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Flashcards in More f@$%# liver. Deck (61):
1

What causes HELP syndrome?

A rare complication of eclampsia in preganancy

Hemolysis
Elevated liver enzymes
Low
Platelets

2

What is acute fatty liver of pregnancy?

Disorder that occurs in preganancy>
ACUTE onset of LIVER DYSFXN (severe> acute hepatic failure/death)

3

What is seen on a liver biopsy of a pt with acute fatty liver of pregnancy?

microvesicular steatosis

4

What is intrahepatic cholestasis of pregnancy?

Estrogenic hormones and biliary secretory defects>
mild increase in serum conjugated bilirubin>
slightly increased risk of:
fetal distress
still births
prematurity

5

What 3 liver abnormalities can occur in pts receiving a bone marrow transplant?

1. Drug toxicity
2. sinusoidal obstruction syndrome
3. graft vs host disease (portal inflammation> vanishing bile ducts w/ fibrosis and cirrhosis)

6

What type of liver abnormalities can occur in pts receiving a liver transplant?

1. Preservation injury (oxygen radicals in hypoxic organ> damage sinusoid)

2. anastomatic problems

3. Rejection (acute or chronic)

7

What is the MC benign neoplasm of the liver?

Hemangioma

8

What is a lesion of DISCRETE RED BLUE HEMORRHAGIC NODULES composed of DILATED endothelial lined BLOOD FILLED channels that is often accidentially found?

Hemangioma

9

What is a simple liver cyst?

Single/small cluster of cysts

composed of atrophic BILIARYepithelium

10

What is polycystic liver disease?

multiple cysts assocaited w/ polycystic kidney disease

11

What is a choledochal cyst?

CONGENITAL dilation of the common BILE DUCT

12

What complications are associated w/ choledochal cysts?

Dilated common bile duct>

1. biliary obstruction
2. stones
3. bile duct carcinoma

13

What is Caroli's disease?

congenital disorder>
intrahepatic biliary dilations>
1. congenital hepatic fibrosis
2. increases risk of cholangiocarcinoma

14

What is congenital hepatic fibrosis?

AR
non cirrhotic fibrotic liver disease of children

Assoc w/ PCKD
Increases risk of cholangiocarcinoma

15

What is focal nodular hyperplasia?

Localized vascular occlusive event>
Proliferation of liver parenchyma (CV, hepatocytes, portal triads)>
WELL DEMARCATED lesion
NOT malignant

16

What is nodular regenerative hyperplasia?

diffuse NONfibrosing hyperplasia of the liver

*pts are usually assumptomatic

17

What may be seen on angiography of focal nodular hyperplasia?

Peripheral filling pattern w/ central scar

18

What is a key complication of nodular regenerative hyperplasia?

Often assocaited w/ conditions that affect intrahepatic blood flow:
1. solid organ transplant
2. bone marrow transplant
3. vasculitis

19

A young adult is asymptomatic but pathology of the liver reveals a mass w/ CENTRAL FIBROUS scar and STELLATE configuration.

Dx?

Focal nodular hyperplasia

20

What is hepatocellular adenoma?

well circumscribed BENIGN neoplasm composed of well differentiated hepatocytes>
hemorrhagic necrosis>
massive bleed

21

What population commonly gets hepatocellular adenomas?

Young reproductive age women

Assoc: OCP w/ high estrogen and anabolic steroids

22

What is the difference between a bile duct hamartoma and a bile duct adenoma?

hamartoma- MULTIPLE small white nodules

adenoma- SOLITARY, benign proliferation of bile ducts

23

Describe a CT image finding of a malignancy metastatic to the liver.

Multiple hepatic metasteses
solitary liver mass

24

How are metastatic tumors diagnosed?

Usually multiple tumors
from carcinomas of the:
lung
GI tract
breast
and pancreas

25

What are the RF for hepatocellular carcinoma?

1. hepatotrophic viruses (HBV, HCV)
2. hepatocarcinogens (toxin)
3. Cirrhosis (EtOH)

*chronic liver diseases

26

Grossly, _____________, appears as a diffusely infiltrative, SOFT and HEMORRHAGIC, solitary mass or multiple nodules.

HCC

27

How does the occurance of HCC in the US compare to that in SE Asia/Africa?

US- age 60, 80-95% assoc. w/ CIRRHOSIS

Africa/SE Asia- age 20-40, endemic HBV

28

What procedure can be used to screen for HCC?

High resolution US or CT

HIGH risk (cirrhosis/HBV) screen every 6 mos w/ liver US

29

How does fibrolamellar HCC differ from typical HCC?

Occurs in YOUNG adults w/ cirrhosis or chronic hepatitis, but has a BETTER prognosis than typical HCC

30

What is the characteristic microscopic appearance of fibrolamellar HCC?

POLYGONAL oncoytic tumor cells in
NESTS and CORDS
separated by
LAMEALLAR FIBROUS STROMA

31

What is a cholangiocarcinoma?

carcinoma arising from INTRA or EXTRA hepatic bile ducts

**ALWAYS adenocarcinoma

32

What are some RF for intrahepatic cholangiocarcinoma?

>60
NO pre-existing conditions

1. chronic cholangitis
2. chronic HBV/HCV

33

What do you have to exclue before you can make a dx of intrahepatic cholangiocarcinoma?

metastases

34

What is a hepatoblastoma?

Rare tumor that occurs in infants or <3 children

Malignancy of imm. hepatocytes

35

What is an angiosarcoma of hte liver?

AGGRESSIVE
malignancy of endothelial cells>
tumor of anastomosing vascular channels lined by malignant endothelial cells

36

What cancer is associated w/ exposure to thorotrast, vinyl chloride and arsenic?

angiocarcinioma

37

What is a phrygian cap?

FUNDUS of gallbladder is FOLDED

38

What are the RF for the formation of a cholesterol gall stone?

N european, N/S american heritage
+ fam hx

FORTY, FAT, FEMALE, FERTILE

39

What are hte RF for the formation of pigment gall stone?

E asian
+ fam hx
Increased hemolysis
increased biliary tract infections

40

What imaging modality is used to detect gall stones?

Ultrasound

41

What are some complications of gallstones?

1. biliary colic (pain w/ a fatty meal)
2. acute cholecystitis
3. chronic cholecystitis
4. choledocholithiasis= stones in common bile duct
5. ascneding cholangitis (bacterial infxn of intrahepatic BD)

42

What are complications of acute cholecystitis?

Perforation
bile peritonitis
acute cholanitis
sepsis
biliary enteric fistula
gallstone ileus

43

What is choledocholithiasis?

stones in the common bile duct

44

What is the MCC of extrahepatic biliary obstruction?

stones in common bile duct

45

Are most gallstones symptomatic?

NO

70-80% are asymptomatic

46

What is chronic cholecystitis?

chronic inflamm. of the GB is almost always asssociated w/ cholelithiasis (stone obstruction)

Often caused by SUPERSATURATED BILE> chronic inflammation and formation of stones

47

What is a porcelain gallbladder?

dystrophic calcification of gallbladder wall

48

What is the gross appearance of cholesterolosis?

yellow mucosal flecks

49

What is the gross appearance of cholesterol polyps?

yellow small polyps

50

What is the gross appearance of mucocele?

distended GB w/ atrophic wall

51

What is an adenoma of hte GB?

BENIGN NEOPLASM

52

What is an adenomyoma of the GB?

gallbaldder diverticulae w/ focal muscular hypertrophy>
intramural thickening of the fundic wall

*usually located at hte fundus

53

Is an adenoma or adenomyoma neoplastic?

adenoma is a BENIGN neoplasm

adenomyoma is NOT a true neoplasm

54

What is a RF for GB carcinoma?

>50
Female
cholelithiasis (irrative trauma, chronic inflamm)

55

Why is the survival rate for carcinoma of the GB so low?

SILENT TUMOR

by the time sxs appear has usually spread to liver or LN

56

What are the 3 types of cholangiocarcinomas?

1. Intrahepatic (LC)
2. Extrahepatic (MC)
3. Distral extraheaptic

57

What other name is sometimes used for perihilar cholangiocarcinoma?

Extrahepatic (MC)

58

What is periampullary carcinoma?

from upper border of pancreas to ampulla

59

What are some RF for extrahepatic cholangiocarcinoma?

conditions> chronic cholangitis
1. liver fluke infxn
2. PSC
3. choledochal cysts
4. stones

60

What is the clinical presentation and lab findings of extrahepatic cholangiocarcinoma? Is it similar to that seen in carcinoma of the head of hte pancreas?

Painless jaundice secondary to obstruction

increased ALP/GGT

61

Why is the prognosis poor for extrahepatic cholangiocarcinoma and better for periampullary carcinoma?

prognosis is VERY POOR...idk why prognosis is better for the other guys