When Good Hepatocytes Go Bad
This disease is responsible for a 35-year-old woman presenting with fatigue and pruritus. Labs show Alk Phos 480 U/L, AST 65, ALT 70, positive antimitochondrial antibodies. Imaging shows normal bile ducts.
What is primary biliary cholangitis (PBC)?
This is the source of tissue contributing to the transaminase elevation in a 10-year-old boy with elevated AST 250 U/L, ALT 120 U/L, with normal liver imaging, but creatinine kinase is markedly elevated.
What is skeletal muscle?
These liver-resident macrophages, located in sinusoids, are critical for phagocytosing bacteria, immune complexes, and senescent red blood cells. They also secrete cytokines that influence fibrosis.
What are Kupffer cells?
The liver plays a central role in ammonia detoxification by converting it into this; it's less toxic compound for excretion.
What is urea?
A patient has HBsAg negative, anti-HBc total positive, and anti-HBs positive. This pattern suggests:
What is recovery from Hepatitis B infection?
This liver tumor, associated with chronic hepatitis and cirrhosis, is typically screened for with ultrasound every 6 months, with or without alpha-fetoprotein measurement.
What is hepatocellular carcinoma?
This gene mutation is the cause of cholestatic liver disease associated with low serum ceruloplasm, cholestatic liver injury, and Kayser-Fleisher rings, and sometimes neuropsychiatric symptoms.
What is ATP7b?
This is the cause of hyperbilirubinemia in a 29-year-old woman who presents with mild jaundice, with labs showing total bilirubin of 3 mg/dL, indirect fraction 2.5 mg/dL, AST 45, ALT 40, alkaline phosphatase normal. She has elevated lactate dehydrogenase (LDH) and reticulocytosis.
What is hemolysis?
Damage to this zone of the hepatic acinus occurs in a 3-year-old patient with near-drowning and resultant hypoxic brain injury, with markedly elevated AST and ALT and imaging showing centrilobular necrosis.
What is zone 3 (centrilobular zone)?
This peptide hormone, released from the small intestine after a fatty meal, stimulates hepatic bile acid secretion.
What is cholecystokinin (CCK)?
This is the interpretation of testing for a 30 year old man found to have HBsAg positive, anti-HBs negative, and anti-HBc IgM positive serologies with elevated ALT.
What is acute Hepatitis B infection?
Beta blockers can be given to patients to prevent variceal bleeding in the setting of portal hypertension, at this threshold pressure at which varices can bleed.
What is 12 mmHg?
Characterized by panacinar emphysema in the lungs and PAS-positive globules in hepatocytes, this inherited disorder often manifests with neonatal cholestasis or adult cirrhosis.
What is alpha-1 antitrypsin deficiency?
This is the cause of hepatocellular pattern of injury in an acutely ill male on vasopressors is in the intensive care unit, whose labs show AST of 3500, ALT of 3200, alkaline phosphatase of 120 U/L, and total bilirubin of 2.5 mg/dL.
What is ischemic hepatitis (shock liver)?
This histologic feature, commonly seen in chronic hepatitis B infection, is a hepatocyte containing eosinophilic, glassy, intranuclear inclusions due to accumulation of viral proteins.
What are ground glass hepatocytes?
A defect in the liver's ability to convert heme from aged red blood cells into bilirubin, due to UDP-glycouronyltransferase deficiency, results in this syndrome.
What is Gilbert syndrome?
Coinfection or superinfection with this virus dramatically increases the risks of fulminant hepatitis in an HBV-infected patient.
What is Hepatitis D?
In hepatic encephalopathy, lactulose works by acidifying the gut lumen, which converts ammonia (NH₃) into this non-absorbable ion.
What is NH4 or ammonium?
This disease is responsible for a patient coming in for care in acute liver failure, with high Ig G levels, positive anti-smooth muscle antibodies, and interface hepatitis on biopsy.
What is autoimmune hepatitis?
This pattern of injury is found in a patient in a patient presenting with fatigue and pruritus, with markedly elevated alkaline phosphatase of 450 U/L, GGT 380 U/L, AST 50 and ALT 60 with otherwise normal liver ultrasound.
What is cholestatic liver injury?
This distinctive histologic finding in primary sclerosing cholangitis features a periductal fibrosis surrounding medium and large bile ducts, eventually leading to duct obliteration.
What is onion-skin fibrosis?
These amino acids are likely affected by a patient who has a genetic defect in bile salt-amino acid conjugation, leading to poorly soluble bile and cholestasis.
What are glycine and taurine?
This population is at highest risk of severe disease, in travelers returning with acute hepatitis, where testing reveals HEV IgM positivity, along with elevated ALT and mild thrombocytopenia.
Who are pregnant women?
Increased hepatic venous pressure gradient and decreased arteriolar resistance leads to this to accumulate in patients with cirrhosis?
What is ascites?
Although often associated with metabolic risk factors, this disease is associated with ballooned hepatocytes and Mallory-Denk bodies, which are histologic features required to distinguish it from simple steatosis.
What is Metabolic Dysfunction-associated steatohepatitis (MASH)?
This is the cause of liver disease of a newborn term male in the NICU, with total bilirubin of 28 mg/dL with no direct bilirubin of 0.9 mg/dL, normal AST and ALT, alkaline phosphatase and GGT, and no evidence of hemolysis, in which phototherapy offers only partial improvement.
What is Crigler-Najjar syndrome?
This hepatocyte enzyme system, located primarily in the pericentral zone 3 region, is responsible for phase I oxidative metabolism of drugs, and is highly sensitive to toxins.
What is cytochrome P450 system?
This specialized liver cell, located in the space of Disse, stores vitamin A in lipid droplets and can differentiate into myofibroblasts during chronic liver injury, contributing to fibrosis.
What is a hepatic stellate cell?
This is the mode of transmission in a 22-year-old man presenting with fatigue, jaundice, and dark urine, whose labs reveal positive anti-HAV IgM, elevated AST and ALT, and normal alkaline phosphatase.
What is fecal-oral transmission?
Patients with cirrhosis may develop this condition in which hyperestrogenemia and altered IGF-1 signaling lead to preferential loss of fast-twitch fibers, contributing to frailty and increased mortality—even independent of MELD.
What is sarcopenia?