Path: Liver

Question 0

What are the 2 main complications from fibrosis of the liver?

Answer 0

(1) Impedes the synthetic and clearing functions of the liver.
(2) Increases resistance in the liver leading to portal hypertension.

Question 1

What are the stages of fibrosis that lead to cirrhosis?

Answer 1

(1) expansion
(2) formation of septae
(3) bridging of septae
(4) cirrhosis

Question 2

What is AST?

Answer 2

Aspartate aminotransferase.

Question 3

What is ALT?

Answer 3

Alanine aminotransferase.

Question 4

What is GGT?

Answer 4

Gamma-glutamyl transpeptidase.

Question 5

Where is ALT produced?

Answer 5

The liver predominantly.

Question 6

Where is AST produced?

Answer 6

Liver, muscle, kidney, heart.

Question 7

Where is AST most present in the hepatocyte?

Answer 7

The cytoplasm and mitochondria.

Question 8

Where is ALT most present in the hepatocyte?

Answer 8

The cytoplasm.

Question 9

What enzyme is most aberrantly elevated in hepatitis?

Answer 9

ALT.

Question 10

What enzyme is most aberrantly elevated in alcohol-induced liver disease?

Answer 10

AST.

Question 11

J: This process is responsible for elevated LFTs after hepatocyte injury.

Answer 11

What is cytoplasmic blebbing?

Question 12

What is unique about the caudate lobe as compared to the other lobes of the liver?

Answer 12

It has direct venous drainage into the inferior vena cava.

Question 13

In the event of venous outflow obstruction in the liver, which zone will show the earliest signs of congestion?

Answer 13

Zone 3.

Question 14

What is the course of chronic Budd-Chiari?

Answer 14

(1) The hepatic veins become obstructed.
(2) The non-caudate lobes of the liver become congested and enlarged.
(3) These lobes eventually become fibrotic and atrophy.
(4) To compensate for this functional loss, the caudate lobe undergoes hypertrophy.

Question 15

What are the initial effects of a hepatic portal vein thrombosis?

Answer 15

Likely nothing. (The spleen may become enlarged.)

Question 16

What are the long-term effects of a hepatic portal vein thrombosis?

Answer 16

Remodeling and fibrosis may lead to an obliteration of the portal vein and portal hypertension.

Question 17

What is the most common cause of portal hypertension worldwide?

Answer 17

Schistosomiasis.

Question 18

What are consequences of obstruction of the hepatic artery?

Answer 18

Bile duct infarction followed by a biloma, a large lesion consisting of spreading biliary contents and necrotic material.

Question 19

Why is the hepatic bile duct more prone to infarction?

Answer 19

It only receives blood from the hepatic artery.

Question 20

What is a hepatitic pattern of liver injury?

Answer 20

(1) The portal tracts become infiltrated by lymphocytes and plasma cells.
(2) This infiltrate can spill over into neighboring hepatocytes leading to a sparse lymphocytic infiltrate in the lobules.
(3) ALT and AST become elevated, whereas alkaline phosphatase, GGT, and bilirubin are normal.
(4) Hepatocytes may undergo Fas-mediated apoptosis.

Question 21

In the liver, what is a limiting plate?

Answer 21

The hepatocytes at the junction of the portal tract and the parenchyma.

Question 22

Is hepatitis C a DNA or RNA virus?

Answer 22

RNA.

Question 23

What percentage of individuals with hepatitis C develop chronic hepatitis?

Answer 23

85%.

Question 24

Which zone in the liver is most likely to be damaged in acetaminophen toxicity? Why?

Answer 24

Zone 3. The metabolic product, NAPQI, is the toxic element and P450 metabolism occurs predominantly in this zone.

Question 25

What is the pattern of injury in acetaminophen toxicity?

Answer 25

An acute, hepatitic pattern of injury.

Question 26

What is steatohepatitis?

Answer 26

A fatty liver with hepatocellular death due to the fat. It is usually associated with alcohol abuse.

Question 27

What is the LFT profile of steatohepatitis?

Answer 27

(1) Elevated ALT and AST (2) Slightly elevated ALK and GGT (3) Normal bilirubin

Question 28

J: This refers to ubiquitinated intermediate filaments in hepatocytes, often associated with steatohepatitis.

Answer 28

What is Mallory's hyaline?

Question 29

J: This term describes the character of hepatocellular injury in steatohepatitis.

Answer 29

What is ballooning degeneration?

Question 30

How does amyloidosis cause portal hypertension?

Answer 30

There is no fibrosis, rather it lines the sinusoids increasing resistance.

Question 31

What is the LFT profile of amyloidosis?

Answer 31

Normal.

Question 32

What is the LFT profile of cholestasis?

Answer 32

(1) slightly elevated ALT and AST (2) extremely elevated ALK and GGT (3) elevated bilirubin

Question 33

What is cholestasis?

Answer 33

Bile plugs composed of bilirubin become trapped in the bile canaliculi, reducing bile flow from the liver.

Question 34

J: This refers to the character of hepatocellular injury in cholestasis.

Answer 34

What is feathering degeneration?

Question 35

What is suspected when fibrosis of the liver begins in zone 3?

Answer 35

Venous outflow obstruction.

Question 36

What are complications of cirrhosis?

Answer 36

(1) decreased synthetic and clearing function (2) portal hypertension (3) increased risk of hepatocellular carcinoma

Question 37

What are complications of choledochal cysts?

Answer 37

(1) obstruction of the bile duct through twisting (2) formation of gallstones (3) rarely, adenocarcinoma

Question 38

Is a choledochal cyst a true or pseudo diverticulum?

Answer 38

True.

Question 39

J: This refers to a cholangiocarcinoma that occurs at the junction of the left and right hepatic ducts.

Answer 39

What is a Klatskin tumor?

Question 40

What disorders are associated with cholangiocarcinoma?

Answer 40

(1) ulcerative colitis | (2) PSC

Question 41

What should you look into in the event of intrahepatic choledocholithiasis?

Answer 41

Low-level gram negative bacterial infection in the liver.

Question 42

What are causes of small-duct biliary disease in an adult?

Answer 42

(1) PBC (2) PSC (3) sarcoidosis (4) graft vs host (5) drug-induced ductopenia

Question 43

What is the pathogenesis of PBC?

Answer 43

(1) Abnormal expression and/or antigenic mimicry of the E2 component of pyruvate dehydrogenase on the apical surface of biliary epithelial cells. (2) Cellular immunologic attack. (3) Biliary epithelial cell death.

Question 44

What are the most common associated diseases with PBC?

Answer 44

(1) sicca syndrome (2) thyroid disease (3) arthralgia (4) Raynaud's syndrome (5) sclerodactyly (6) fibrosing alveolitis

Question 45

Which ducts are at risk in PSC?

Answer 45

Large biliary ducts.

Question 46

How does PSC appear on ERCP?

Answer 46

Beads on a string.

Question 47

What is the most common source of metastatic tumors in the liver?

Answer 47

GI.

Question 48

Is hepatic adenoma a precursor lesion of hepatocellular carcinoma? Bile duct adenoma for cholangiocarcinoma? Hemangioma for angiosarcoma?

Answer 48

No. No. No.

Question 49

What are the 3 most common liver tumors?

Answer 49

(1) hepatocellular carcinoma (2) cholangiocarcinoma (3) hepatoblastoma