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Pathology > Liver > Flashcards

Liver Flashcards

1
Q

Signs of liver disease
Acute and chronic

A

icterus (jaundice), hepatomegaly, tenderness in right hypochondrium, peripheral edema

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2
Q

Signs of liver disease
Chronic

A

splenomegaly, palmar erythema, spider angiomas, gynecomastia and testicular atrophy, Dupuytren contracture, parotid enlargement, clubbing, white nails (leukonychia), muscle wasting

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3
Q

Classification of jaundice
Pre-hepatic

A

excess production (predominantly UNconjugated) (hemolytic anemia, increased blood resorption from hemorrhage, ineffective erythropoiesis)

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4
Q

Classification of jaundice
Post-hepatic

A

Impaired bile flow (predominantly conjugated)
Gallstones, Ca head of pancreas and extrahepatic bile ducts
Biliary atresia common in neonates (

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5
Q

Classification of jaundice: Hepatic

A

Reduced uptake (predominantly UNconjugated)
Drugs (interfere with membrane carrier system)
Diffuse liver disease (ex: viral hepatitis, cirrhosis)
Impaired conjugation (predominantly UNconjugated)– physiologic disease of newborn
Decreased excretion (predominantly conjugated)– drugs, transporter deficiency
Impaired bile flow (

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6
Q

Check alkaline phosphatase and GGTs levels to differentiate

A

primarily biliary duct disease vs primarily hepatic damage 🡪 will be higher in biliary duct disease

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7
Q

Portal triad –

A

bile duct, portal vein, hepatic artery

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8
Q

Limiting plate

A

1st layer of cells surrounding portal triad

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9
Q

Sinusoids

A

discontinuous endothelial cells between 2 hepatocytes, will take blood from portal vein/hepatic artery to central vein

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10
Q

Viral pathology will affect mostly zone

A

1

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11
Q

Drugs will predominantly affect zone

A

2

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12
Q

Bile duct damage will be in zone

A

1

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13
Q

heart failure damage will be in zone

A

3

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14
Q

Ballooning degeneration

A

irregularly clumped cytoplasm

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15
Q

Feathery degeneration

A

ine foamy cytoplasm because of detergent action of bile salts

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16
Q

Clinical pathologic syndromes

A

asymptomatic infection, carrier state, acute hepatitis, chronic hepatitis (more than 6 months), fulminant hepatitis

17
Q

Chronic hepatitis

A

Chronic necro-inflammatory diseases in which hepatocytes rather than biliary structures are the main target
Clinical disease process of more than 6 months duration

18
Q

Viral hepatitis

A

Most common infective disease of the liver
However the term viral hepatitis is used for group of diseases caused by a group of hepatotropic viruses 🡪 hepatitis viruses A to E

19
Q

Hepatitis A

A

Caused by ssRNA virus
incubation period is 2-6 weeks
Does not cause chronic hepatitis
no carrier state

20
Q

Hepatitis B

A

Caused by enveloped DNA virus, long incubation period 4-26 weeks
Present in all pathological and physiological fluids
Transmission occurs by: transfusion of blood and blood products, sexual intercourse, IV drug abuse, homosexuals, needle stick injuries

21
Q

Hepatitis C

A

Most important cause of transfusion associated hepatitis and chronic liver disease
Incubation period is 1-3 weeks, much more propensity for chronicity, ssRNA
Inherently unstable virus so no vaccine yet
Persistent infection and chronicity are hallmark

22
Q

Fulminant hepatitis

A

clinical hepatic insufficiency that progresses rapidly to hepatic encephalopathy within 2-3 weeks
Viral hepatitis is the most important cause

23
Q

Alpha-1 antitrypsin deficiency

A

Autosomal recessive disorder
Markedly low levels of alpha antitrypsin (is protease inhibitor)
Is a glycoprotein encoded by PiMM gene in chromosome 14
Synthesized by liver
PiZZ is homozygote form (markedly reduced levels)
Forms with markedly reduced levels have lung disease (emphysema)

24
Q

Autoimmune hepatitis

A

Common in females, morphological features of chronic hepatitis, high titers of IgG (lot of plasma cells
Anti-nuclear and anti-smooth muscle antibodies (ANA/ASMA)
Anti-LKM (liver kidney microsomal type) antibodies
Responds to immunosuppressive therapy

25
Q

Primary biliary cirrhosis

A

Possibly autoimmune – anti-mitochondrial antibodies (AMA) in 90%
Disease of middle aged women

26
Q

Primary sclerosing cholangitis

A

Inflammation, fibrosis, and dilatation of intrahepatic and extrahepatic ducts
ERCP – beading of the biliary tree
Males > females
P-ANCA in ~80% cases
Association with chronic ulcerative colitis

27
Q

Alcoholic liver disease

A

20 grams of alcohol in women or 60 grams in men can produce liver injury when consumed daily for years

hepatic steatosis, alcoholic hepatitis (inflammation and steatohepatitis), variable amount of fibrosis to cirrhosis
Mallory hyaline/bodies – tangled skeins of intermediate filaments, seen as eosinophilic cytoplasmic inclusions

28
Q

Non-alcoholic fatty liver disease

A

Changes like ALD in non-drinkers, steatosis with or without hepatitis
Risk factors – obesity (insulin resistance, HLDs)
Usually asymptomatic – mild elevation of serum transferases, may lead to cirrhosis

29
Q

Alcohol – increased

A

increased fat synthesis and FFA, decreased FA oxidation, decreased VLDL export, steatohepatitis, stop drinking

30
Q

Obesity – increased

A

ncreased FFA, increased FA oxidation, decreased VLDL export, steatohepatitis, diet exercise

31
Q

Hemochromatosis

A

Excessive accumulation of iron
Primary/genetic AR (HFE gene on chromosome 6) – increased Fe2+ absorption, common in males, rarely manifests in bone before 40
Secondary/acquired
Characterized by mononuclear cirrhosis, DM, skin pigmentation
Treatment – phlebotomy

32
Q

Cirrhosis

A

bridging fibrous septa, parenchymal nodules created by regeneration, architectural disruption
usually features of portal HTN and liver failure,

33
Q

Budd-Chiari syndrome)

A

clot/thrombus in hepatic vein

34
Q

Liver cell adenoma

A

Commonly associated with oral contraceptive pill (also anabolic steroids)
May spontaneously hemorrhage and may undergo malignant transformation
May be fetal during pregnancy

35
Q

Focal nodular hyperplasia

A

No relation to oral contraceptive pills, F:M = 4:1, most often small (may be very large), central scar on CT/MRI, normal liver spleen scan, resect if symptomatic or uncertain diagnosis

36
Q

Hepatocellular carcinoma

A

most common malignant tumor worldwide
strongly related to prevalence of HBV

37
Q

Metastatic carcinoma

A

Most common malignant tumor involving the liver
Common primary sites in adults – colon, pancreas, lung, breast

Pathology (9 decks)

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