liver/GB/pancreas pathology

Question 1

among top 10 most common causes of death in the US and the primary route for liver-related deaths

Answer 1

cirrhosis

Question 2

etiologies of cirrhosis

Answer 2

alcohol abuse, viral hepatitis, non-alcohol steatohepatitis, biliary disease, iron overload

Question 3

iron overload can lead to _____ and _____; complications include:

Answer 3

hepatocyte death and inflammation

reduced liver function, portal hypertension, and increased risk for hepatocellular cancer

Question 4

morphologic changes in cirrhosis include:

Answer 4

1. bridging fibrous septae
2. parenchymal nodules
3. changes in architecture that lead to parenchymal injury and scarring

Question 5

a fibrotic liver has markedly compromised ____ and decreased ___

Answer 5

blood supply; function

Question 6

portal hypertension leads to:

Answer 6

1. ascites
2. esophageal varices
3. splenomegaly
4. hepatic encephalopathy
5. hypogonadism

Question 7

portal hypertension can occur ____, ____, and _____

Answer 7

prehepatic (obstructive thrombi), intrahepatic (cirrhosis), and post hepatic (right sided heart failure)

Question 8

causes of jaundice

Answer 8

hemolytic anemias (#1 cause), bilirubin overproduction, hepatitis, reduced hepatocyte uptake, obstruction of bile flow

Question 9

hepatocyte injury that is associated with inflammation

Answer 9

hepatitis

Question 10

benign, self-limiting disease; viremia is transient- rarely screen donor blood for this

Answer 10

hepatitis A virus (HAV

Question 11

route of transmission for HAV

Answer 11

fecal-oral route of transmission- seen with overcrowded/unsanitary condition; ingestion of contaminated food and water

Question 12

hepatitis B induced liver disease is an important precursor for _____

Answer 12

hepatocellular carcinoma

Question 13

hepatitis B is a ___ virus spread by _____; incubation period: _____

Answer 13

DNA; parenteral contact/sexual spread; 4-26 weeks

Question 14

_____ determines the ultimate outcome of Hep B

Answer 14

host immune response

Question 15

hallmark features of hepatitis C (85%)

Answer 15

persistent infection + chronic hepatitis

Question 16

hepatitis C is the most frequent viral infection associated with the need for _____

Answer 16

liver transplantation

Question 17

hep C previously treated with ____; now, treatment with _____ considered curative

Answer 17

interferon and ribavirin; protease and nucleoside inhibitors

Question 18

hep D requires presence of _____ for infection (co-infection usually presents as ____ and _____

Answer 18

Hep B; transient; self-limited

Question 19

Hep E (which is similar to _____) is an enterically transmitted, water-borne infection with high mortality rate in _____; not associated with chronic liver disease

Answer 19

similar to hep A; pregnant women

Question 20

hep G has some similarity to ____ but is not hepatotropic; does not increase ____ such as _____

Answer 20

hep C; liver enzymes; serum aminotransferases

Question 21

Hep G replicates in ____ and ____

Answer 21

bone marrow; spleen

Question 22

a chronic, progressive hepatitis variant with an unknown etiology; pathology is associated with T-cell mediated autoimmunity

Answer 22

autoimmune hepatitis

Question 23

3 overlapping forms of alcoholic liver disease

Answer 23

1. hepatic steatosis (fatty liver)
2. alcoholic hepatitis
3. cirrhosis (only develops in a minority of patients

Question 24

____ of chronic liver disease is associated with overuse of alcohol

Answer 24

60%

Question 25

____ of deaths in alcoholic liver disease due to cirrhosis

Answer 25

40-50%

Question 26

clumps of cytokeratins, eosinophilic cytoplasmic inclusions in fatty liver from alcohol

Answer 26

mallory or mallory-denk bodies

Question 27

most common metabolic liver disease

Answer 27

non-alcoholic fatty liver disease

Question 28

primary cause of liver disease in the US; can arise with or without nonspecific inflammation

Answer 28

non-alcoholic fatty liver disease

Question 29

patients develop hepatocyte injury and 10-20% progress to cirrhosis (seen primarily in obese patients)

Answer 29

nonalcoholic steatohepatitis (NASH)

Question 30

approx ____ of obese persons have some form of fatty liver disease

Answer 30

70%

Question 31

excessive accumulation of body iron; most is deposited in the liver, pancreas, and heart

Answer 31

hemochromatosis

Question 32

classic triad associated with hemochromatosis

Answer 32

cirrhosis with hepatomegaly, diabetes mellitus, and skin pigmentation

Question 33

results from a failure to incorporate copper (Cu) into ceruloplasmin; consequently get accumulation of toxic Cu levels in the liver, brain, and eye

Answer 33

wilson's disease

Question 34

liver features of hemochromatosis include ____ cirrhosis with ____

Answer 34

micronodular cirrhosis; hemosiderin

Question 35

develop pulmonary emphysema from protein degrading enzymes; also develop liver disease, formation of mallory bodies, and PAS positive granules within hepatocytes

Answer 35

alpha1-antitrypsin deficiency

Question 36

results from obstruction of extrahepatic duct

Answer 36

secondary biliary cirrhosis

Question 37

primary cause is cholelithiasis (gall stones), then malignancies of biliary tree or head of pancreas

Answer 37

biliary tree obstruction

Question 38

inflammatory autoimmune disease; affects intrahepatic bile ducts

Answer 38

primary biliary cirrhosis (PBS)

Question 39

fibrosing cholangitis of bile ducts- develop luminal obliteration; liver eventually develops biliary cirrhosis

Answer 39

primary sclerosing cholangitis (PSC)

Question 40

there is an increase in ____ and _____ in PSC patients

Answer 40

chronic pancreatitis; hepatocellular carcinoma (HCC)

Question 41

nodular hyperplasia can lead to focal or diffuse alteration in _____, resulting in _____ and a _____

Answer 41

hepatic blood supply; obliteration of the portal veins; compensatory increase in arterial supply

Question 42

cancer of biliary tree; most are adenocarcinomas; very desmoplastic tumor- tumors firm and gritty; generally fatal within 6 months

Answer 42

cholangiocarcinoma (CCA)- bile duct carcinoma

Question 43

most common liver tumor in young pediatric patients; epithelioid type; rapidly fatal (within months) if not treated

Answer 43

hepatoblastoma

Question 44

benign; associated with oral contraceptives (if discontinued, may regress); histology: bland hepatocytes and no bile ducts

Answer 44

hepatocellular adenoma

Question 45

worldwide the 3rd leading cause of cancer deaths in western countries (5th in the US); male predominance 3:1

Answer 45

hepatocellular carcinoma

Question 46

etiologic factors for HCC

Answer 46

cirrhosis (90%), due to chronic viral infection (HBV, HCV) or chronic alcoholism, NASH (nonalcoholic steatohepatitis), food contaminants (primarily aflatoxins)

Question 47

all HCC variants have strong propensity for _____

Answer 47

vascular invasion

Question 48

found in young males and females (20s-40s), distinct from HCC, no known risk factors, "scirrhous tumor," better prognosis

Answer 48

fibrolamellar variant of HCC

Question 49

primary soft tissue sites for metastasis to occur (metastatic tumors more common than primary tumors); most common primary cancers are:

Answer 49

liver and lungs | colon, breast, lung, and pancreas

Question 50

often the only sign of metastatic spread to liver is _____ bc liver has tremendous functional reserve

Answer 50

hepatomegaly

Question 51

pathogenesis of gall stone formation (cholelithiasis)

Answer 51

supersaturation, initiation, growth

Question 52

two types of stones

Answer 52

cholesterol cholelithiasis (mostly radiolucent) and bilirubin cholelithiasis (mostly radiopaque)

Question 53

risk factors for pigment stones

Answer 53

hemolysis, GI disorders, biliary infections

Question 54

risk factors for cholesterol stones

Answer 54

increased in caucasians, increasing age and obesity; more women than men (2:1), estrogens (pregnancy and oral contraceptives), gall bladder stasis, hereditary contribution

Question 55

increased frequency in women in their 7th decade of life; associated with gallstones (95%) or infectious agents within the gallbladder (chronic inflammatory states)

Answer 55

adenocarcinoma of the gallbladder (malignant cancer)

Question 56

reversible parenchymal injury of the pancreas associated with inflammation

Answer 56

acute pancreatitis

Question 57

80% of cases of acute pancreatitis related to ____ or ____

Answer 57

biliary tract disease; alcoholism

Question 58

symptoms of acute pancreatitis are _____ (cardinal manifestation)

Answer 58

abdominal pain ; "acute abdomen" ; "upper back intense pain"

Question 59

develop irreversible destruction of the exocrine pancreas, with ensuing fibrosis and eventual destruction of the endocrine parenchyma

Answer 59

chronic pancreatitis

Question 60

pancreatic cancers (mostly adenocarcinomas) are the ____ leading cause of cancer deaths in the US

Answer 60

4th

Question 61

increased risk for pancreatic cancers with ____, ____, and ____

Answer 61

smoking; diabetes mellitus; chronic pancreatitis

Question 62

___ is usually the first sign of pancreatic cancers, but typically too late; _____ is associated with tumors at the pancreatic head

Answer 62

pain; obstructive jaundice

Question 63

migratory thrombophlebitis formation of platelet aggregation factors and procoagulents from pancreatic tumor or its necrotic products

Answer 63

Trousseau sign