3.2.3 Pathology of Liver Injury I

Question 1

What is this an iamge of?

Answer 1

Ductal proliferation associated with secondary biliary cirrhosis

Question 2

What is Crigler-Najjar syndrome?

Answer 2

Type I has complete lack of enzyme needed for the conjugation of glucuronic acid to bilirubin

Type II - has partial lack of enzyme

Question 3

What are the three main causes of cirrhosis?

Answer 3

Alcohol, viral hepatitis, and fatty liver disease

Question 4

Mallory hyaline is most often associated with what in liver disease?

Answer 4

Alcohol

Question 5

What is this an image of?

Answer 5

Lipofusion - will not stain with Perls Iron stain

Question 6

What is this an image of?

Answer 6

Alpha-1 antitrypsin deficiency

PAS-diastase resistant globules

Question 7

Portal hypertension can lead to ascites. What is that?

Answer 7

Fluid is driven into the space of disse

Tons of fluid in the abdomen

Question 8

This patient has what type of defect?

Answer 8

0.2/1.3 (Conjugated bili:Total) = 0.15 - Unconjugated hyperbilirubinemia

Question 9

What are the sources of defective conjugation hyperbilirubinemia?

Answer 9

Question 10

Elevated direct (conjugated) bilirubin is a sign of what (2)?

Answer 10

Decreased hepatocellular excretion

Impaired bile flow

Question 11

What is this an image of?

Answer 11

Perls Iron staining - hemachromotosis

Question 12

What is this an image of?

Answer 12

Fluorid duct lesion associated with PBC

Question 13

What is this an image of?

Answer 13

Cirrhosis of the liver

Question 14

How can a defect in RBC lead in increased bilirubin?

Answer 14

A defect in which there are too many dead RBCs (hemolytic jaundice)

Question 15

What are the characteristics of unconjugated bilirubin?

Answer 15

Insoluble in water - exists in tight complexes with albumin

Connot be excreted in the urine

Question 16

What is jaundice?

Answer 16

Too much bilirubin in the blood

Question 17

What is primary biliary cirrhosis?

Answer 17

Chronic bile duct destructive disease

Autoimmune disease

Most important: Serum anti-mitochondrial antibody (AMA) is increased

Question 18

What are the causes of sudden massive hepatic necrosis?

Answer 18

Question 19

Portal hypertension tends to lead to what?

Answer 19

Portosystemic shunts

Hemorrhoids

Esophageal varicies

Caput medusa

Question 20

What is this an image of?

Answer 20

Bile degeneration - bile accumulation in cells

Question 21

What are some of the things that can accumulate intracellularly in the liver (6)?

Answer 21

Bile

Fat

Iron

Copper

Lipofuscin

Protein in RER

Question 22

What zone is most susceptible to ischemia?

Answer 22

Zone 3 - closest to central vein

Question 23

What are the tests for cholestasis?

Answer 23

Alk phos and GGT

Question 24

What is the cell that causes fibrosis of the liver?

Answer 24

Stellate cells

Question 25

What is Dubin-Johnson syndrome?

Answer 25

Absence of canalicular protein MDR2 - increased levels of conjugated bilirubin

Question 26

What is this an image of?

Answer 26

Confluent necrosis

Question 27

Liver receives blood from where?

Answer 27

Portal vein Hepatic artery

Question 28

What disease is associated with this image?

Answer 28

Primary sclerosing cholangitis

Question 29

What is this an image of?

Answer 29

Steatosis - fatty accumulations

Question 30

What is this an image of?

Answer 30

Interface hepatitis

Question 31

What is the microscopic finding with PSC?

Answer 31

Periductal fibrosis

Question 32

What is this an image of?

Answer 32

Apoptosis - eosinophilic body in viral hepatitis - aka dead red

Question 33

What will be the characteristics of secondary biliary cirrhosis?

Answer 33

Prolonged obstruction of biliary tree - most often gallstones Microscopically finding ductal proliferation

Question 34

What are the types of apoptosis and necrosis of the liver?

Answer 34

Question 35

What is liver cirrhosis?

Answer 35

Progressive fibrosis and reorganization of vascular microarchitecture of the liver Types I and III collagen are deposited in the lobule

Question 36

What are the lab studies that acute hepatitis, cirrhosis, chronic liver disease, and obstructive liver disease will yield?

Answer 36

Question 37

What are the diseases of obstructive jaundice?

Answer 37

Question 38

Elevated indirect (unconjugated) is a sign of what (3)?

Answer 38

Excessive production of bilirubin Reduced hepatic uptake Impaired conjugation

Question 39

What are each of the covered parts

Answer 39

Question 40

What will you see on PBC histology?

Answer 40

Lymphocytic infiltrate in the bile ducts Granulomas

Question 41

What is this an image of?

Answer 41

PBC

Question 42

What will be the cholangiogram findings be in PCS

Answer 42

Beaded areas

Question 43

What are the characteristics of primary sclerosing cholangitis (PSC)?

Answer 43

Affects younger men 20-40 Associated with ulcerative colitis p-ANCA in 80% of cases

Question 44

What is this an image of?

Answer 44

Iron

Question 45

What is Gilbert syndrome?

Answer 45

Mutation in the UGT gene - decreased levels - leads to decreased ability to conjugate bilirubin

Question 46

What are the characteristics of conjugated bili?

Answer 46

Water soluble and non-toxic Can be excreted in the urine