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Flashcards in Liver Deck (49)
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1

describe macrovesicular steatosis and causes of it

  • large droplet: single fat vacuole displaces the nucleus to periphery
  • small droplet: multiple fat vacuoles (not as fine as microvesicular)
  • causes:
    • alcohol
    • NASH/NAFLD (metabolic)
    • malnutrition

2

describe microvesicular steatosis and causes of it

  • multiple fine vacuoles, nucleus is central
    • acute fatty liver of pregnancy
    • Reye syndrome
    • drugs
      • NSAIDs, acetaminophen 

3

list the 3 characteristics of cirrhosis

  • bridging fibrous septa
  • parenchymal nodules created by regeneration
  • diffuse involvement of liver

4

cirrhosis leads to an increased risk of ___

cirrhosis leads to an increased risk of hepatocellular cancer (HCC)

5

describe the consequences of portal HTN

6

describe autoimmune hepatitis

  • common in females
  • elevated serum IgG
  • anti-nuclear and anti-smooth muscle antibodies
  • anti-LKM (liver kidney microsomal type) antibodies 
    • type 2, children/teens
  • prominent interface and lobular activity, plasma cell infiltrate common
  • respond to immunosuppressive therapy

7

describe primary biliary cholangitis

  • formerly called primary biliary cirrhosis
  • disease of middle-aged women
  • antimitochondrial antibodies
  • non-suppurative, granulomatous destruction of small and medium-sized bile ducts
  • ductopenia and cirrhosis
  • secondary biliary cirrhosis
    • due to partial or total bile duct obstruction
    • tumors, strictures, gallstones implicated

8

____ antibodies are found in PBC

antimitochondrial antibodies are found in PBC

9

describe the histology in primary biliary cholangitis (PBC)

  • histology:
    • non-suppurative
    • granulomatous destruction of small and medium-sized bile ducts

10

what condition is seen in the image?

primary biliary cholangitis (primary biliary cirrhosis)

11

describe primary sclerosing cholangitis

  • extrahepatic and large intrahepatic ducts
  • periductal inflammation and fibrosis → "onion skin" lesions
  • ERCP or MRCP: dilatation and beading of the biliary tree
  • p-ANCA often positive
  • associated with UC

12

PSC affects the ___ and ____

PSC affects the extrahepatic and large intrahepatic ducts

13

PSC leads to ____ inflammation and fibrosis with lesions that look like ____

PSC leads to periductal inflammation and fibrosis with lesions that look like onion skins

14

what is seen on ERCP/MRCP in PSC?

dilatation and beading of the biliary tree

15

PSC is often ____ positive and is associated with ____

PSC is often p-ANCA positive and is associated with UC

16

describe what is seen in the image

17

the HFE gene is located on chr. ____

the HFE gene is located on chr .  6

18

list causes of secondary iron overload

  • parenteral iron overload
    • repeated blood transfusions
    • iron dextran injections
  • ineffective erythropoiesis
    • B-thalassemia
    • other chronic hemolytic anemias
  • increased oral intake
    • Bantu disease
  • chronic liver disease
    • alcohol, hepatitis C

19

describe how hemochromatosis affects the pancreas

  • pancreas
    • intensely pigmented
    • diffuse interstitial fibrosis
    • hemosiderin in both acinar and islet cells
    • diabetes mellitus

20

describe how hemochromatosis affects the heart

  • heart:
    • hemosiderin in myocardial fibers (cardiomyopathy)
    • delicate interstitial fibrosis

21

describe how hemochromatosis affects the skin

  • skin
    • slate gray coloration
    • iron in dermal melanophages
    • increased melanin production

22

describe Wilson disease

  • AR disorder located on chr. 13
  • toxic levels of Cu in liver, brain and eyes
    • brain = deposited in basal ganglia
    • eyes = deposits of copper in descemet membrane of corneal limbus = KF rings
      • sunflower cataracts
    • blood = hemolysis

23

describe investigations in Wilson disease

  • investigations:
    • low serum ceruloplasmin
    • increased urinary Cu excretion
    • increased hepatic Cu

24

describe the images 

25

describe hemangioma of the liver

vast majority require no treatment

  • remainder:
    • pain
    • bleeding
    • platelet consumption

26

describe the image

hepatic hemangioma

27

hepatic adenoma is associated with ___ and ___

hepatic adenoma is associated with oral contraceptives and anabolic steroids

28

describe a hepatic adenoma

  • associated with oral contraceptives, anabolic steroids
  • spontaneously hemorrhage, malignant transformation
  • may be fatal during pregnancy
  • clinical pres.:
    • acute:
      • pain in abdomen
      • shock and hemorrhage
        • hemorrhage into tumor or peritoneal cavity
      • episodic pain or discomfort
    • incidental
  • normal serum AFP

29

describe the 3 mutations associated with hepatic adenomas

30

describe focal nodular hyperplasia (FNH)

  • associated with OCs
  • most often small, may be large
  • central scar on CT, MRI
  • resect if symptomatic or uncertain diagnosis