Hepatobiliary 1

Question 1

Councilman bodies

Answer 1

necrotic, shrunken, eosinophilic hepatocytes following apoptosis

Question 2

Where are councilman bodies found?

Answer 2

liver cell necrosis

Question 3

hyperbilirubinemia

Answer 3

unconjugated bilirubin in blood like red cell destruction or abnormal hepatocyte metabolism

Question 4

kernicterus (hyperbilirubinemia)

Answer 4

a bilirubin induced brain dysfunction

Question 5

cirrhosis

Answer 5

diffuse involvement of whole liver by fibrosis

Question 6

cirrhosis is caused by hepatocellular injury by

Answer 6

chronic hep B or chronic hep C, nonalcoholic fatty liver disease

Question 7

what are less common causes of cirrhosis?

Answer 7

autoimmune disease or iron overload like deposition of glycogen or copper

Question 8

What happens to the architecture of the liver in cirrhosis?

Answer 8

• normal architecture is diffusely replaced by regenerated nodules of liver cells, separated by bands of fibrotic collagen
• lack usual architecture of ordered sinusoids + central vein
• micronodular vs. macronodular patterns

Question 9

Is cirrhosis reversible?

Answer 9

irreversible and end stage of many processes

Question 10

cirrhosis may lead to death from

Answer 10

progressive liver failure, portal hypertension, hepatocellular carcinoma

Question 11

What is the most common type of liver cancer?

Answer 11

hepatocellular carcinoma

Question 12

What is the most common intrahepatic cause of portal hypertension?

Answer 12

cirrhosis

Question 13

etiology of cirrhosis

Answer 13

hemochromatosis + wilson disease

Question 14

hemochromatosis

Answer 14

• excessive iron accumulation in liver, pancreas, heart, pituitary, joints, + others
• organ dysfunction

Question 15

wilson disease

Answer 15

• inadequate hepatic excretion of copper
• excess copper accumulates in liver, brain, eyes
• causes cirrhosis
• kayser feischer rings

Question 16

What are kayser feisher rings, seen in Wilson’s disease?

Answer 16

pathognomonic of cirrhosis, deposition of copper in corneal limbus, dark rings encircling the iris

Question 17

What is the most common cause of chronic liver disease?

Answer 17

alcohol (toxic liver disease)

Question 18

In toxic liver disease, what is the metabolic product that damages the liver?

Answer 18

aldehyde

Question 19

nonalcoholic fatty liver disease is caused by

Answer 19

obesity, type 2 diabetes, hypertension, dyslipidemia

Question 20

alcoholic liver disease; heavy drinkers develop

Answer 20

1 steatosis (90-100%)
2 alcoholic hepatitis (10-35%)- fever, jaundice, hepatomegaly, elevated AST, alkaline phosphatase, and ACT
3 alcoholic cirrhosis (8-20%)= portal hypertension, 10-20% develop carcinoma

Question 21

alcoholic hepatitis (alcoholic liver disease)

Answer 21

• associated w/ extreme fatty change + sometimes cirrhosis

- results from prolonged alcoholic abuse

Question 22

histopathology of alcoholic hepatitis

Answer 22

• swelling+ necrosis of hepatocytes
• acute inflammation
• formation of alcoholic pink hyaline (mallory bodies) in swollen hepatocytes

Question 23

Are mallory bodies pathognomonic for alcoholic hepatitis?

Answer 23

No, not pathognomonic since also seen in Wilson disease, hepatocellular carcinoma, + biliary cirrhosis

Question 24

What is the most common manifestation of alcoholic liver disease?

Answer 24

steatosis

Question 25

3 primary manifestations of alcoholic liver disease

Answer 25

steatosis, hepatitis, and cirrhosis

Question 26

What is associated with right heart failure

Answer 26

chronic passive congestion

Question 27

What is nutmeg liver associated with?

Answer 27

chronic passive congestion

Question 28

nutmeg liver in chronic passive congestion

Answer 28

enlarged due to back pressure from systemic veins to hepatic veins, accentuation of the lobular pattern; variegated, mottled red

Question 29

budd chiari syndrome

Answer 29

hepatic vein thrombosis

Question 30

budd chiari syndrome (hepatic vein thrombosis)

Answer 30

rare; acute or insidious; may lead to hepatomegaly, ascites + death -hepatic vein obstruction resulting in chronic congested liver , portal hypertension + jaundice

Question 31

What are the causes of budd chiari syndrome?

Answer 31

polycythemia, vera and myeloproliferative disorders, pregnancy, oral contraceptives, and hepatocellular carcinoma

Question 32

Is hepatocellular carcinoma (hepatoma) malignant?

Answer 32

Hepatomas are malignant!

Question 33

What is 80% of primary liver neoplasms?

Answer 33

hepatocellular carcinoma (hepatoma)

Question 34

hepatocellular carcinoma (hepatoma)

Answer 34

male predilection 3-8:1;

Question 35

What is hepatocellular carcinoma/hepatoma associated with?

Answer 35

associated w/ HBV and HCV infection, hepatitis, cirrhosis, nonalcoholic fatty liver disease, aflatoxin

Question 36

hepatocellular carcinoma (hepatoma) symptoms

Answer 36

abdominal pain, swelling, weight loss, weakness, jaundice, fever, loss of appetite

Question 37

hepatocellular carcinoma (hepatoma) death from

Answer 37

hemorrhage + liver failure | -5 yr survival= 16% (3% if distant metastasis)

Question 38

What is the most common malignancy of the liver?

Answer 38

mestastatic carcinoma

Question 39

Where does the metastasis of metastatic malignancy of the liver come from?

Answer 39

lung, colon, pancreas, or breast; multiple well circumscribed nodules in markedly enlarged liver

Question 40

most common site for gallstone formation (i.e. cholelithiasis)

Answer 40

gallbladder

Question 41

what is the most common cause of biliary tree disease?

Answer 41

gallstones

Question 42

gallstones come from constituents of bile which are

Answer 42

cholesterol, bilirubin (calcium bilirubinate) + calcium salts (phosphates, carbonates)

Question 43

when bile becomes supersaturated w/ cholesterol, this creates

Answer 43

cholesterol stones

Question 44

What causes cholesterol stones?

Answer 44

either too much cholesterol or insufficient bile salts to keep cholesterol in solution

Question 45

pigment stones come from

Answer 45

clumps of pigment derived from excess insoluble unconjugated bilirubin (*calcium bilirubinate + lesser amounts of calcium salts + mucoproteins *)

Question 46

when bile becomes supersaturated w/ bile pigment, this creates

Answer 46

pigment stones

Question 47

What percentage are gallstones in the biliary tract asymptomatic?

Answer 47

70-80%

Question 48

acute cholecystitis is when

Answer 48

gallstone obstructs gallbladder neck or cystic duct

Question 49

chronic cholecystitis is almost always accompanied by

Answer 49

cholelithiasis (formation of gallstones)

Question 50

chronic cholecystitis secondary gross changes

Answer 50

extensive calcification of wall ("porcelain gallbladder") | -cystic outpouces in walls= rokitansky aschoff sinuses

Question 51

obstructive jaundice

Answer 51

obstruction of common bile duct

Question 52

obstructive jaundice=obstruction of common bile duct due to

Answer 52

1.gallstones (most often) 2. carcinoma of the pancreas 3 carcinoma of the ampulla of vater 4. carcinoma of the bile duct 5 fibrous stricture (often postoperative)

Question 53

Gross view of obstructive jaundice

Answer 53

liver is green, stained, enlarged

Question 54

malignancies of the gallbladder

Answer 54

adenocarcinoma of the gallbladder

Question 55

most common primary tumor of the gallbladder

Answer 55

adenocarcinoma of the gallbladder

Question 56

Adenocarcinoma of the gallbladder is usually associated w/

Answer 56

gallstones and/or chronic cholecystitis (inflammation of gallbladder)