Liver, Pancreas, Gallbladder - DONE Flashcards Preview

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Flashcards in Liver, Pancreas, Gallbladder - DONE Deck (78):

Give examples of systemic viral infections:

- Herpes
- Adeno


What is the difference between systemic viral infection and viral hepatitis?

Systemic viral infection can involve the liver but the term viral hepatitis is reserved for infection of the liver caused by the group of viruses having a particular affinity for the liver (hepatotropic viruses HAV, HBV, HCV, HDV, HEV, HGV)


Asymptomatic acute infection:

serologic evidence only


Acute hepatitis:

anicteric or icteric


Chronic hepatitis:

without or with progression to cirrhosis


Chronic carrier state:

asymptomatic without apparent disease


Fulminant hepatitis:

submassive to massive hepatic necrosis with acute liver failure


Acute viral hepatitis- histological picture

- Hypercellularity and disarrangement of liver structure
- The inflammatory infiltrate (mostly lymphocytes) in portal tracts. Sometimes with necrosis of periportal hepatocytes („interface hepatitis”)


Damage of hepatocytes in acute viral hepatitis:

1. vacuolar, balooning degeneration,
2. a few hepatocytes in phase of apoptosis - apoptotic/Councilman bodies – round, dark red eosinophilic bodies;
3. colliquative necrosis of single hepatocytesempty place surrounded by neutrophils or macrophages or macrophage aggregates;
4. in severe cases confluent necrosis (bridging necrosis)


Where do we find bridging necrosis?

in acute viral hepatitis


Where do we find apoptosisapoptotic/Councilman bodies?

in acute viral hepatitis


What happens with the number of Kuppfer cells in acute viral hepatitis?

Increase in number of Kuppfer cells
- comma like small cells situated between hepatocytes


What is an inconstant finding in acute viral hepatitis?

An inconstant finding is cholestasis
* with bile plugs in canaliculi and brown pigmentation of hepatocytes


Which virus cause „Ground-glass” hepatocytes?



How does HBV alter the tissue in acute viral hepatitis?

„Ground-glass” hepatocytes with a finely granular, eosinophilic cytoplasm- accumulation of HBsAg (chronic hepatitis)


How does HCV alter the tissue in acute viral hepatitis?

- Steatosis/fatty change of hepatocytes (acute and chronic hepatitis)
- Ductular proliferation in portal tract and lymphoid aggregate formation (chronic hepatitis)


What is „Ground-glass” hepatocytes ?

hepatocytes with diffuse granular cytoplasm, so-called ground glass hepatocytes.


What is the term cirrhosis is applied to?

The term cirrhosis is applied to the end stage of chronic liver injury


What defines cirrhosis? (cirrhosis= end stage of chronic liver injury)

- Bridging fibrous septa (delicate bands or broad scars)

- Parenchymal nodules created by regeneration, varying from small (<3mm, micronodules) to large (macronodules)

- Disruption of the architecture of the entire liver


How is the parenchyma and the fibrosis in cirrhosis?

- The parenchymal injury and fibrosis are diffuse

- The fibrosis is generally irreversible (regression is observed in rare instances of schistostomiasis and hemochromatosis)


What is requisite for the diagnosis of cirrhosis?

Nodularity is requisite for the diagnosis


Fibrosis def (google):

the thickening and scarring of connective tissue, usually as a result of injury


How is the vascular architecture in the liver in cirrhosis?

Vascular architecture is reorganized with the formation of abnormal interconnections between vascular inflow and hepatic vein outflow channels


The chief worldwide causes of cirrhosis are:

- alcohol abuse
- viral hepatitis
- non-alcoholic steatohepatitis (NASH)


Other causes of cirrhosis:

- Biliary diseases
- Primary hemochromatosis
- Wilson disease
- Alfa1-antitrypsin disease
- Cryptogenic cirrhosis


What usually happens before macronodular cirrhosis?

Macronodular cirrhosis is most frequently preceded by chronic viral hepatitis although it is also attributable to the Wilson’s disease


Macronodular cirrhosis was formerly named what?

Macronodular cirrhosis was formerly named postnecrotic or posthepatitic cirrhosis


Macronodular hepatic cirrhosis - Macrolevel:

liver is diminished and composed of nodules of various size and shape surrounded by broad areas of collapsed stroma


What causes Micronodular cirrhosis in most cases?

Micronodular cirrhosis is caused in most cases by chronic alcohol abuse


Micronodular cirrhosis was formerly named what?

previously „portal”


What characterizes Micronodular hepatic cirrhosis?

- It is characterized by small uniform nodules, which represent fragments of previous hepatic lobules.
- The characteristic diffuse nodularity of the surface reflects the interplay between nodular regeneration and scarring.


Micronodular hepatic cirrhosis - Macrolevel:

the liver shows fine, fairly regular yellowish nodularity


What is Micronodular cirrhosis is seen along with?

Micronodular cirrhosis is seen along with moderate fatty change


Hepatocellular nodules vary in size in c. (cirrhosis):

macronodular c. - the big nodules often contain the axis in the form of portal triads or central veins (axial nodules)

micronodular c. - the nodules do not contain either central vein or portal tracts (non-axial nodules)


What are the nodules surrounded by in nodular cirrhosis?

The nodules are surrounded by fibrous septa

-> within the fibrous septas we can see elements of portal tracts, proliferated bile ductules and mononuclear infiltration.


How are the hepatocytes in nodular cirrhosis (general)?

- plates of hepatocytes are irregular
- bilayered plates of hepatocytes reflect the tendency of parenchyma to regenerate


How are the hepatocytes in the different types of cirrhosis?

In macronodular c. hepatocytes are predominantly normal, without the fatty degeneration

In micronodular c. hepatocytes are usually in state of steatosis


How many and how is the cirrhosis when asymptomatic?

About 40% of individuals with cirrhosis are asymptomatic until late in the course of the disease.


How many and how is the cirrhosis when symptomatic?

they present with nonspecific clinical manifestations:
- anorexia
- weight loss
- weakness
- in advanced disease, symptoms and signs of hepatic failure


The ultimate mechanism of deaths in most cirrhotic patients is:

1. progressive liver failure,
2. a complication related to portal hypertension, or
3. the development of hepatocellular carcinoma



Hepatocellular carcinoma


HCC constitutes how much of all cancers?

HCC constitutes approximately 5.4% of all cancers, but the incidence varies widely in different areas of the world


Where does most of the cases of Hepatocellular carcinoma occur? (in general)

More than 85% of cases occur in countries with high rates of chronic HBV infection.


In which countries are the highest incidences of Hepatocellular carcinoma (HCC) found?

Asian countries:
- Southeast China
- Korea
- Taiwan

African countries


Who gets Hepatocellular carcinoma (HCC) in Western countries?

In Western populations HCC is rarely present before age 60, and in almost 90% of cases tumors develop in persons with cirrhosis


Are the males or females in the majority when it comes to having Hepatocellular carcinoma (HCC)?

There is a pronounced male preponderance of HCC throughout the world:
- about 3 : 1 in low-incidence areas
- as high as 8 : 1 in high-incidence areas


What are the risk factors for Hepatocellular carcinoma (HCC)?

- infection HBV
- alcohol


(Hepatocellular carcinoma)
Three major etiologic associations have been established:

- infection with HBV or HCV
- chronic alcoholism
- aflatoxin exposure (high exposure to dietary aflatoxins derived from the fungus Aspergillus flavus. These carcinogenic toxins are found in "moldy" grains and peanuts)


(Hepatocellular carcinoma)
Other etiologic associations have been established:

- hemochromatosis
- tyrosinemia (extremely rare in which almost 40% of patients develop this tumor despite adequate dietary control).


What constitutes 80% of all primary liver cancers?

Hepatocellular carcinoma


Hepatocellular carcinoma - Macrolevel:

unifocal, multifocal, diffusely infiltrative cancer.

Tumor masses are usually yellow-white, punctuated sometimes by bile staining and areas of hemorrhage or necrosis.

All patterns of HCC have a strong propensity for invasion of vascular channels.


(more) Hepatocellular carcinoma - Macrolevel:

Extensive intrahepatic metastases ensue, and occasionally snakelike masses of tumor invade the portal vein (with occlusion of the portal circulation) or inferior vena cava, extending even into the right side of the heart.


Hepatocellular carcinoma histological range:
(Hepatocellular carcinoma – conventional variant)

- from well-differentiated lesions that reproduce hepatocytes arranged in cords, trabeculae or pseudoglandular patterns

- to poorly differentiated lesions.

In the better differentiated variants, globules of bile may be found within the cytoplasm of cells and in pseudocanaliculi between cells.


What explains the soft consistency of HCC?
(Hepatocellular carcinoma – conventional variant)

There is surprisingly scant stroma in most HCCs, explaining the soft consistency of these tumors.


Where are the globules of bile found in HCC?
(Hepatocellular carcinoma – conventional variant)

In the better differentiated variants, globules of bile may be found within the cytoplasm of cells and in pseudocanaliculi between cells.


HCC - fibrolamellar variant

A distinctive clinicopathologic variant of HCC is the fibrolamellar variant.


Who gets HCC - fibrolamellar variant?

- occurs in young male and female adults (20-40 years of age) with equal incidence
- has no association with cirrhosis or other risk factors.


How is the prognosis in HCC in the fibrolamellar variant compared to the convetional variant?

The prognosis is better in the fibrolamellar variant than the conventional HCC.


Hepatocellular carcinoma - Macrolevel:
(fibrolamellar variant)

It usually consists of a single large, hard "scirrhous" tumor with fibrous bands coursing through it


Hepatocellular carcinoma - Histologically:
(fibrolamellar variant)

it is composed of well-differentiated polygonal cells growing in nests or cords and separated by parallel lamellae of dense collagen bundles.


Pancreatitis def:

Pancreatitis encompasses a group of disorders characterized by inflammation of the pancreas with injury to the exocrine pancreas.


Acute pancreatitis def:

By definition, in acute pancreatitis, the gland can return to normal if the underlying cause of the pancreatitis is removed.


Chronic pancreatitis def:

By contrast, chronic pancreatitis is defined by the presence of irreversible destruction of exocrine pancreatic parenchyma.


What characterizes chronic pancreatitis?

Chronic pancreatitis is characterized by inflammation of the pancreas with destruction of exocrine parenchyma, fibrosis, and, in the late stages, the destruction of endocrine parenchyma


What is the prevalence of chronic pancreatitis?

The prevalence of chronic pancreatitis is hard to determine, but it probably ranges between 0.04% and 5%


What is the most common cause of chronic pancreatitis?

long-term alcohol abuse,
*and these patients are usually middle-aged males.


Chronic pancreatitis - Morphology

Grossly, the gland is hard, sometimes with extremely dilated ducts and visible calcified concretions.


Chronic pancreatitis is characterized by (three things):

- parenchymal fibrosis
- reduced number and size of acini with relative sparing of the islets of Langerhans
- variable dilation of the pancreatic ducts.


What is the most common malignancy of the extrahepatic biliary tract?

Gallbladder carcinoma


In which gender is Gallbladder carcinoma more common?

slightly more common in women


When do people get Gallbladder carcinoma?

it occurs most frequently in the seventh decade of life.


What is the most important risk factor associated with gallbladder carcinoma, and how many get it?

The most important risk factor associated with g.c. is gallstones (cholelithiasis), which are present in 60-95% of cases.

- only 0.5% of patients with gallstones develop gallbladder cancer after 20 or more years.


Gallbladder carcinoma prognosis:

Only rarely is it discovered at a resectable stage, and the mean 5-year survival rate has remained for many years at about 5% despite surgical intervention.


What is the morphology of Gallbladder carcinoma?

They show two patterns of growth:
- infiltrating (more common)
- exophytic


The infiltrating pattern of Gallbladder carcinoma:

- more common than the exophytic pattern
- usually appears as a poorly defined area of thickening and induration of the gallbladder wall.
- are scirrhous and have a very firm consistency.


The exophytic pattern of Gallbladder carcinoma:

grows into the lumen as an irregular, cauliflower mass but at the same time invades the underlying wall.


What are the common sites of the exophytic pattern of Gallbladder carcinoma?

The most common sites of involvement are the fundus and the neck; about 20% involve the lateral walls


Gallbladder carcinoma - Microlevel:

Most carcinomas of the gallbladder are adenocarcinomas.

They may be papillary, poorly differentiated, or undifferentiated infiltrating tumors.

About 5% are squamous cell carcinomas or have adenosquamous differentiation.

A minority are neuroendocrine tumors.