Microvesicular vs Macrovesicular hepatic change. I thought i knew this!

[okt3]

I always thought Microvesicular fatty change assoc with Alcoholic Fatty liver

However, Uworld says Macrovesicular = Chronic ethanol consumption
Microvesicular = Reye Syndrome in Kids.

Can someone sort this out for me, wiki isn't giving me a clear answer except, i did see where it says alcohol can cause both.

I am confused😕

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[okt3]

Wait a second. Is micronodular and microvesicular same thing?
Oh God. Brain Fart Puffffffffff!!

Please someone help me on this. Thank you

 

[aashkab]

Wait a second. Is micronodular and microvesicular same thing?
Oh God. Brain Fart Puffffffffff!!

Please someone help me on this. Thank you

micronodular refers to cirrhosis and is caused by toxic insults -> chronic alcohol or wilson's disease

macronodular cirrhosis is caused by viral hepatitis

microvesicular fatty change = reye's syndrome in kids

macrovesicular fatty change = alcoholic fatty liver

 

[PokerDoc]

yeah nodular and vesicular are not the same thing.


macrovesicular vesicular change is seen in alcoholic hepatosteatosis like it says. I think diabetes causes it too

 

[okt3]

Thank you aashkab and pokerdoc for straightening this out for me!

 

[knuckles]

for micronodular, I remember wah-a. wilsons, alcohol, hemochromatosis, a1-antitrypsin

 

[aashkab]

Thank you aashkab and pokerdoc for straightening this out for me!

np Muromonab, oh SNAP, lol, had to do it

 

[puskadali]

micronodular refers to cirrhosis and is caused by toxic insults -> chronic alcohol or wilson's disease

macronodular cirrhosis is caused by viral hepatitis

microvesicular fatty change = reye's syndrome in kids

macrovesicular fatty change = alcoholic fatty liver

You Also get maccrovesicular fatty change in Methotrexate toxicity

 

[sanj238]

I always thought Microvesicular fatty change assoc with Alcoholic Fatty liver

However, Uworld says Macrovesicular = Chronic ethanol consumption
Microvesicular = Reye Syndrome in Kids.

Can someone sort this out for me, wiki isn't giving me a clear answer except, i did see where it says alcohol can cause both.

I am confused😕

I think some important points need to be straightened here. The facts above are all correct and high yield, but no one has explained the underlying issues.

Macrovesicular and microvesicular revolve around cellular changes. In macrovesicular- there is increased fat build up and the vesicles appear enlarged and round due to the fat droplets. These buildups are a result of reversible fatty changes to the liver- fat builds up because of decreased beta oxidation for energy - shunting via alcohol.

In microvesicular- the toxic damage to the liver cells causes shrinking of the vesicle membranes. Eventually fulminant toxicity with wrinkled liver can happen.

Micronodular is a more permanent result that damages the liver nodules. The hepatic nodule is the portion of the main unit of the liver. These nodules consist of the variety of veins and arteries, triads etc - the nodular regeneration and the sclerosis that cirrhosis is about. So cirrhosis is the tissue, the micro/macro is the cellular changes found in reyes/fatty liver.

 

[notbobtrustme]

I think some important points need to be straightened here. The facts above are all correct and high yield, but no one has explained the underlying issues.

Macrovesicular and microvesicular revolve around cellular changes. In macrovesicular- there is increased fat build up and the vesicles appear enlarged and round due to the fat droplets. These buildups are a result of reversible fatty changes to the liver- fat builds up because of decreased beta oxidation for energy - shunting via alcohol.

In microvesicular- the toxic damage to the liver cells causes shrinking of the vesicle membranes. Eventually fulminant toxicity with wrinkled liver can happen.

Micronodular is a more permanent result that damages the liver nodules. The hepatic nodule is the portion of the main unit of the liver. These nodules consist of the variety of veins and arteries, triads etc - the nodular regeneration and the sclerosis that cirrhosis is about. So cirrhosis is the tissue, the micro/macro is the cellular changes found in reyes/fatty liver.

holy ****, wicked explanation bro! makes it so much clearer now rather than memorizing a bunch of random factoids.

 

[sanj238]

holy ****, wicked explanation bro! makes it so much clearer now rather than memorizing a bunch of random factoids.

Yeah I agree. took me a while to figure it out...its in Goljan's RR book. though no concise comparison contrast, but if you read its there.

 

[chillaxbro]

Just remember reyes syndrome is in kids so microvesicular, alcohol cirrhosis is in adults so macrovesicular. You're welcome!

 

[liverdoc17]

Macrovesicular steatosis is the commonest form of liver injury, from alcohol, metabolic syndrome (diabetes, dyslipidemia). It can cause liver injury (fibrosis) over many years/decades. It is a large fat droplet in the cytoplasm of the hepatocyte and will push the nucleus to one side.

Microvesicular steatosis (reviewed in J Hepatol 1997;26 (Suppl 1): 13-22) is rare and thought to be secondary to defects in mitochondrial function or beta oxidation of fatty acids. It can cause liver failure quickly. Causes include ASA (Reye's Syndrome) and Valproic acid - perhaps by sequestering coenzyme A; high dose tetracycline by inhibiting beta-oxidation enzymes; HIV medications (ddC and ddI and perhaps d4T ie dideoxynucleosides) and an old hepatitis B medication (FIAU - see NEJM 1995;333:1099 for good clinical description of what happened) by inhibiting mitochondrial DNA replication. It is seen as many small fat vesicles in the cytoplasm of the hepatocyte that will not push the nucleus to the side.

Micronodular cirrhosis: regenerative/cirrhotic nodules are small, usually earlier in a cirrhotic process of any cause.

Macronodular cirrhosis: when cirrhotic nodules coalesce into larger nodules, usually later on in a cirrhotic process of any cause.