Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI II Block 2 > Liver Pathology > Flashcards

Liver Pathology Flashcards

(46 cards)

Start Studying
1
Q

Reversible Changes to Hepatocytes (2)

A

Steatosis: accumulation of fat

Cholestasis: accumulation of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Irreversible Damage to Hepatocytes Descriptions
Necrosis: Process (2) and Types (2)
Apoptosis: Process (3) and Morphology

A

Necrosis:
Response to oxidative stress, death due to ischemia
Cells die via lysis due to swelling from osmosis disruption
Confluent happens around Central V
Bridging connects 2 or more lobules

Apoptosis:
Pyknosis (shrinking), Karyorrhexis (fragmentation) and Apoptotic body formation
Acidophil bodies called Councilman bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Liver Scar Formation

Principal Cell Description and Pathogenesis (3)

A

Myofibroblastic hepatic stellate cells

Stellate cells release PDGFR-beta
Kupffer cells release TGF-beta, MMPR2, TIMP1/2
Fibrous septa formed where parenchyma is lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Tests for Hepatocytes
Integrity Tests (3) and Synthetic Functioning Tests (3)
A

ALT
AST
LDH (Lactate dehydrogenase)

Serum albumin
Coagulation factors
Serum ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
Tests for Biliary System
Excretory Function (3) and Canaliculi Damage (2)
A

Serum bilirubin
Urine bilirubin
Serum bile acids

Serum ALP
Serum GGT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute Liver Failure

Timeline, Causes (8), Clinical Features (6), Labs (3)

A

Failure happens within 26 weeks of initial injury

Massive hepatic necrosis from:
Acetaminophen/Hep A/Autoimmune Hepatitis
Hep B
Hep C
Hep D
Hep E/Esoteric (WIlson's, Budd Chiari)
N/V and jaundice followed by:
Encephalopathy (Asterixis)**
Coagulopathy**
Portal HTN
Hepatorenal Syndrome

Elevated conjugated bilirubin
Elevated ALT/AST
Elevated IgM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chronic Liver Failure

Causes (4), Symptoms/Signs (7) and Association

A

Alcoholic liver disease
Hep B
Hep C
Nonalcoholic liver disease

Spider Telangiectasias
Palmar erythema
Hypogonadism
Gynecomastia
Pruritis
Dupuytren's Contracture
Asterixis and Coagulopathies

Often associated with Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Liver Cirrhosis

Description, Child Pugh Classifications (3), Sequelae (6)

A

Diffuse transformation of liver into regenerative parenchymal nodules surrounded by fibrous bands

Class A: Well compensated
Class B: Partially compensated, with varices
Class C: Decompensated

Chronic liver failure
Intrahepatic Portal HTN (most common cause)
Ascites
Splenomegaly
Esophageal Varices
Encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
Hep A Virus
Clinical Features (4), Transmission, Diagnosis (2)
A

Benign process that doesn’t produce chronic hepatitis
Smoking aversion
Elevated ALT/AST
Elevated Bilirubin/ALP (cholestasis)

Fecal-oral transmission

anti-HAV IgM if active infection
anti-HAV IgG shows immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q 
Hep B Virus
Clinical Features (3) Disease Associations (2) Transmission (3), Diagnosis (5), Morphology
A

Smoking Aversion
Elevated ALT/AST
Can progress to chronic

Polyarteritis nodosa
Risk of Hepatocellular carcinoma if chronic

Parenteral, sexual or perinatal transmission

HBsAg seen in infected people
HBsAb seen in immunized or prior infected
HBcAb IgM if Acute infection
HBcAb IgG if Chronic infection
HBeAg shows infectivity (actively replicating)

Ground glass hepatocytes with HBsAg
(diagnostic for chronic HBV)

*HBcAb IgM is the only (+) lab finding during the window period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q 
Hep C Virus
Clinical Features (5) Disease Associations (3) Transmission, Diagnosis (2), Morphology (2)
A

Generally asymptomatic but persistent infection
Fluctuating levels of AST/ALT
Decreased serum cholesterol
Mixed Cryoglobulinemia
Most progress to chronic and show cirrhosis

Metabolic syndrome
Coinfection with HIV
Risk of Hepatocellular carcinoma

Blood transmission (IVDU, Intranasal DU, Fighters)

HCV RNA PCR during active
anti-HCV Ab if immune

Lymphoid aggregates or lymphoid follicles
Scattered steatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Hepatitis D Virus
Clinical Features (4), Transmission, Diagnosis (2)
A

Seen either as a coinfection or superinfection of Hep B
Superinfections more likely to progress to chronic
Higher rate of acute liver failure if IVDU
Hep B vaccine also prevents Hep D

Parenteral transmission

Serum HDV IgM/IgG**
Serum HDV RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
Hepatitis E Virus
Clinical Features (3), Transmission, Diagnosis (2)
A

Seen in immunocompromised patients
Only progresses to chronic if treated with Tacrolimus
Causes fulminant hepatitis in pregnant women

Fecal-oral transmission (via pigs)

anti-HEV IgG/IgM
PCR for HEV RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Autoimmune Hepatitis Type 1 vs Type 2

Population and Antibody

A

Type 1
Adults
anti-Smooth Muscle Abs

Type 2
Kids and Teenagers
anti-LKM1 Abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Autoimmune Hepatitis

Morphology (3), Clinical Features (4) and Treatment

A

Mononuclear infiltrate of plasma cells
Hepatocyte rosettes in inflammatory regions
Eventual cirrhosis with little inflammatory activity

HLA DRB1 association
Female predominance
Acute fulminant hepatitis
Hepatic encephalopathy

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acetaminophen-Induced Hepatitis

Pathogenesis (2) Morphology and Clinical Features (2)

A

**Most common heptotoxin in acute liver failure
Toxic metabolite from CYTP450 in Zone 3 acinar cells

Causes massive hepatocellular necrosis

Rumack Matthew Nomogram for severity of toxicity
N-acetylcysteine used as antidote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Toxin-Induced Hepatitis Morphology

Anabolic Steroids and Aspirin

A

Steroids:
Bland hepatocellular cholestasis without inflammation

Aspirin:
Microvascular steatosis (diffuse small droplet fat)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Agents that Cause Hepatic Neoplasia

Adenoma (2), Carcinoma (2), Cholangiocarcinoma (1) and Angiosarcoma (3)

A

Hepatocellular Adenoma:
Oral contraceptives, Anabolic steroids

Hepatocellular carcinoma:
Alcohol, Thorotrast

Cholangiocarcinoma:
Thorotrast

Angiosarcoma:
Thorotrast, Vinyl chloride, Arsenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Steatosis

Pathogenesis (3), Morphology and Clinical Features (3)

Study These Flashcards
A

Upregulation of lipid generation, dysfunction of lipoprotein synthesis and peripheral fat catabolism

Microvesicular lipid droplets within hepatocytes

Hepatomegaly
Mildly elevated ALP and Bilirubin

20
Q

Steatohepatitis

Pathogenesis (3), Morphology (3) and Clinical Features (4)

Study These Flashcards
A

Acetaldehyde induces lipid peroxidation and protein adduct formation
Induces CYTP450 which creates ROS
Inhibits methionine metabolism which decreases glutathione that is ROS protective

Hepatocyte swelling and necrosis
Mallory-Denk Bodies (damaged intermediate filaments)
Cytokeratin within Hepatocytes

Tender hepatomegaly
Hyperbilirubinemia
AST:ALT is 2:1
Elevated ALP

21
Q

Alcoholic Liver Disease (Steatofibrosis)

Pathogenesis (4) Morphology (2) and Clinical Features (2)

Study These Flashcards
A

Chronic disorder of steatosis, hepatitis, progressive fibrosis and deranged perfusion

Chicken wire fence pattern of scarring
Laennec cirrhosis signals end stage ALD

Hypoproteinemia
Coagulation abnormalities

22
Q

Metabolic Syndrome Criteria (8)

Study These Flashcards
A 
One of:
Diabetes Mellitus or
Impaired glucose tolerance or
Impaired fasting glucose or
Insulin resistance

And two of:
BP > 140/90
Dyslipidemia
Central obesity
Microalbuminuria
23
Q

Nonalcoholic Fatty Liver Disease

Pathogenesis (3), Risk Factors (4) Morphology (4) and Clinical Features (3)

Study These Flashcards
A

Insulin resistance leading to hepatic steatosis
Hepatocellular oxidative injury leading to necrosis and inflammation

Diabetes
Obesity
Hypertriglyceridemia
Hispanic ethnicity

Pathologic steatosis
Mononuclear cell infiltrates
Portal fibrosis
Some mallory denk bodies

RUQ pain
Mildly elevated AST/ALT
Death via cardiovascular event

24
Q

Hemochromatosis

Pathogenesis (3), Morphology (3), Clinical Features (5), Treatment (2)

Study These Flashcards
A

HFE gene mutation alters hepcidin functioning
Increased intestinal iron absorption
Iron deposition causes lipid peroxidation and DNA damage

Shrunken liver with micronodular cirrhosis
Golden-yellow hemosiderin granules on liver
Pigmented pancreas/heart

Cirrhosis with Hepatomegaly
Gray-slate skin color
Diabetes
Cardiac dysfunction
Increased risk of hepatocellular carcinoma

Weekly phlebotomy
Deferoxamine

25
Wilson Disease | Pathogenesis (3), Morphology (3) Clinical Features (5) and Treatment
Autosomal recessive ATP7B mutation Decreased copper secretion via cerruloplasmin Toxic liver damage via ROS Mallory-Denk bodies Basal ganglia atrophy/cavitation Kayser-Fleischer rings ``` Elevated urine copper Decreased plasma cerruloplasmin Movement disorders/Rigid dystonia Psychiatric symptoms Hemolytic anemia causing elevated bilirubin ``` Penicillamine
26
alpha-1 Antitrypsin Deficiency | Pathogenesis (3), Morphology (2) and Clinical Features (3)
Autosomal recessive PiMM/PiZZ defect Causes AAT to be trapped in endoplasmic reticulum ER stress leads to hepatocyte apoptosis PAS (+) periportal hepatocytes with globular cytoplasmic inclusions Panacinar emphysema Cirrhosis/Cholestasis Neonatal hepatitis
27
Unconjugated Hyperbilirubinemia Etiologies (6)
``` Hemolytic Anemia Ineffective erythropoiesis (Pernicious anemia) Crigler-Najjar Syndrome Gilbert Syndrome Hepatitis Physiologic Jaundice of the Newborn ```
28
Conjugated Hyperbilirubinemia Etiologies (4)
Dubin-Johnson Syndrome Rotor Syndrome Bile duct obstruction Autoimmune cholangiopathy
29
Crigler-Najjar Syndrome | Types (2) with Defect and Clinical Course
Type 1 Autosomal Recessive absence of UGT1A1 Neonatal fatality Type 2 Autosomal Dominant decrease in UGT1A1 Mild clinical course, occasional kernicterus
30
Dubin-Johnson Syndrome | Pathogenesis (2) and Morphology
Autosomal recessive MRP2 gene defect Causes impaired bilirubin glucuronides secretion Pigmented cytoplasmic globules makes liver black
31
Cholestasis | Definition, Symptoms (4) and Labs (3)
Impaired bile formation/flow from obstruction or defective secretion causing bile pigment to accumulate Jaundice Pruritis Xanthomas Malabsorption and Vit ADEK deficiency Elevated gamma-glutamyl transferase (GGT)** Elevated ALP Normal AST/ALT
32
Primary Biliary Cirrhosis (AI Cholangiopathy) | Demographic, Disease Associations (2), Serology (2), Morphology (2), Clinical Features (2)
Middle aged women Sjogren's syndrome Hashimoto Thyroiditis anti-Mitochondrial Ab Positive ANA Positive Florid duct lesions with loss of small ducts only Mallory-Denk bodies Isolated increased ALP Hypercholesterolemia causing Xanthelasmas
33
Primary Sclerosing Cholangitis (AI Cholangiopathy) | Demographic, Disease Association, Complication, Serology, Morphology (2), Presentation (4)
Men in their 30s Ulcerative colitis Cholangiocarcinoma May be ANCA positive Strictures and beading of large bile ducts (Beads on a string on ERCP) Onion skin fibrosis of smaller ducts (biopsy) Jaundice Pruritis Elevated ALP and Conjugated Bilirubin
34
Biliary Tree Cystic Abnormality Descriptions | Choledochal (2) and Fibropolycystic (4)
Choledochal cysts: Congenital dilations of common bile duct Present in kids with jaundice and biliary colic Fibropolycystic Disease: Congenital malformations of biliary tree Von Meyenburg Complexes: hamartomatous cysts Caroli Disease: simple cysts Caroli Syndrome: Congenital Hepatic Fibrosis
35
Intrahepatic Flow Disorders | Etiologies (2) and Clinical Manifestations (4)
Cirrhosis, Sinusoidal occlusion Ascites, Varices, Hepatomegaly, Increased AST/ALT
36
Preeclampsia and Eclampsia | Clinical Features of Each (4/2) and Subclinical Features (3)
``` Preeclampsia: Maternal HTN Proteinuria Peripheral edema Coagulation abnormalities ``` Eclampsia: Hyperrelfexia (clonus) Convulsions HELLP Syndrome: Hemolysis Elevated liver enzymes Low platelet count
37
``` Acute Fatty Liver Disease of Pregnancy Clinical Features (2) Morphology and Treatment ```
Presents in 3rd trimester with symptoms of liver failure Elevated AST/ALT Characteristic diffuse microvesicular steatosis of hepatocytes Treat with pregnancy termination
38
Focal Nodular Hyperplasia | Etiology, Prognosis, Morphology (2)
Spontaneous lesion in otherwise normal liver Benign Single well demarcated lesion Central stellate scar
39
Nodular Regenerative Hyperplasia | Associations (2), Prognosis (2) and Morphology (2)
HIV and Autoimmune Disease Benign but can lead to Portal HTN ``` Plump hepatocytes surrounded by atrophic hepatocytes Multiple nodules (like cirrhosis without fibrous septa) ```
40
Hepatocellular Adenomas Clinical Features (2) Types with Risk for Malignancy (3)
Incidentally discovered, present with some pain Associated with anabolic steroid and oral contraceptives HNF1-alpha Activated: No risk, completely benign Inflammatory Adenomas: Small but definite risk of malignancy Beta-catenin Activated: Very high risk for malignancy
41
Hepatoblastoma | Genetics (2), Morphology Types (2) and Clinical Features (3)
APC gene mutation WNT pathway activation Epithelial Type: Polygonal fetal or embryonal cells Mixed Type: Mesenchymal foci of osteoid, cartilage and striated muscle Most common liver tumor in kids Associated with FAP and Beckwith-Wiedemann Syndrome
42
Hepatocellular Carcinoma | Genetics (2), Clinical Features (3), Risk Factors (4)
``` Beta-catenin activation p53 activation (by aflatoxin) ``` Hepatomegaly Elevated alpha-fetoprotein (AFP) Death via cachexia, bleeding, liver failure Aflatoxin (Aspergillus) HBV in Asia HCV in US Any condition causing cirrhosis
43
``` Hepatocellular Carcinoma Precursor Characteristics High Grade (3), Low Grade (2), Large Change (2), Small Change (2) ```
High Grade Dysplasia: Cellular Atypia Definitely Premalignant Viral hepatitis and Alcoholic liver disease pathway Low Grade Dysplasia: Clonal but lacking sign of atypia Maybe Premalignant Large Cell Change: Large scattered hepatocytes with normal cytoplasm ratio Premalignant in HBV Small Cell Change: High cytoplasm ratio with nuclear hyperchromasia Definitely Premalignant
44
Hepatic Lymphoma | Population, Associations (4) and Cancer Course (2)
Middle aged men HBV HCV HIV Primary Biliary Cirrhosis Diffuse Large B cell Lymphomas followed by MALTomas
45
Cholangiocarcinoma Morphology (2), Risk Factors (3), Precursor Lesion Clinical Features of Intrahepatic (2) and Extrahepatic (3)
Adenocarcinomas that incite desmoplasia Perihilar (Klatskin) tumors are hepatic duct junction Liver flukes in Southeast Asia Primary sclerosing cholangitis Cholelithiasis Biliary Intraepithelial Neoplasia Intrahepatic: Obstruction to bile flow Symtpomatic liver mass Extrahepatic: RUQ pain Biliary obstruction Cholangitis
46
Sites of Tumors that Metastasize to Liver (5)
``` Colon* Breast* Lung* Pancreas* Melanoma ``` Secondary liver tumors far more common than primary *=most common sites

GI II Block 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions