GI 3 Flashcards
(112 cards)
1
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Cirrhosis
Shrunken, atrophic liver (scarring then liver tries to regenerate, forming nodules)
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Cirrhosis
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Cirrhosis
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Cirrhosis
5
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Cirrhosis
6
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Cirrhosis
Blue collagen bands in trichome stain
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Cirrhosis
8
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Steatosis
9
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Steatosis
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Steatosis
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Steatosis
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Alcoholic Hepatitis
Typically involves neutrophils that infiltrate lobules
13
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Alcoholic Hepatitis
Arrow: Mallory body
Aggregate of inflammatory cells *largely neutrophils
14
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Alcoholic Hepatitis Mallory Body
Eosinophilic inclusion, composed mostly of filaments caused by damage to filaments to form cytokeratin
*EXAM*
15
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Alcoholic Hepatitis
Mallory Hyaline Body
16
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Alcoholic Liver Disease
17
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Viral Hepatitis
18
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Viral Hepatitis (Hemorrhagic)
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Acute Viral Hepatitis
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21
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Viral Hepatitis
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Viral Hepatitis
Acidophilic (Councilman) body (arrow)
A hepatocyte undergoing apoptosis
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Viral Hepatitis
Balloon hepatocytes that are degrading
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Viral Hepatitis B
Ground glass change - cytoplasm turns into smooth ground glass appearance due to viral replication
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Viral Hepatitis
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Viral Hepatitis
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Hemochromatosis
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Hemochromatosis
Excessive hemosiderin stores
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Hemochromatosis
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Hemochromatosis
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Hemochromatosis
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
Small tumors at periphery
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
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Metastatic Carcinoma
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Metastatic Carcinoma
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Metastatic Carcinoma
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Metastatic Carcinoma
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Metastatic Carcinoma
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Metastatic Carcinoma
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Cholelithiasis
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Cholelithiasis
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Cholelithiasis
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Cholelithiasis
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Cholelithiasis (Pigment Gallstones)
Indicative of chronic hemolysis
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Choledocholithiasis
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Acute cholecystitis
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Acute cholecystitis
PMNs infiltrating mucosa
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Chronic Cholecystitis
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Chronic Cholecystitis
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Chronic cholecystitis
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Porcelain gallbladder
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Porcelain Gallbladder
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Adenocarcinoma of GB
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Adenocarcinoma of GB
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Adenocarcinoma of GB
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Acute Pancreatitis
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Acute Pancreatitis
60
Acute Pancreatitis
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Acute Pancreatitis
White foci= fat necrosis due to fat digestion by lipase, releasing fatty acids that bind to calcium forming soaps (saponification)
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Acute Pancreatitis
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Acute Pancreatitis
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Acute Pancreatitis
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Acute Pancreatitis
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Chronic Pancreatitis
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Chronic Pancreatitis
Concretions and atrophy replaced by chronic scar tissue
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Chronic Pancreatitis Pancreaticpseudocyst (no epithelial lining)
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Chronic Pancreatitis Pancreatic pseudocyst
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Pancreatic Carcinoma
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Pancreatic Carcinoma
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Pancreatic carcinoma
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Pancreatic carcinoma
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PancreaticCarcinoma
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Pancreatic carcinoma
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Pancreatic carcinoma
77
What is the definition of cirrhosis?
Scarring of entire liver with 1) diffuse fibrosis 2) loss of lobular architecture 3) nodular regeneration
It is the end-stage of many chronic disorders, so it is difficult to determine precise etiology by histology alone
78
What is the traditional classification of cirrhosis (and its associated diseases)?
Macronodular (\>3 mm)
* Viral hepatitis
* Alpha-1 antitrypisin deficiency
* Wilson's Disease
Micronodular (\<3 mm)
* Alcoholism
* Hemochromatosis
* Primary biliary cirrhosis
* Wilson's Disease
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What are some complications of cirrhosis?
Portal HTN
Esophageal varices
Ascites
Splenomegaly
Hepatic encephalopathy
Hepatocellular carcinoma
80
What is steatosis?
Increased storage of lipid in liver, resulting in yellow appearance (macroscopic) and cytoplasmic vacuoles (microscopic)
May be due to variety of causes (alcohol, DM, obesity, protein malnutrition, metabolic disorders)
81
What is alcoholic hepatitis?
Develops in 20-25% of heavy drinks
Characterized by:
Inflammation and hepatocyte degeneration
Neutrophilic infiltrate
Steatosis
Mallory bodies (eosinophilic PAS +, corkscrew shaped intracytoplasmic stuctures made of intermediate filaments (keratin)
82
What is acute hepatitis characterized by?
Inflammation (mostly lymphocytic, with some neutrophils and eosinophils)
Lobular disarray
Ballooning degeneration
Acidophil (Councilman) bodies
May see bridging necrosis (severe cases)
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How do you distinguish chronic from acute hepatitis?
Distinction from acute made clinically, not pathologically
Usually requires elevation of liver enzymes for \>6 months (or persistently elevated viral load)
84
what is hereditary hemochromatosis?
Hereditary hemochromatosis (Bronze diabetes)
Autosomal recessive disorder of iron metabolism (HFE gene, chromosome 6p)
1-2/1,000 and M:F = 7:1 (men present earlier in life)
Prussian blue stain for iron shows granular staining in hepatocytes
85
How do you distinguish hemochromatosis from secondary hemosiderosis?
Quantitative irone analysis
Secondary hemosiderosis = iron overload where iron accumulation typically affects Kupffer cells
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What are complications of hereditary hemochromatosis?
Cirrhosis
Hepatocellular carcinoma
Hypopituitarism, skin pigmentation, cardiac failure, DM, arthropathy, testicular atrophy
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What are predisposing factors for hepatocellular carcinoma (hepatoma)?
Cirrhosis
Hep B and C
Thorotrast (formerly used as radiographic contrast agent)
Alcohol
Radiation
Alpha-1 antitrypsin deficiency
Hemochromatosis
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What serum marker may be elevated in hepatocellular carcinoma?
Alpha feto-protein
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What is the macroscopic and microscopic description of hepatocellular carcinoma?
Macro: single/multiple, may have bile staining
Micro: Atypical hepatocytes with nuclear pleomorphisms, thickened trabeculae (several layers thick), absent portal tracts
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What is the prognosis of hepatocellular carcinoma?
Poor
10% 5-year survival
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What is the most common malignant tumor of the liver?
Metastatic carcinoma
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What are the most common primary sites for metastatic carcinoma?
GI tract, breast, and lung
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Describe metastatic carcinoma
Usually multiple circumscribed nodules
94
Describe (macro and micro) the normal gall bladder
Macro: sac-like with thin wall and green mucosal lining
Micro: columnar epithelial lining, lamina propria, muscularis propria (no muscularis mucosae or submucosa)
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What are the types of gallstones
Gallstones occur secondary to supersaturation of bile
only 10% of gallstones are pure
1. cholesterol stones: pale, yellow, round/oval, single, radiolucent
2. pigment stones (Ca2+ bilirubinate): black/brown, oval, multiple
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Risk factors for cholesterol stones
Female, fat, \>40, fertile
Drugs
GI disorders
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What are some risk factors for pigment stones?
Chronic hemolysis
Certain infections (Bacteria - E. coli; Parasites - Clonorchis)
GI disorders
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How do gallstones form
Secondary to supersaturation of bile
99
What is acute cholecystitis and how is it characterized?
Acute onset of symptoms, 90% associated with gallstones
Gallbladder often enlarged, tense
Fibrinous serosal exudates
May be hemorrhagic, filled with pus, or health with calcification (porcelain GB)
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What is chronic cholecystitis and how is it characterized?
Recurrent biliary colic or absence of prior acute cholecystitis, virtually always associated with gallstones
Wall thickened and fibrotic
Chronic inflammation
Entrapped epithelial crypts (Rokitansky-Aschoff sinuses)
101
What is an adenocarcinoma of the Gallbladder?
- How often does it occur?
- Who does it occur in most?
- Association with gallstones?
Rare malignancy that is more common in females
80-90% associated with gallstones
Most have invaded liver by time of diagnosis
Uniformly fatal
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What is acute pancreatitis associated with?
80% of cases associated with gallstones or alcoholism
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What is acute pancreatitis characterized by?
Diffuse edema, acute inflammation, hemorrhage, fat necrosis, fibrosis, calcification
20% mortality
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Pathogenesis of acute pancreatitis
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What is chronic pancreatitis?
Usually not associated with acute pancreatitis
Chronic inflammation, ductal ectasia, squamous metaplasia of ducts, calcification, fibrosis, stone formation, pseudocysts
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What are some complications of acute pancreatitis?
Systemic organ failure, shock, ARDS, acute renal failure
DIC
Pancreatic abscess
Pancreatic pseudocyst
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What are some complications of chronic pancreatitis?
Pseudocyst
Duct obstruction
Malabsorption, steatorrhea
Secondary diabetes
108
How common are ductal adenocarcinomas?
Where in the pancreas do most of these malignancies occur?
Pretty common
85% of all pancreatic malignancies
2/3 occur in head of pancreas
109
Describe a pancreatic adenocarinoma (macro/microscopically)
Macro: Infiltrative, firm, tan-white tumor
Micro: irregular ducts/glands lined by atypical cuboidal to columnar cells, desmoplastic stromal response
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What are some complications of pancreatic adenocarcinoma?
Primary effects:
* Metastases (lung, liver, peritoneum)
* Pancreatic carcinoma
* Abdominal pain (peripheral lymphatic invasion)
Secondary effects:
* Trousseau syndrome: Migratory peripheral thrombophlebitis (10-25%)
* Courvosier gallbladder: painless jaundice, dilated gallbladder
* Weight loss
* Obstructive jaundice
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What is the prognosis of pancreatic adenocarcinoma?
\<20% of tumors at diagnosis are surgically resectable
Overall poor prognosis: 10% 1-year survival; 2% 5-year survival
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What are some of the mutations associated wth pancreatico adenocarcinoma?
K-Ras, p16, p53, BRCA2, DPC4/SMAD4
