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Gastroenterology > Liver Pathology > Flashcards

Liver Pathology Flashcards

(45 cards)

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1
Q

Reye syndrome is associated with…that has been treated with…

A

Viral infection (especially VZV and influenza B); aspirin

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2
Q

What is the mechanism by which aspirin treatment lead to microvesicular fatty liver change in pts with Reye syndrome?

A

Aspirin metabolites decreased beta-oxidation of fatty acids by reversible inhibition of mitochondrial enzymes.

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3
Q

Aspirin should be avoided in children, except in those with…

A

Kawasaki disease.

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4
Q

What is Reye syndrome?

A

Rare, often fatal childhood hepatic encephalopathy.

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5
Q

Macrovesicular fatty liver change that may be reversible with alcohol cessation is known as…

A

Hepatic steatosis

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6
Q

Describe the histopathology observed in alcoholic hepatitis.

A

Swollen and necrotic hepatocytes with neutrophilic infiltration. Liver biopsy reveals Mallory bodies.

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7
Q

What are Mallory bodies?

A

Intracytoplasmic eosinophilic inclusions of damaged keratin filaments

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8
Q

Development of alcoholic hepatitis requires…

A

Sustained, long-term alcohol consumption.

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9
Q

Describe the gross and histologic pathology seen in alcoholic cirrhosis.

A

Gross findings: micronodular, irregularly shrunken liver with “hobnail” appearance

Histologic findings: sclerosis around central vein (zone III)

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10
Q

Describe the pathogenesis of non-alcoholic fatty liver disease.

A

Metabolic syndrome (insulin resistance) leads to fatty infiltration of hepatocytes, which results in cellular “ballooning” and eventual necrosis.

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11
Q

Non-alcoholic fatty liver disease may cause…

A

Cirrhosis and HCC.

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12
Q

In non-alcoholic fatty liver disease, ALT levels are…

A

Greater than AST levels.

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13
Q

Describe the pathogenesis of hepatic encephalopathy due to cirrhosis.

A

Cirrhosis –> portosystemic shunts –> decreased NH3 metabolism –> neuropsychiatric dysfunction

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14
Q

Triggers of hepatic encephalopathy

A
  1. Increased NH3 production and absorption (due to dietary protein, GI bleed, constipation, infection)
  2. Decreased NH3 removal (due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS)
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15
Q

Treatment of hepatic encephalopathy

A
  1. Lactulose (increases NH4+ generation)

2. Rifaximin (decreases NH3 production)

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16
Q

Most common primary malignant tumor of liver in adults.

A

HCC, also known as hepatoma

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17
Q

HHC is associated with…

A

HBV infection (+/- cirrhosis) and all other causes of cirrhosis (including HCV, alcoholic and non-alcoholic fatty liver disease, autoimmune disease, hemochromatosis, alpha1-antitrypsin deficiency, Wilson disease) and specific carcinogens (e.g., aflatoxin from Aspergillus).

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18
Q

HHC may lead to…

A

Budd-Chiari syndrome.

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19
Q

Describe the pathogenesis of Budd-Chiari syndrome.

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A

Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis –> congestive liver disease (hepatomegaly, varices, abdominal pain, eventual liver failure)

20
Q

A specific clinical finding that aids in the diagnosis of Budd-Chiari syndrome.

Study These Flashcards
A

Absence of JVD.

21
Q

Budd-Chiari syndrome is associated with…

Study These Flashcards
A
  1. Hypercoagulable states
  2. Polycythemia vera
  3. Postpartum state
  4. HCC
22
Q

Clinical findings in HCC

Study These Flashcards
A
  1. Jaundice
  2. Tender hepatomegaly
  3. Ascites
  4. Polycythemia
  5. Anorexia
23
Q

HCC spreads…

Study These Flashcards
A

hematogenously.

24
Q

Diagnosis of HCC is made by:

Study These Flashcards
A
  1. Increased alpha-fetoprotein
  2. Ultrasound or contrast CT/MRI
  3. Biopsy
25
Why is biopsy of cavernous hemangioma contraindicated?
B/c of risk of hemorrhage.
26
Common, benign liver tumor consisting of a collection of dilated blood vessels
Cavernous hemangioma -- typically occurs at age 30-50
27
Rare, benign liver tumor that is often related to oral contraceptive or anabolic steroid use
Hepatic adenoma -- may regress spontaneously or rupture, producing abdominal pain and shock
28
Malignant tumor of endothelial origin that is associated with exposure to arsenic and vinyl chloride
Angiosarcoma
29
Most common liver tumors
Metastases of GI, breast, and lung cancers
30
Describe the pathogenesis of alpha1-antitrypsin deficiency as it pertains to 1) the liver and 2) the lungs.
1) Misfolded alpha1-antitrypsin protein aggregates in hepatocellular ER --> cirrhosis with PAS + globules in liver 2) In the lungs, decreased alpha1-antitrypsin --> uninhibited elastase in alveoli --> decreased elastic tissue --> panacinar emphysema
31
Clinical findings in Reye syndrome
1. Mitochondrial abnormalities 2. Fatty liver (microvesicular fatty change) 3. Hypoglycemia 4. Vomiting 5. Hepatomegaly 6. Coma
32
Causes of unconjugated (indirect) hyperbilirubinemia
1. Hemolytic 2. Physiologic (newborns) 3. Crigler-Najjar syndrome 4. Gilbert syndrome
33
Causes of conjugated (direct) hyperbilirubinemia
1. Biliary tract obstruction: gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke 2. Biliary tract disease: primary sclerosing cholangitis, primary biliary cirrhosis 3. Excretion defect: Dubin-Johnson syndrome, Rotor syndrome
34
Causes of mixed (direct and indirect) hyperbilirubinemia
1. Hepatitis | 2. Cirrhosis
35
Describe the pathogenesis of physiologic neonatal jaundice.
At birth, immature UDP-glucuronosyltransferase --> unconjugated hyperbilirubinemia --> jaundice/kernicterus
36
What is kernicterus?
Bilirubin deposition in the neonatal brain, particularly in the basal ganglia
37
Treatment for physiologic neonatal jaundice
Phototherapy (converts unconjugated bilirubin to water-soluble form)
38
Syndrome characterized by mildly decreased UDP-glucuronosyltransferase conjugation and impaired bilirubin uptake.
Gilbert syndrome -- often asymptomatic, but may cause mild jaundice
39
In patients with Gilbert syndrome, indirect bilirubin levels increase with...
Fasting and stress.
40
Gilbert syndrome is characterized clinically by...
Increased unconjugated bilirubin levels without overt hemolysis.
41
Syndrome characterized by absence of UDP-glucuronosyltransferase.
Crigler-Najjar syndrome, type I
42
Clinical findings in Crigler-Najjar syndrome, type I
Jaundice, kernicterus (bilirubin deposition in brain), increased unconjugated bilirubin
43
Treatment for Crigler-Najjar syndrome, type I
Plasmapheresis and phototherapy
44
Crigler-Najjar syndrome, type II is...and responds to...
Less severe than type I; phenobarbital, which increases liver enzyme synthesis
45
Syndrome characterized by conjugated hyperbilirubinemia due to defective liver excretion. Liver appears grossly black.
Dubin-Johnson syndrome -- benign condition

Gastroenterology (6 decks)

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