Liver 2

Question 1

What are 4 histological features of acute steatohepatitis?

Answer 1

1. fat
2. ballooned hepatocytes
3. mallory bodies
4. acute inflammation (neutrophils)

Question 2

What pattern of fibrosis do we see on trichome stain of alcoholic steatohepatitis damage?

Answer 2

spider web (sinusoidal)

Question 3

What is the recommended drinks per day for men? women? what is the individual susceptibility for ETOH liver damage?

Answer 3

• 2
• 1
• 1 in 6 heavy ETOH users

Question 4

What is it called when there is just fatty change without inflammation or liver damage?

Answer 4

steatosis

Question 5

What do mallory bodies look like?

Answer 5

pink, ropey material

Question 6

T-f—damage from steatohepatitis first leads to portal fibrosis?

Answer 6

False, central vein

Question 7

What is the AST:ALT ratio in steatohep.?

Answer 7

2:1

Question 8

T_F– Alk phos is often elevated out of proportion to GGT in steatohepatitis?

Answer 8

False- the other way around

Question 9

Amyloidosis affecting the liver would look like what histologically?

Answer 9

waxy pink material filling the sub sinusoidal spaces

poor prognoses (in the case his alk phos was huge compared to the GGT even though AST:ALT was 2:1

Question 10

NASH is related to what other metabolic issues?

Answer 10

insulin resistance and metabolic syndrome

Question 11

What might explain cryptogenic cirrhosis?

Answer 11

NASH

Question 12

What are the differences histologically between NASH and alcohol damage?

Answer 12

Similar but more fat and glycogenated nuclei and less inflammation, ballooning and mallory hyaline

Question 13

What is the AST ALT ratio in NASH?

Answer 13

Usually ALT will be higher

Question 14

Is NASH or alcoholic steatohepatitis related to macrocytic anemia?

Answer 14

alc. steatohep.

Question 15

T-F—NASH usually has a high titre positive ANA?

Answer 15

False- low

Question 16

What histo features do we see in acute heart failure? Chronic?

Answer 16

1. centrilobar congestion and necrosis

2. nutmeg liver

Question 17

What is buds chiari syndrome?

Answer 17

obstruction of hepatic vein—associated with hypercoaguable state

Question 18

Where do we see the fibrosis in chronic congestive heart failure?

Answer 18

centrilobar fibrosis leading to cirrhosis

Question 19

what is the mottled color of nutmeg liver due to?

Answer 19

combination of congestion and pale fibrous tissue

Question 20

In budd chiari what do we see histologically around the central vein?

Answer 20

marked congestion with surrounding sinusoidal congestion.

[hepatocytes get choked off and undergo necrosis

Question 21

In budd chiari- do light pink areas or dark pink areas mean more necrosis?

Answer 21

light pink

Question 22

T-F– ferritin is an acute phase reactant?

Answer 22

True

Question 23

In hemochromatosis, the liver is often first to accumulate…what follows?

Answer 23

pancreas-->diabetes
heart-->cardiomyopathy
joints-->arthralgia
pituitary-->infertile
thyroid-->hypothyroid
skin-->bronze

Question 24

What gene is defective in hemochromatosis?

Answer 24

HFE Gene

usually homozygous C282Y (europeans)

Question 25

T-F-- hemochromatosis liver disease is often found concurrently with HCV or alcohol which accelerates the fibrosis?

Answer 25

True

Question 26

Is hemochromatosis a risk factor for developing hepatocellular carcinoma?

Answer 26

YEs

Question 27

how do we treat hemochromatosis?

Answer 27

phlebotomy

Question 28

is alpha-1 antitrypsin deficiency autosomal dominant?

Answer 28

no- recessive

Question 29

what abnormal protease inhibitor alleles are associated with liver disease in alpha-1 antitrypsin deficiency?

Answer 29

Z and M PIMM is wild type.

Question 30

how do we visualize histologically alpha-1 antitrypsin deficiency?

Answer 30

PAS-D stain- globules are bright pink inside hepatocytes

Question 31

is alpha-1 antitrypsin deficiency less treatable than hemochromatosis? is it a risk factor for hepatocellular carcinoma?

Answer 31

yes, yes

Question 32

Is wilson's disease autosomal dominant?

Answer 32

No recessive

Question 33

What is wilson's disease?

Answer 33

impaired copper excretion into bile and a failure to incorporate copper into ceruloplasmin

Question 34

Where is copper accumulation highest?

Answer 34

liver, brian and eye. also kidney

Question 35

What is bland cholestasis?

Answer 35

only bile stasis is seen without other findings of liver damage in his to you just see brown bile blobs in normal looking hepatocytes

Question 36

can bland cholestasis lead to jaundice?

Answer 36

yes

Question 37

what is the classic cause of bland cholestasis?

Answer 37

drugs--> oral contraceptives | also gilbert's, pregnancy, post-operative and infection

Question 38

Does gilbert's syndrome lead to unconjugated or conjugated hyperbilirubinemia?

Answer 38

unconjugated

Question 39

how does one become jaundiced when they have gilbert's syndrome?

Answer 39

``` illness fasting/eating low calories dehydration menstruation stress lack of sleep exercise ```

Question 40

What is the most common cause of obstruction of extra hepatic duct? what are some others?

Answer 40

1. gallstone | 2. tumor in bile duct, ampulla, head of pancreas, also congenital problems