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Pathology II Exam II > Liver 3 > Flashcards

Flashcards in Liver 3 Deck (56):
1

What is a dense portal inflammatory infiltrate with abundant histiocytes forming a granuloma around damaged ducts? what disease is it associated with?

1. florid duct lesion
2. PBC

2

Primary biliary cirrhosis is associated with auto-immune antibody?

anti-mitochondrial antibody

3

Is PBC or PSC intrahepatic and extrahepatic?

PSC--- PBC is intrahepatic only

4

What liver enzymes are elevated in PBC and PSC?

alk phos and GGT

5

T-F -- in PBC and PSC there is equal involvement of obstruction in all triads?

False- patchy involvement of triads

obstruction in all triads would be found outside liver

6

Is PBC more common in males or females? PSC?

1. female
2. Male

7

What antibody is often found in PSC?

UC-ANCA

8

What do we see on a cholangiogram in PBC? PSC?

1. pruned biliary tree
2. beaded bile ducts

9

What is the distinctive lesion in PBC? PSC?

1. florid duct
2. fibro-obliterative

10

Is PBC or PSC at risk to cholangiocarcinoma?

PSC

11

What does a fibro-obliterative lesion look like? what disease is it associated with?

1. onion skin inflammation- periductal concentric
2. PSC

12

If there is mixed hepatitic cholangitic, what should we be thinking/

overlap syndromes, but mainly adverse drug reaction

13

When serum albumin drops, what is the consequence?

edema

14

What does ammonia cause in the brain?

hepatic encephalopathy/coma

15

What is the antidote to acetaminophen overdose?

N-acetylcysteine

16

Where (zone wise) dose necrosis in acetaminophen toxicity begin?

centrilobular (least oxygen)

and extends through the others

17

Fulminant hepatic necrosis can be caused by what viruses?

Hep A and B

18

What is the main drug that causes fulminant hepatic necrosis?

acetaminophen- most common cause in our population

19

What vascular problem causes fulminant hepatic necrosis?

Budd-Chiari
(acute venous outflow obstruction)

20

What conditions can increase susceptibility in acetaminophen toxicity?

1. alcohol users
2. malnutrition
3. chronic liver disease

21

T-F-- cirrhosis can be caused by many things even if they don't cause chronic liver disease?

false- only ones that cause chronic liver disease

22

What are three genetic causes of cirrhosis?

hemochromatosis
alpha-1-antitrypsin
Wilson's disease

23

What 3 biliary disease causes cirrhosis?

PBC
PSC
Bile Duct Obstruction

24

What is a very prominent sign of cirrhosis from the gross image standpoint?

regenerative nodules

25

Cirrhosis leads to excess of what hormone? what does it lead to?

-estrogen-
-gynecomastia, spider hemaniomas, testicular atrophy, palmar erythema

26

What does portal hypertension lead to?

1. esophageal varices
2. enlarged spleen
3. ascites
4. collateral vessels

27

Patients with cirrhosis are at particular high risk of elevated ammonia because of what 3 things?

1. bleeding into esophageal varicose-->gut break down of blood to ammonia
2. reduced hepatocyte number to metabolize ammonia
3. ammonia bypasses liver in collateral vessels that arise in portal hypertensions

28

What are the 4 main causes of death in cirrhosis?

1. bleeding- esophageal varices
2. hepatic coma
3. Infection
4. hepatocellular carcinoma

29

Benign hepatic tumors are uncommon, but what is the most common type?

hepatic adenomas

30

Are primary or secondary malignant tumors more common in the liver-

secondary by far

31

90% of primary malignant hepatic tumors are of what type?

hepatocellular carcinoma

(others are cholangiocarcinoma, angiosarcoma, hepatoblastoma)

32

What histological sign is common in hepatic adenoma?

free-floating arteriole

33

What is the most common cause of hepatic adenoma that they want us to know about?

oral contraceptives

34

What is a main clinical problem seen in hepatic adenoma?

subcapsular adenoma can rupture when large, particularly during pregnancy

35

T-F- hepatocellular carcinoma is the most common cause of cancer deaths world-wide?

False- 3rd (majority of chronic HBV infection from 3rd world countries)

36

What food contaminant causes hepatocellular carcinoma?

aflatoxin

37

What tumor marker do your see in hepatocellular carcinoma?

alpha-fetoprotein

38

In HCC, why is the tumor green?

malignant cells make bile

39

The majority of cholangiocarcinoma are sporadic, but what are they also associated with?

-primary sclerosing cholangitis
-liver flukes

[POOR PROGNOSIS]

40

Is the gallbladder essential for biliary function?

No

41

what percentage of gallstones are silent?

80%

(10-20% of people have stones)

42

How does a gallstone lead to intestinal obstruction?

large stone erodes directly into adjacent loop of small bowel

43

What is the most common type of gallstone?

cholesterol stones

44

What are the risk factors for cholesterol stones?

Female, Fat, Forty, Fertile

Rapid weight loss
stasis
disorders of bile metabolism
hyperlipidemia

45

what are pigment stones?

excess unconjugated bilirubin-

46

what is acalculous cholecystitis?

No stones- occurs in severely ill and thought to be from ischemia

FATAL IF NOT TREATED

47

chronic cholecystitis leads to what?

wall fibrosis

48

what is choledocholithiasis?

stones within the bile ducts

-asymptomatic
-pancreatitis
-obstructions
-cholangitis
-hepatic abscess
- secondary biliary cirrhosis
-acute calculous cholecystitis

49

What is cholangitis?

bacterial infection of the bile ducts (usually gram-negative aerobes)

50

What is a risk factor for cholangitis?

obstructed bile flow

51

What are the signs and symptoms of pancreatitis?

abdominal and back pain
elevated serum amylase and lipase

52

What are the complications of acute pancreatitis?

shock
pseudocyst

53

What are the complications of chronic pancreatitis?

intractable pain
maldigestion
pseudocyst

54

What is the 4th leading cause of cancer deaths in the US?

pancreatic adenocarcinoma

55

Where do pancreatic adenocarcinomas arise from?

the duct

56

T-F--pancreatic adenocarcinomas are usually subclinical until lethal?

True- extremely poor prognosis