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Flashcards in Liver pathology Deck (57):
1

The ______ constitutes 70% of the afferent blood volume of the liver and is rich in nutrients but relatively poor in oxygen

portal vein

2

What is the anatomic unit of the liver?

liver lobule- histologically definable and divided into periportal, mid, and centrilobular areas

3

What is the functional unit of the liver?

Liver acinus (zones 1 to 3) occupies adjacent sectors of neighbor hexagonal liver lobules

4

The hepatocytes in zone 3 (the centrilobular area) have the highest levels of _________

CYP450 enzymes
= least oxygen and greatest levels of toxic eletrophilic metabolites generated by P450s

5

What conditions show ballooning degeneration?

alcohol, drugs, toxins, ACUTE viral hepatitis

6

In what conditions do triglycerides accumulate in injured but viable hepatocytes?

Alcohol, drug toxicity (aspirin- Reye's in children), HCV, Wilson's disease

7

In the setting of ______, visible bile pigment may occur in canaliculi and hepatocytes and the centrilobular hepatocytes may be ballooned

cholestasis

8

______ accumulates in hereditary hemochromatosis while _____ accumulates in Wilson's disease

iron; copper

9

In _______, the outlines of dead hepatocytes perisist but the nuclei disappear leaving anucleate pink cells

coagulative necrosis

10

Coagulative necrosis is seen in the setting of _______

ischemia

11

In ______, individual hepatocytes undergo lytic necrosis due to severe osmotic disturbances and the space previously occupied by hepatocytes is filled by inflammatory cells.

spotty necrosis

12

Spotty necrosis is seen in _____ and damage due to ______

viral hepatitis; alcohol

13

In _______, zone 3 of the liver parenchyma is most affected

focal necrosis

14

What conditions lead to focal necrosis?

ischemic injury
acetaminophen toxicity
venous outflow obstruction, Budd Chiari

15

What is Budd Chiari syndrome?

Budd–Chiari syndrome is a condition caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites and liver enlargement. Examples of occlusion include thrombosis of hepatic veins.

16

_________ is severe diffuse liver injury involving most liver lobules and can be seen in acute liver failure, drugs, toxins, poisons, severe viral infection, and severe autoimmune hepatitis

massive necrosis

17

What etiologies can cause apoptosis in hepatocytes?

viral hepatitis, drugs

18

List the three leading causes of cirrhosis

alcohol
viral hepatitis
NAFLD

19

Describe the gross appearance of the liver in alcoholic steatosis

swollen, yellow, greasy

20

Describe the microscopic appearance of the liver in alcoholic steatosis

pure steatosis with no inflammation, most pronounced in zone 3

21

Describe the microscopic appearance of alcoholic steatoheptatitis

steatosis with neutrophilic inflammation
Mallory bodies- degenerating cytokeratin intermediate filaments

22

What sort of inflammatory infiltrate is seen in alcoholic steatohepatitis?

neutrophilic

23

Alcoholic cirrhosis is initially characterized by uniform _________

micronodular cirrhosis

24

List the clinical entities included within the category NAFLD

steatosis
NASH
Cirrhosis

25

Describe the inflammatory infiltrate in viral hepatitis

mixed but predominantly lymphocytes

26

Describe the histology of acute viral hepatitis

Mixed inflammation throughout the liver in parenchyma and portal tracts
Ballooning of hepatocytes
Apoptotic bodies

27

Describe the histology of chronic viral hepatits

Portal inflammation with lymphocyte predominance
Interface inflammation extending from periphery of portal tract into parenchyma
Ground glass hepatocytes in HBV
no ballooning

28

The ________ appearance of hepatocytes is characteristic of chronic HBV infection

ground glass

29

Describe the pattern of inflammation in chronic viral hepatitis

interface inflammation with lymphocyte predominance

30

Describe the pattern of inflammation in autoimmune hepatitis

plasma cells

31

Describe the histologic findings in hereditary hemochromatosis

brown iron pigment diffusely in all hepatocytes
increasing fibrosis or cirrhosis

32

How does iron damage hepatocytes

Direct hepatotoxin, causes free radical injury to hepatocytes

33

What other organs are affected by hereditary hemochromatosis?

pancreas
skin
myocardium
endocrine organs

34

In Wilson's disease, _______ levels are decreased

ceruloplasmin

35

How does alpha 1 antitrypsin deficiency cause liver damage?

PiZZ genotype
abnormally folded protein accumulates in hepatocytes leading to cell death, fibrosis, cirrhosis

36

What characteristic histologic feature is seen in A1AT deficiency

pink protein globules in hepatocytes, stain + for PAS

37

How does congestive heart failure lead to liver damage?

increased pressure in vena cava-->
increased pressure in hepatic veins-->
dilation of terminal hepatic vein and sinusoids (nutmeg liver)-->
pressure atrophy and necrosis of perivenular hepatocytes-->
perivenular fibrosis leading to cirrhosis

38

________ is due to infection of the biliary tree with enteric bacteria

ascending cholangitis

39

List signs and symptoms of biliary disease

cholestasis
pruritis
janudice
increases in ALKP, GGT, conjugated bilirubin

40

__________ antibodies are often seen in primary biliary cirrhosis

anti mitochondrial

41

Describe the pattern of inflammation in PBC

inflammation is centered on the bile dugs giving rise to florid bile duct lesions (lymphocytes and granulomas near bile duct)

42

Lymphocytic infiltration and formation of granulomas near the bile duct is characteristic of ______

primary biliary cirrhosis, PBC

43

Describe the findings in primary sclerosing cholangitis

segmental acute inflammation and periductal fibrosis
strictures and beading
onion skin lesions with periduductal concentric fibrosis

44

PSC is associated with an increased risk of:

cholangiocarcinoma

45

Histologic finding of onion skin lesions with periduductal concentric fibrosis is highly suggestive of:

Primary sclerosing cholangitis

46

Metastatic tumors of the liver are more common than primary liver tumors. What primary tumors most commonly metastasize to the liver

colon> lung> breast> pancreas> stomach

47

List the major etiologic agents associated with hepatocellular carcinoma

chronic HBV or HCV
chronic alcohol
NASH
Hereditary hemochromatosis
aflatoxin

48

Describe the histology of hepatocellular carcinoma

- well differentiated: cells arranged in trabeculae or cords or tubular acini
- poorly differentiated: cells arranged in sheets
- nuclei are larger, darker, atypical appearing

49

List etiologic risk factors for cholangiocarcinoma

PSC
liver fluke opisthorchis sinensis

50

Describe the microscopic appearance of cholagniocarcinoma

The carcinoma cells are arranged in tubules (acini) or are in solid nests or sheets.
They are associated with an intense fibrous stroma, called a desmoplastic response.

51

_________ invasion by malignant cells is common in cholangiocarcinoma

perineural

52

______ is a pediatric malignant neoplasm composed of epithelial cells

hepatoblastoma

53

_______ is a mesenchymal neoplasm of the liver formed by vascular channels lined by malignant endothelial cells

angiosarcoma

54

List risk factors for angiosarcoma

polyvinyl chloride
arsenic
thorotrast

55

_______ is a benign neoplasm of hepatocytes with a bland cytology and is common in young women on oral contraceptives or men using anabolic steroids

hepatic adenoma

56

CCL4 exposure is a risk for development of:

fatty liver and necrosis

57

nitrosamines in smoked foods are a risk factor for development of:

esophageal squamous cell carcinoma and some gastric adenocarcinomas