Liver Pathology Flashcards
(31 cards)
Zone for ischemic injury?
Bile duct gets blood from?
ITO cell hyperplasia from?
Zone 3 near central vein (blood goes from zone 1 to zone 3)
Hepatic artery
Hypervitaminosis A; leads to fibrosis and cirrhosis
Acetaminophen toxicy causes?
H and E?
Tx?
Fulmenant liver failure
Necrosis without inflammation in ZONE 3 (most C450 enzyme highest here); NAPQI is the toxic molecule
NAC
Acute inflammaiton happens where in liver?
Chronic hepatitis happens where?
Canallicular cholestatis only; common clinically in what scenario?
Ductual cholestatis (ducts with inspisated bile) think?
Lobule (lobular disarray)
Portal tracks/periportal
Estrogen and steroids in young men
Sepsis
EBV hepatitis you see?
Bridging fibrosis think?
Which Hepatitis is DNA?
What Hep casues HCC?
Lymphocytes in the Sinusoids
Autoimmune hepatitis
Hep B (other RNA)
B,C, D
Chronic hepatisis H and E?
Hep C genotype associated with steatosis?
Other causes?
“Blue portal tracts” and some steatosis
3
Hep B, C, D; Chronic autoimmune, emds, Wilson, Alpha-1 antitrypsin, Lymphoma
Ground glass hepatocyts, think?
Most common Autoimmune hepatitis?
Tx?
H and E?
Hepatitis B from proliferating endoplasic responding to HbsAg
Type 1 adults (P-ANCA); type 2 in kids (anti-LKM1)
Tx: Steroids
Portal inflammation, Zone 3 with inflammation (vs tylenol which has no inflammation)
A1-antitrypsin, gene?
See what clinical issues?
H and E?
PiM means?
Chr14; SERPINA1 gene; folding abnormality and doesn’t go into blood
Emphysema (can’t inhibit elsastase) and chronic liver disease
H and E: Periportal PAS-D globules adn hepatitic changes
PiM normal
PiS and PiZ common deficency alleals (Z lowest production)
PiZZ most severe
Hereditary Hemochromatosis gene, presentation?
H and E?
Special stain?
Auto recessive; HFE gene (C282Y–highest Fe Overload and H63D), Diabetes, skin pigmentation, cirrhosis
Hepatocytes around zone 1; vs blood transfusions show hemosidering in Kupfer cells
Prussian blue
Gene in Wilsons?
Copper is where in eyes?
Liver H and E?
Lab test?
Know EM has seperations and increased matrix and crystaline inclusions
ATP7B; copper transporter in Golgi
Descement membrame
Steatosis, hepatitis, glycongenated nuclei, Mallory hyaline, Copper by Rhodanine
Common low ceruloplasmin and increased urine copper
Bland cholestasis caused by what drugs?
Is periportal copper always Wilson’s?
Estrogen and anabolic steroids (intrahepatic only)
NO! Can be from biliary damage
What is primamry billiary cholangitis?
Antibody?
Elevated Ig?
H and E?
Autoimmune; loss of intrahepatic bile ducts; Mid age females; Puritis
Antimitochondrial antibody; some AMA negative
IgM vs IgG in autoimmune
Chronic cholestatis, florid bile duct lesion–lymphocytes, non-caseating granulomas, increased copper
Primary Schlerosis Choleangitis disease, population, Key association?
H and E?
ERCP picture?
Fibroinflammatory disease; intra and extrahepatic biliary tree; Males, UC 65%; risk cholangiosarcoma
Fibrous obliteration of bile ducts: Periductal fibrosis (onion skin) and Ductopenia (with proliferation and damage)
Beads on a string
Macrovesicular steatosis causes?
Obesity, diabetes, metabolic syndrome
Malnutrition, TPN
Alcohol
WIlson’s
Hep C
Micro vesicular steatosis causes?
Nuclei indented with fat vacuoles
Pregnancy (AFLD)
Reye’s
Drugs
Valproic acid
Mushrooms
Tetracycline
Where does steatohepatis start?
Stain Mallory-Denk bodies?
Drugs that make Mallory hyaline?
Zone 3:
Mallory-Denk bodies: p62+, ubiquitin; intermediate filaments metabolized by cytokeratin from injury
Amiodarone (granular hepatocytes with lysozome inclusions on EM); Methotrexate, Tamoxifen
Fibrin ring granuloma think?
Hydadid cyst, contact with?
Worry if contents spills?
Hydatid sand is?
Q-Fever, Coxiella burnetiil; fat globule, fibrin and granuloma
Sheep and dogs; Echinoccous Granulosis, Lamanated membrane GMS+
Anaplylaxis
Capsules, free scolices and loose hooklets
Non-zonal (geographic) necrosis think about?
Herpes (hemmorhage common) and Adenovirus (smudgy nuclei) are common
Zone prone to ischemia?
Gross?
Zone 3 coagulative necrosis without inflammation; some intralobulal bile duct damage possible
Nutmeg liver
Budd-Chiari is?
H and E?
Common clinical?
Suprahepatic vein outflow issues; Polycythemia vera, infections, malignancy
Sinusoidal dilation, congestion (RBCs), hemorrhage, hepatocyte atrophy
2-3 weeks post stem cell transplant from chemo
What is hepatoportal sclerosis?
DDx?
Central vein abnormally close to portal areas; Portal fibrosis with portal vein narrowing or obliteraiton
Portal vein thrombosis
What is nodular regenerative hyperplasia?
Disease associations?
Does it cause portal hypertension?
Nodules in parenchyma; Trichrome negative; reticulin highlights nodules
Rheumatologic, PV, lymphoma, azathioprine
Yes! Reticulin shows compressed portal between nodules, variable hepatocyte sizes
What is a hepatic adenoma?
Associated with?
Reticulin and CD34 staining?
Tx?
Solitary, well circumscribed, non cirrhotic, Benign hepatocytes (1-2 layers thick); clear cell glycogen chagnes; NO PROTAL TRIADS just naked arteries
Oral contraceptives
Intact reticulin, CD34 increased
Tx: Surgery, malignant rare
What type of hepetic adenoma has HCC risk?
IHC?
B-Catenin; 10% of adenomas, cytologic atypia present
IHC: Beta-catenin and diffuse glutamine synthetase (Staining pattern similar to HCC; not useful)
Two liver lesions with scar?
FNH, population?
H and E?
IHC?
Fibrolamellar carcinoma and focal nodular hyperplasia
Women 3rd-4th decade and kids txed for malignancy; Not associated with OCP
Non-cirrhotic, Hepatocytes divided into nodules but hick walled arteries (at edges) in fibrous septate, ductular reaction at junction
Map like glutamine synthetase (spared around scar and septae)
