Liver and Gallbladder Flashcards
(148 cards)
1
Q
what is the normal weight of a liver
A
1650 g
2
Q
what are the 5 components of the portal hepatis
A
portal vein
hepatic artery
common hepatic duct
nerves
lymphatics
3
Q
what are non-pathologic grooves of the liver called
A
leibermeister grooves
4
Q
what is the anatomic unit which organizes the liver
A
lobule - made of sheets of hepatocytes
5
Q
what is an important sinusoid cell of the liver
A
kupffer cells - breaks down red blood cells
6
Q
why doesn’t the liver normally undergo necrosis
A
it has two blood supplies - portal vein and hepatic artery
7
Q
what are the three components of a portal triad (tract)
A
portal venule
hepatic arteriole
bile duct
8
Q
what are the three main mechanisms of liver injury
A
cholestasis
necrosis
apoptotic death
9
Q
define cholestasis
A
accumulation of fat and bilirubin within the liver, typically due to an obstruction of the bile tract
10
Q
how does cholestasis present microscopically
A
orange-yellow pigments
11
Q
what is the most common cause of cholestasis
A
sepsis
12
Q
what do you see microscopically in acute liver inflammation
A
lots of lymphocytic infiltration
13
Q
what is hepatocytic ballooning (degeneration)
A
when presented with oxidative stress, hepatocytes undergo morphologic change and become much larger in size
additionally, they have a cleared out cytoplasm
14
Q
what are councilman bodies
A
these are eosinophilic apoptotic bodies outside of hepatocytes
15
Q
what are the two most common causes of multi-lobulated necrosis of the liver
A
acetaminophen toxicity and acute viral hepatitis
16
Q
what is the macroscopic presentation of massive necrosis of the liver
A
small organ with a soft, yellow cut surface
17
Q
what is the most common form of liver disease
A
hepatic steatosis
18
Q
what are four common causes of macrovesicular steatosis
A
alcohol abuse
obesity
diabetes mellitus
viral hepatitis C
19
Q
which special stain can be used to diagnose hepatic steatosis
A
oil red O
20
Q
what are mallory-denk bodies
A
thick, ropy eosinophilic clumps within a ballooned hepatocyte
21
Q
what is the main difference between a mallory-denk body and a councilman body
A
a mallory-denk body is only seen within a ballooning hepatocyte
a councilman body are found outside of the hepatocytes
22
Q
which liver condition has a greasy cut surface due to lipid accumulation
A
steatohepatitis
23
Q
define hemosiderosis
A
too much iron in the body
24
Q
how does iron deposition in the liver appear microscopically
A
brown, granular pigments
25
what is Wilson disease
a recessive disorder caused by a mutation of the ATP7B gene which results in impaired copper excretion, thus causing it to build up in the body
26
what is alpha1-antitrypsin deficiency
genetic disease that is characterized by an accumulation of PAS positive cytoplasmic granules
27
what is nutmeg liver
chronic passive congestion of the liver
28
what is bridging fibrosis
fibrosis that spans between two central veins or portal tracts
29
fibrous strands surrounding liver nodules are suggestive of what
cirrhosis
30
define periductal fibrosis
onion skinning (concentric) fibrosis surrounding ducts - can be suggestive of primary sclerosing cholangitis
31
what is the macroscopic presentation of liver cirrhosis
nodules surrounded by dense bands of fibrosis cause a bumpy surface
32
what is the size of the nodules in macronodular cirrhosis
greater than 3 mm
33
what is the size of the nodules in micronodular cirrhosis
less than 3 mm
34
what is the etiology of macronodular cirrhosis
viral
35
what is the etiology of micronodular cirrhosis
alcohol
36
what do liver enzyme tests do
determine hepatocyte integrity
37
what do bilirubin tests do
test biliary excretory function
38
what do serum protein/albumin tests do
test hepatocyte function
39
what is hepatitis A (HAV)
mostly benign and self limiting infection that does not cause chronic hepatitis
40
what is hepatitis B (HBV)
uncommon infection thanks to vaccines
most patients are asymptomatic
increases your risk for developing hepatocellular carcinoma
41
what is hepatitis C (HCV)
infection that most commonly leads to chronic disease
significantly increases your risk for developing hepatocellular carcinoma
42
what is the most common type of viral hepatitis
hepatitis C (HCV)
43
what is hepatitis D (HDV)
infection that only occurs in those who also have hepatitis B (HBV)
44
what is hepatitis E (HEV)
water-borne infection that does not cause chronic hepatitis or hepatocellular carcinoma
45
what is fulminant hepatic failure
liver disease that can be caused by viruses
can only be cured through a liver transplant
46
what is the criteria for a chronic hepatitis diagnosis
persistent or relapsing hepatic disease for a period of time more than 6 months
47
what are the three triggers for autoimmune hepatitis
viral infections, drugs, or toxin exposures
48
who is most affected by autoimmune hepatitis
females - 78%
49
who is most affected by type 1 autoimmune hepatitis
middle-age/older individuals
50
who is most affected by type 2 autoimmune hepatitis
children/teenagers
51
what are the two distinguishing microscopic features of autoimmune hepatitis
hepatocyte rosettes and lots of plasma cells
52
what are the 5 progressive steps of liver disease
isolated steatosis
non-alcoholic steatohepatitis (NASH)
alcoholic liver disease
fibrosis
cirrhosis
53
what is the most well-known cause of fatty liver disease
alcohol
54
what are the three stages/presentations of fatty liver disease
steatosis
steatohepatitis
cirrhosis
55
what are the three criteria for an alcoholic liver disease diagnosis
hepatic steatosis
alcoholic hepatitis
fibrosis and cirrhosis
56
which special stain is used to differentiate fibrosis
Trichrome stain
57
what percentage of heavy drinkers will develop fatty liver (hepatic steatosis)
90-100%
58
what percentage of heavy drinkers with fatty liver (hepatic steatosis) will develop alcoholic hepatitis
10-35%
59
what percentage of heavy drinkers with fatty liver (hepatic steatosis) and alcoholic hepatitis will develop cirrhosis
8-20%
60
30% of chronic alcoholics have which disease
hepatitis C (HCV)
61
your risk of cirrhosis increases with how much alcohol a day
30 g of alcohol per day
62
how much alcohol is considered short term intake
80 g of alcohol per day
63
how much alcohol is considered long term intake
40-80 g of alcohol per day
64
what is the most common cause of chronic liver disease in the US
nonalcoholic fatty liver disease (NAFLD) - will develop into chronic liver disease
65
what are the five conditions associated with nonalcoholic fatty liver disease
metabolic syndromes
type 2 diabetes
obesity
dyslipidemia
hypertension
66
what is an ascending infection
an infection that comes from the gut and biliary tract to reach the liver
67
what is the most common vascular seeding location to the liver
through the portal system via the GI tract
68
what is hemochromatosis
excessive absorption of iron caused by a mutation in the HFE gene
69
what are three primary sites of iron deposition in the body
liver, pancreas, and skin
70
what can fully developed cases of hemochromatosis lead to
diabetes mellitus and abnormal skin pigmentation
71
in Wilson disease, copper builds up in which three structures
liver
brain
eye
72
what is a Kayser-Fleischer ring
ring of copper build up seen in the eye in Wilson disease
73
where is alpha1-antitrypsin synthesized
in the liver
74
10-20% of neonates present with hepatitis and cholestatic jaundice if they have which condition
alpha1-antitrypsin deficiency
75
what are two common examples of drug and toxin induced liver injury
Tylenol (acetaminophen) and cholesterol medication
76
define acute liver failure
liver disease that produces hepatic encephalopathy within 6 months of the initial diagnosis
77
what is fulminant liver failure
acute liver failure where the encephalopathy develops within 2 weeks of onset of jaundice
78
what is sub-fulminant liver failure
liver failure where the encephalopathy develops within three months of the onset of jaundice
79
what is a retic (reticulin) stain used for
looks for type 3 collagen
80
what are four consequences of portal hypertension
ascites, encephalopathy, splenomegaly, and esophageal varices
81
what are the four major steps of bilirubin metabolism
uptake from circulation
intracellular storage
conjugation with glucuronic acid
biliary excretion
82
what are the two types of bilirubin
unconjugated and conjugated
83
what is the normal serum bilirubin levels in an adult
0.3 to 1.2 mg/dL
84
what serum bilirubin levels would someone with jaundice have
greater than 2 mg/dL
85
what is neonatal jaundice
jaundice in a newborn due to the fact that they cannot conjugate and excrete bilirubin until they are fully mature at 2 weeks of age
86
what is Gilbert syndrome
condition where a person cannot conjugate bilirubin so it accumulates
87
what is Dublin-Johnson syndrome
condition where a person cannot excrete bilirubin so it accumulates
most often affects jewish and Japanese people
88
what are two possible clinical presentations of cholestasis
xanthomas and intestinal malabsorption
89
what are the four steps of cholestasis
enlargement of hepatocytes
dilated canaliculi
apoptotic hepatocytes
bile pigment hepatocytes
90
what is feathery degeneration
foamy bile pigment of hepatocytes that is seen in advanced cholestasis
91
what are the three causes of bile duct obstruction in adults
extrahepatic cholelithiasis (gallstones)
malignant obstructions
post surgical strictures
92
what is the most common cause of bile duct obstruction in adults
extrahepatic cholelithiasis (gallstones)
93
what are the two most common causes of bile duct obstruction in children
biliary atresia (stricture) and cystic fibrosis
94
define neonatal cholestasis
prolonged conjugated hyperbilirubinemia in the neonate
95
what are the two most common causes of neonatal cholestasis
primary biliary atresia (stricture) and neonatal hepatitis
96
what is primary biliary cholangitis
inflammation and destruction of intrahepatic bile ducts which leads to fibrosis
97
what is primary sclerosing cholangitis
inflammation and fibrosis of intrahepatic and extrahepatic bile ducts which leads to dilation
98
who is most affected by primary biliary cholangitis
females
99
who is most affected by primary sclerosing cholangitis
males
100
which condition is associated with primary biliary cholangitis
sjogren syndrome
101
which condition is associated with primary sclerosing cholangitis
inflammatory bowel disease
102
in which condition would you see strictures and beading of large bile ducts
primary sclerosis cholangitis
103
what is the most common cause of extrahepatic portal vein obstruction
cause of most cases is unknown
104
what is an infarct of Zahn
red-blue discoloration seen in the liver due to intrahepatic portal vein obstruction
105
what are the two most common causes of intrahepatic portal vein obstruction
schistosomiasis and obliterative portal venopathy
106
how does schistosomiasis affect the liver
the eggs of the parasite lodge themselves into the smallest portal vein branches and cause obstructions
107
mortality is high in which type of hepatic venous outflow condition
hepatic vein thrombosis
108
what is sinusoidal obstruction syndrome
occlusion of the smallest intrahepatic branches of the liver
109
what are three causes of sinusoidal obstruction syndrome
Jamaican bush tea
stem cell transplantation
chemotherapy
110
what is Budd-chiari syndrome
obstruction of two or more major hepatic veins which causes an enlarged liver
111
what are the two major risk factors of hepatic venous outflow obstructions
pregnancy and oral contraceptives
112
what is the cause of chronic passive congestion of the liver "nutmeg liver"
right sided heart failure
113
what is focal nodular hyperplasia
a tumor of the hepatocytes
grossly shows a central scar
114
what is the most common cause of focal nodular hyperplasia
alterations in hepatic parenchymal blood supply
ex. arteriovenous malformations
115
what is a cavernous hemangioma
benign, vascular tumor of the liver
leads to dilated and thin-walled vessels microscopically
116
what is the most common **benign** liver tumor
cavernous hemangioma (made of blood vessels)
117
what is a hepatocellular adenoma
benign neoplasm of the hepatocytes that tend to be very large
have malignant transformation potential
118
what is a hamartoma
bengin mass of disorganized tissue such as cartilage that is native to a particular anatomic location
119
what is a bile duct hamartoma
benign lesions of aggregates of bile ducts with irregularly shaped open lumens (von meyenburg complexes)
120
what are von Meyenburg complexes
hamartomas - channels of proliferating cartilage in the liver
121
in which condition would you see von Meyenburg complexes
bile duct hamartoma
122
what is the most common primary liver tumor
hepatocellular carcinoma - a tumor of the hepatocytes
123
what is the second most common primary liver tumor
cholangiocarcinoma - a tumor of the bile ducts
124
what is a hepatoblastoma
liver tumor of infants and children that is made tissue resembling fetal liver cells, mature liver cells, or bile duct cells
125
what is an angiosarcoma
hepatic tumor that originates from endothelial and fibroblastic tissue
made mostly of vessels
126
what are 4 common causes of hepatocellular carcinoma
HBV
HCV
aflatoxin
alcohol
127
what is the most common cause of hepatocellular carcinoma
chronic liver disease
128
how does hepatocellular carcinoma spread
vascular invasion or direct extension
129
what is cholangiocarcinoma
malignant adenocarcinoma arising from intrahepatic and extra hepatic bile ducts
commonly caused by certain foods/parasites
130
what is the most common liver tumor of early childhood
hepatoblastoma
131
a hepatoblastoma is associated with which two conditions
FAP (familial adenomatous polyposis) and Beckwith-Wiedmann syndrome
132
what is the most common metastasis location of hepatocellular carcinoma
lungs
133
how can Clostridium perfringes affect the liver
it can cause gangrenous gas necrosis which leads to abscess pockets (should not be confused with cysts)
134
chronic transplant rejection (CTR) presents clinically as what
progressive cholestasis
135
what is the most common congenital anomaly of the gallbladder
Phrygian cap
136
what is unique about the wall of the gallbladder
it has no submucosa
137
define choleliths
gallstone
138
95% of biliary tract disease is caused by what
choleliths (gallstones)
139
what are the two main types of gallstones
cholesterol and pigment stones
140
what are pigment stones made out of
bilirubin calcium salts
141
what are the four F's of gallstone risks
female
fat
forty
fertile
142
define cholecystitis
inflammation of the gallbladder
143
what are rokitansky-aschoff sinuses
benign condition characterized by hyperplastic changes in the wall of the gallbladder
144
define cholesterolosis
"strawberry gallbladder"
deposition of cholesterol laden histiocytes
145
what is porcelain gallbladder
dense, hyaline fibrosis transforming gallbladder wall often with calcifications
most commonly caused by long standing inflammation
146
what is the most common malignancy of the extra hepatic biliary tract
gallbladder carcinoma
147
who is most at risk for gallbladder carcinoma
females around 70 years old
148
what is the most important risk factor associated with gallbladder carcinoma
cholelithiasis
