Liver Pathology

Question 1

What are the causes of cirrhosis?

Answer 1

etoh, viral hepatitis, biliary ds. hereditary hemochromatosis, wilsons ds. A1AT def, NAFLD

Question 2

The 3 most common causes of death in cirrhosis?

Answer 2

hepatic failure
portal htn
hepatocellular carcinoma

Question 3

List the some symptoms of hepatic failure

Answer 3

Jaundice, hypoalbunemia, bleeding, hyperammonemia, hypoglycemia, endocrine and renal failure, encephalopathy, pulmonary and portal htn

Question 4

What is the most common cause of acute hepatic failure? Chronic?

Answer 4

acetaminophen OD

cirrhosis

Question 5

Sinusoidal/central venous fibrosis, parenchymal nodules, arterial portal anastamoses adn hyperdynamic splanchnic circulation are all causes of what liver pathology?

Answer 5

Portal htn

Question 6

Symptoms of portal htn?

Answer 6

ascites, splenomegaly, esophageal varices, hepatic encephalopathy

Question 7

What would be seen on a liver biopsy fo a pt. with alcoholic steatosis?

Answer 7

enlarged lipid vacuoles

Question 8

IF you see mallory bodies think this, yo.

Answer 8

Alcoholic hepatitis

Question 9

What are the differences seen in imaging between early and late alcoholic cirrohsis?

Answer 9

Early- enlarged fatty liver w/micronodules

Late - shrunken, nonfatty, w/variable nodules

Question 10

Causes of mortalitiy in alcoholic cirrhosis?

Answer 10

Hepatic encephalopathy
Esopahgeal varices
Infection
Hetaptorenal syndrome
Hepatocellular carcinoma

Question 11

What is the diff between types of pt with non- alcoholic and alcoholic fatty liver disease?

Answer 11

Non-alcoholic - obese, T-II diabetes, dyslipidemia, and mucho insulin resistance
alcoholic - alcohol consumption

Question 12

What is primary biliary cirrhosis?

Answer 12

inflammatory destruction of small and medium intrahepatic bile ducts

Question 13

Dx tests for PBC?

Answer 13

ALP/GGT - elevated
AMA antibodies or (ANA and ASMA/AIH)
CD8+ T cells

Question 14

What would a typical PBC look like and present as?

Answer 14

Middle age european female with pruritis, xanthelmsa/xanthoma, steatorrhea, osteomalacia/osteoporosis and other autoimmune ds.

Question 15

Name causes of secondary billiary cirrhosis?

Answer 15

Stones, tumors, atresia, CFTR, choledocal cysts

Question 16

What autoimmune disease is associated with PSC?

Answer 16

IBD - 70% of patients

Question 17

What is the key finding for PSC?

Answer 17

Beaded cholangiogram and atypical p-ANCA

Question 18

Describe Hereditary hemochromatosis.

Answer 18

AR decrease in hepcidin synth –> increased Iron absorption. Treated with phlebotomy and iron chelations. Also called bronze diabetes

Question 19

What causes secondary hemochromatosis

Answer 19

parenteral overload
ineffective erythoproeisis
increased oral effective

Question 20

Key difference in biopsy between hereditary and secondary hemochromatosis?

Answer 20

in hereditary iron in hepatocytes while in secondary it is in the Kupfer cells

Question 21

what is the defect in Wilson’s disease?

Answer 21

AR defect in ATP7B- so you can secrete copper and ceruloplasmin into bile.

Question 22

When would you suspect Wilson’s ds?

Answer 22

A teen with liver disease where all tests are coming up negative.

Question 23

What would you see in a liver bx. in A1AT?

Answer 23

build up of A1AT in hepatocytes

Question 24

Diagnosis of A1AT would involve what tests?

Answer 24

A1AT level, A1AT phenotype, liver bx. : PAS + cytoplasmic globular inclusions

Question 25

What is the difference between a direct and unpredictable cause of drug induced liver injury?

Answer 25

direct: all individuals sustain the same level of injury from the same dose unpredictable: level of damage is dependent on the individual

Question 26

What are two causes of neonatal cholestasis?

Answer 26

biliary atresia and neonatal hepatitis

Question 27

Describe neonatal hepatitis?

Answer 27

hepatitis caused by biliary atresia, A1AT inherited metabolic deficiency, tyrosinemia, CFTR, drug toxicity

Question 28

What type of bilirubin accumulates in neonatal cholestasis?

Answer 28

conjugated

Question 29

What are the causes of granulomatous hepatitis?

Answer 29

50% idiopathic, 20% Sarcoidosis, 5% drugs, 3% TB

Question 30

Which liver enzyme is specific to hepatocellular damage?

Answer 30

ALT (alanine aminotransferase)

Question 31

An AST:ALT >2 indicates what etiology of liver disease?

Answer 31

alcoholic

Question 32

What are the liver function enzyme tests that would indicate a cholestatic etiology of liver disease?

Answer 32

ALP and GGT (ALP >>> ALT and AST)

Question 33

If you see an increase in plasma cells on a liver bx., index of suspicion for what diseases are raised?

Answer 33

AIH and PBC (primary biliary cirrhosis)

Question 34

Contrast the patterns seen on liver bx. for HBV and HCV

Answer 34

HBV- ground glass | HCV- periportal hepatitis and mild steatosis

Question 35

What does grading of a liver bx. sample tell you?

Answer 35

the amount of fibrosis

Question 36

When should you be concerned about Gilbert's syndrome?

Answer 36

Never, it is benign, may have icterus and elevated bilirubin during stressed times

Question 37

What is acute cholangitis? What can cause it?

Answer 37

secondary bacterial infection of biliary tree, may be caused by hepatocellular cholestasis

Question 38

Centrilobular fibrosis caused by cor pulomonale, hepatic vein thrombosis, CHF and shock is called this

Answer 38

Chronic passive congestion

Question 39

radiation, BMT, chemo damage the hepatic sinusoidal endothelium causing lesions of small veins, narrowing of central veins

Answer 39

sinusoidal obstruction syndrome

Question 40

Cardiac sclerosis is caused by these two liver vascular problems

Answer 40

Chronic passive congestion | centrilobular hemorrhaic necrosis

Question 41

What is portal vein thrombosis caused by?

Answer 41

``` extrahepatic = trauma, intrabdominal sepsis, pancreatitis, hypercoaguable disorder intrahepatic = cirrhosis and carcinoma ```

Question 42

Blood filled spaces in liver caused by anabolic steroid or bartonella infection?

Answer 42

Peliosis hepatitis

Question 43

What causes acute massive hepatic necrosis? Likley outocomes?

Answer 43

acute hep., drug/toxin, vascular disease, AIH, Wilson's | Death or full recovery

Question 44

Dx tools used for autoimmune hepatitis.

Answer 44

Type 1 - (ANA) (SMA) (anti-SLA/LP) | Type II - anti (ALKM-1), (ALC-1)

Question 45

What does HELLP stand for?

Answer 45

hemolysis, eleveated liver enzymes, liver platelets

Question 46

Dx sign of Acute fatty liver or pregnancy

Answer 46

microvesicalar steatosis

Question 47

Intrahepatic cholestasis of pregnancy is caused by this normal effect of pregnancy

Answer 47

elevated estrogen

Question 48

What are liver complications of a bone marrow transplant?

Answer 48

drug toxicity, sinusoidal obstruction syndrome, graft vs host ds

Question 49

congenital dilation of the bile duct?

Answer 49

choledochal cyst

Question 50

What disorders make up Caroli's disease?

Answer 50

Intrahpetiac dilations + congenital hep fibrosis

Question 51

AR non-cirrhotic liver disease of kids?

Answer 51

Congenital hepatic fibrosis

Question 52

What is nodular regenerative hyperplasia?

Answer 52

diffuse nonfibrosing nodular hyperplasia

Question 53

Typical patient for hepatocellular adenoma?

Answer 53

young woman on oral estrogen contraceptions

Question 54

What is the big concern with bile duct hamartoma?

Answer 54

nodules look like metastatic carcinoma

Question 55

benign proliferation of bile ducts

Answer 55

bile duct adenoma

Question 56

Describe the gross signs of HCC

Answer 56

solitary large mass or multiple nodules, soft, hemorrhagic

Question 57

What is ironic about fibrolamellar variant of HCC?

Answer 57

Young patients with no cirrhosis or hepatitis. Also a firm lesion

Question 58

what things increase risk of intrahepatic carcinoma (cholangiocarcinoma)

Answer 58

liver flukes, PSC, carolis ds, congential hepatic fibrosis, choledochal cyst, viral hep b/c, NAFLD

Question 59

what is perihilar/klastkin tumor?

Answer 59

tumor at R/L hepatic duct confluence

Question 60

Why is the prognosis for distal extrahepatic cholaniocarcinoma worse than most others?

Answer 60

it infiltrates into surrounding tissue

Question 61

Describe cholesterol stones

Answer 61

water soluble, supersaturated bile, usually drugs cause these stones

Question 62

common causes of pigment stones

Answer 62

bacterial and parasitic infection, disorders of hemolysis

Question 63

Symptoms of acute cholecystitis

Answer 63

epigastric RUQ pain, leukocytosis

Question 64

What condition is always present in chronic cholecystisit?

Answer 64

cholestatis

Question 65

dystrophic calcification of the gallbladder wall is called this

Answer 65

porcelain glalbladder

Question 66

describe cholesterolosis

Answer 66

accumulation of lipif laden macrophages (foamy) and yellow flecks

Question 67

Mucocele/hydrops of the gallbladder involves this finding?

Answer 67

distended gallbladder with atrophic wall

Question 68

This thickening of the gall bladders wall is not a true neoplasm.

Answer 68

Adenomyoma of the gallbladder

Question 69

Why is gallbladder carcinoma so dangerous?

Answer 69

Often silent, already metastasized to liver at diagnosis.

Question 70

this benign growth of the gall bladder can progress into adenocarcinoma

Answer 70

adenoma of gallbladder