liver and biliary Flashcards
(129 cards)
1
Q
what does the liver process?
A
amino acids, carbs, lipids and vitamins
2
Q
causes of jaundice?
A
hemolytic anemia, hepatitis, obstructive flow
3
Q
pt. comes to clinic looking yellow and white of eyes are yellow what should be on your differential
A
jaundice
4
Q
pt comes in with unexplained anorexia and says they have hereditary hemochromatosis what organ is being affected and what is wrong with it?
A
the liver is cirrhotic
5
Q
you suspect a pt. has cirrhosis of the liver what are the top non rare causes of it?
A
alcohol abuse, chronic viral hepatitis, biliary disease, hereditary hemochomatosis, cryptogenic cirrhosis
6
Q
What are some rare causes of cirrhosis of the liver?
A
Wilsons Ds Alpha antitrypsin deficiency Cardiac cirrhosis Tertiary syphilis Reactions to drugs Exposure to environmental toxins
7
Q
pathologically what kind of nodules would you find on a liver with cirrhosis?
A
mixed
8
Q
what is infiltrating the liver when it is cirrhotic?
A
cytokines, fibrin
9
Q
cirrhosis of the liver is mostly a silent progress? T/F
A
true
10
Q
If somebody dies of liver cirrhosis what is mostly of?
A
portal hypertension, liver failure, hepatocellular carcinoma
11
Q
example of a prehepatic portal hypertension?
A
portal V thrombosis
12
Q
example of a post hepatic portal hypertension
A
bud chiari syndrome due to thrombosis of the hepatic v.
13
Q
what condition of the heart should be considered if they have bud chiari?
A
right sided heart failure
14
Q
what are most of the cases of cirrhosis of the liver?
A
intraheptic
15
Q
why would somebody with portal hypertension present with hepatic encephalopathy?
A
increased ammonia
16
Q
what are the clinical findings of a pt. who has speenomegaly?
A
ascites, splenomegaly, hepatic encephalopathy, venous shunts,
17
Q
what are some examples of venous shunts when somebody has portal hypertension?
A
internal hemorrhoids, esophageal varices, caput medusa
18
Q
***triad of bud chiari?
A
abdominal pain, ascites, hepatomegaly
19
Q
some other symptoms of budd chiari?
A
acute rapid abdominal pain, jaundice, hepatomegaly, increased LFTs and encephalopathy
20
Q
HAV/ hep A is spread how
A
enterically: fecal matter and poor hygiene
21
Q
when HAV is carried through from the intestines to the liver does in enter the blood stream?
A
no
22
Q
is HAV asmyptomatic?
A
yes
23
Q
does HAV cause chronic hep, carrier state or predispose the pt. to cirrhosis or hepatocellular carcinoma?
A
no
24
Q
HBV spread how?
A
- blood products
- sex
- IV drugs
- perinatal
- healthcare workers
25
are pt. with HBV asymptomatic most of the time or symptomatic?
asymptomatic
26
if a pt. has symptomatic HBV that is mild what is the likely hood of recovery?
good
27
fulimant hepatitis is when what happens?
massive liver necrosis
28
what can chronic hepatitis lead to?
hepatic carcinoma which is an important role in hepatocellular carcinoma
or
cirrhosis of the liver
29
the majority of pt. that have symptomatic HBV _______
recover
30
when inspecting an acute HBV liver under a microscope you notice ?
- cellular infiltrate throughout the lobule
- ballooning of the cytoplasm of degenerative cells
- councilman bodies
- mononuclear cell infiltrate in portal areas
31
Hep c is the leading cause for what?
chronic liver disease
32
HCV is spread by
- mainly blood products
- sometimes sex
- mother to child
33
what can pt.'s with HCV develop?
DM
34
When considering how a pt. will present to clinic with HCV will they present as asymptomatic or will they show signs of progression to chronic disease of the liver?
most pt. will progress to chronic disease of the liver
35
Hep D replicates on where under what circumstances?
in the liver when HBV is present
36
who is most likely to get HDV?
drug addicts and multiple transfusion individuals
37
hep E is contracted how?
water borne infection
38
is HEV associated iwth chronic liver disease?
no
39
HEV has a high mortality rate among which pt.?
pregnant women and HIV
40
which hepatitis virus has a dual infectin that protects against the HIV replication?
HGV
41
how is HGV spread?
- blood to blood products
- maybe sex
- hemodialysis pt.
42
grossly how will the liver look with viral hepatitis?
enlarged
43
micro. how would the liver look with viral hep?
- multifocal areas of necrosis with lymphocytic infiltrates
- ballooning degeneration of the hepatocytes
- councilman bodies
44
how would pt. present if they had symptoms of viral hepatitis?
fever, HA and nasea, vomiting, myalgia, enlarged and tender liver, jaundice with dark urine,
45
what would you find elevated in the serum of a pt. with viral hep?
AST/SGOT is elevated the most
46
leading cause of liver disease in USA is?
alcohol abuse
47
3 forms of liver disease due to alcohol intake?
hepatic steatosis
alcoholic hepatitis
cirrhosis
48
what are the mild reversible changes of the live in somebody who is an alcoholic?
macrovesicular steatosis
49
what would you find microscopically in alcoholic hepatitis
eosinophilic inclusions known as mallory bodies
50
alcoholic cirrhosis is it irreversible or reversible?
it is irreversible
51
alcoholic cirrhosis, is it seen more in men or women?
women
52
is alcoholic cirrhoiss micro or macro?
micro
53
Macorvesicular steatosis is seen with what stain?
oil red O stain
54
key findings of chronic alcoholic liver disease?
Macrovescular steatotis
- mallory bodies
- ballooning degeneration of hepatocytes
- micronudular cirrhosis
55
stage one of alcoholic liver disease?
steatosis - macrovescular
56
2nd stage of alcoholic liver disease
- mallory bodies/neutrophils
| - ballooning hepatocytes
57
stage 3 of alcoholic liver disease?
micronodular cirrhosis of liver
58
what are some inborn errors of metabolism and pediatric liver disease?
wilsons, hemochromatosis, a1-antitrypsin
59
what is hemochromatosis?
excessive accumulation of body iron which is that deposited into the parenchymatous organs/liver and pancrease
60
what is a primary cause of hemochromatosis?
genetic defect/autosomal recessive
61
secondary cause of hemochromatosis?
- iron overload
- parentral iron
- hemolytic anemias
- aplastic anemia = suppressed BM
62
how would the cells appear in a hemochromatosis pt. microscopically?
yellow and golden color
| kupffer cells full of granular brown deposits
63
what are some symptomatic findings in a pt. that has hemochromatosis?
```
liver- micronodular cirrhosis
pancreas - diabetes
Heart- restrictive cardiomegaly
skin- bronze
joints - arthritis
gonads - hypogonadism = amenorrhea and impotence
```
64
what type of stain are the hepatocytes positive for?
prussian blue
65
wilsons disease also known as?
hepatolenticular degeneration
66
in wilsons disease fails to enter circulation in the form of what?
ceruloplasmin
67
what causes the build up of cu in the body in wilsons disease?
absorbed cu fails to enter the circulation in the from of ceruloplasmin and decreased biliary excretion of cu causing liver injury which causes the spill over of cu
68
where does the spilled over cu accumulate?
- putamen of the basal ganglia
| - kayser fleicher rings
69
how would you Dx. the pt. with wilsons?
- a decrease in ceruloplasmin level
- increased hepatic cu
- increased urinary excretion of cu (body fails to absorb so it excretes and spills over into the body)
70
how does the liver look grossly in a pt. with wilsons?
golden, and has mixed nodules
71
a1- antitrypsin deficiency/ AAD causes?
over release of neutrophil elastase at the site of inflammation causing desctruction
72
what does a AAD lead to?
emphysema
hepatitis
liver cirrhosis
73
what stain is used for liver in AAD pt.?
PAS
74
in the lungs of a pt. that has AAD what do you see?
panlobular emphysema
75
causes of secondary biliary cirrhosis
cholelithiasis
strictures from previous surgery
malignancies of biliary tree and head of pancreas
76
prolonged obstruction and secondary inflammation will lead to?
periportal fibrosis > scarring and nodule formation = biliary cirrhosis
77
primary billiary cirrhosis is commonly caused by what?
autoimmune disease: ulcerative colitis, chrons disease
78
which enzyme is affected by antibodies in a pt. with an autoimmune disease that results in biliary cirrhosis?
pyruvate dehydrogenase
| AKA antimitochondrail AB
79
specifically which malignancies will result in billiary cirrhosis?
adenocarcinoma of the head of the pancreas, and cancers of the biliary tree
80
microscopically what would you see in billiary cirrhosis?
- demolished biliary duct
- chronic inflammation in portal areas
- bile duct destruction
81
Kasai procedure is for pt. that have wat?
biliary atresia
82
what is formed in a kasai procedure?
rou-en-Y connection
83
what is reyes syndrome and who does it occur in?
use of salicylates (ASA) in past especially in children.
84
how would a pt. present to clinic with reyes syndrome?
- febrile with URI --> recovery
| - -> projectile vomiting --> delirium and stupor
85
what happens to the body when a pt. has reyes syndrome?
mitochondrial injury to the liver, brain and muscle
86
what type of steatosis to the liver does reyes cause?
microvesicular
87
what stain is used to see panlobular arrangment of lipid
oil red O stains
88
is there hepatocyte necrosis or inflammation with reyes?
no
89
the two type of tumors that are caused by contraceptives in women in there childbearing years that and benign?
focal nodular hyperplasia & liver cell hepatocellular or hepatic adenoma
90
what is a cavernous hemangioma?
congential vascular channel defect
91
what is the most common bengign lesion of the liver?
cavernous hemangioma
92
how does the tumors appear on the liver with cavernous hemangioma
red blue nodules less than 2cm
93
what is different about the growth of the liver cell adenoma?
they are hormone dependent
94
the liver cell adenoma is benign what kind of characteristic does it have?
well demarcated
95
where would you commonly see the liver cell adenoma?
beneath the capsule
96
complication of a liver cell adenoma?
rupture leading to severe hemorrhage
| and very rarely may develop into malignancy
97
what is the likelyhood of a pt. having primary carcinoma of the liver?
relatively uncommon
98
what do the primary carcinoma of the liver arise from?
hepatocytes
99
is hepatocellular carcinoma/HCC more common in men or women?
men
100
what may cause HCC?
- cirrhosis of the liver due to HBV and HCV
- dietary aflatoxins from aspergillus
- chemicals such as thoratrast
101
what is a more common form of HCC? 1ry or 2ry?
2ry by METS
102
what are the most common 1ry sites of cancer that spread to form 2ry HCC?
lung
breast
colon
pancreas
103
what is focal nodular hyperplasia?
benign tumor like lesion due to a vascular disturbance
104
what may you see microscopically in a liver that has focal nodular hyperplasia of the liver
- hepatocellular nodules
- central stellate scar
- radiating fibrous septa
- lymphocytic infiltrate
- has large feeder artery in capsule
105
for a FNH liver what stain is used?
actin immunohistochemistry
106
mesenchymal hamartoma of liver is what?
-uncommon benign tumor of childhood
- multiple cycsts grossly
-
107
what is the etiology of mesenchymal hamartoma of liver?
- primary bile dust plate malformation
vs
- abnormal mesodermal development
108
what does the mesenchymal hamartoma consists of?
mesenchyme, bile ducts, hepatocyte cords and cysts
109
which brain tumor that occurs in children spread to the liver
neuroblastoma
110
forty year old woman pt. comes to clinic and says they had abdominal surgery what was it?
cholelithiasis
111
what are the 2 types of stone you can find in a pt. that had gallstones?
cholesterol(yellow) and pigment (dark green)
112
which stones found in gallbladder are associated with chronic hemolysis?
pigment stones
113
what is the only pathway for cholesterol elimination
bile
114
when would gallstones be acquired?
the [cholesterol] exceeds solubilizing capacity of bile causing solid cholesterol monohydrate crystals
115
fat fertile and forty is a saying used for what
to describe who is more likely to get choleslithiasis
116
what is almost always associated with gallstones?
cholecystitis
117
acute calculuous cholecystitis is what?
acute inflammation of the gallbladder that has stones
118
obstruction of what in the gallbladder will lead to acute calculuous cholecystitis?
neck or the cystic duct
119
what is the most common complication of gallstones?
acute calculuous cholecystitis
120
pathologically how would the gall bladder appear with acute calculuous cholecystitis
- enlarged with red adematous wall
- serous coat covered with fibrinous or suppurative exudate
- mucosal ulcerations
- stones are present
121
clinically how would a pt. with acute calculuous cholecystitis present?
- upper abdominal pn. that radiates --> shoulder
- colicky with stones
- fever
- nausea
- vomiting
- right subcostal region is tender
- distended gallbladder
122
what bacteria may cause chronic cholecystitis
e coli
123
what are some causes of cholecystitis
- repeated bouts of acute cholecystitis
- stones
- supersaturation of bile
-
124
how would the gallblader appear grossly?
- contracted
- thick grey wall
- stones
125
tumors of the gallbladder are common or uncommon more in women?
common
126
if somebody has a tumor of the gallbladder where is located?
the biliary tract?
127
pt. comes in and says that have gallbladder cancer and they caught late what is the outlook?
death
128
pathologically what kind of tumor would be located in the gallbladder?
adenocarcinoma
129
if a pt. comes in with symptoms of cholelithiasis what must the Dr. test for because they present with the same clinical signs?
adenocarcinoma of the gallbladder
