |extremities, face, neck (severe, |“bull’s eye” presentation”; |-can use systemic steroids |Syn. = | |

| |-can involve skin or mucosa | |painful, oral lesions) |oral lesions can present as | |skin, eye, mouth, | |

| | | | |large areas of epith. | |genitals | |

| | | | |necrosis w/ sloughing) | | | |

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