Pathology Flashcards
(201 cards)
1
Q
This is a sudden liver illness that is associated with encepthalopathy within 6 months after the initial Dx.
A
Acute liver failure.
2
Q
This form of acute liver failure is when the encephalopahy develops within 2 weeks of the onset of jaundice.
A
Fulminant liver failure
3
Q
This form of acute liver failure is when the enceopahlopathy develops within 2 months of the onset of jaundice.
A
Sub-fulminant liver failure
4
Q
What is the main pathological change in acute liver failure?
A
massive hepatic necrosis
5
Q
Which drug accounts for 50% of cases of acute liver failure?
A
acetaminophen
6
Q
Which hepatitis viruses can lead to acute liver failure?
A
HAV, HBV, and HCV
7
Q
This is the most common cause of hepati failure and is the end point of relentless long term hepatitis ending in cirrhosis.
A
Chronic liver disease
8
Q
This is the condition when the hepatocytes remain viable but are unable to perform normal metabolic fxn.
A
Hepatic dysfxn without overt necrosis
9
Q
Generally, this is the failure of the hepatocytes to perform their homeostatic functions.
A
Hepatic failure.
10
Q
The elevation of what substance in the blood and CNS contributes to hepatic encephalopathy?
A
ammonia levels
11
Q
What are some common neurological manifestations of hepatic encephalopathy?
A
Rigidity, hyperreflexia, and asterixis
12
Q
Which cells swell in the brain that may not just be a minor morphological change?
A
astrocytes
13
Q
True or False: encephalopathy is reversible if the underlying hepatic condition is corrected.
A
True!
14
Q
This is the condition where there is renal failure in individuals with severe chronic liver disease.
A
Hepatorenal syndrome.
15
Q
What is the main contributor that causes hepatorenal syndrome?
A
Decreased renal blood flow
16
Q
What will change with the urine output in hepatorenal syndrome?
A
It’ll decrease
17
Q
In hepatorenal syndrome, which 2 substances increase in teh blood?
A
BUN and creatinine
18
Q
This condition is characterized by the triad of chronic liver disease, hypoxemia, and IVPD.
A
hepatopulmonary syndrome (HPS)
19
Q
In HPS, which mediator is produced more in the lung?
A
NO
20
Q
What are the 2 main manifestations for HPS?
A
orthodeoxia and platypnea
21
Q
These are delicate bands or broad scars linking portal tracts with 1 another in cirrhosis.
A
Bridging fibrous septa
22
Q
These are nodules containing hepatocytes encircled by fibrosis in cirrhosis.
A
Parenchymal nodules
23
Q
True or False: focal injury with scarring consitutes cirrhosis.
A
FALSE. the parenchymal injury and fibrosis is diffuse.
24
Q
This condition is the triad of hepatocyte death, ECM deposition, and vascular reorganization.
A
Cirrhosis
25
What do you lose in cirrhosis which leads to intrasinusoidal HTN?
fenestrations of sinusoidal endothelial cells.
26
Which cells proliferate and are activated, which is the predominant mechnaism of fibrosis in cirrhosis?
hepatic stellate cells
27
Hepatic stellate cells are activated into what cells as a result of PDGFR-beta?
myofibroflasts
28
Portal HTN, hypoalbuminemia, and hyperaldosteronism can lead to what condition where there is excess fluids in the peritoneal cavity?
Ascites
29
True or False: the concentration of solutes in ascites is similiar to that of the blood.
True.
30
This is the condition when a rise is portal system pressure causes reversal of the flow from portal to the systemic circulation.
Portosystemic venous shunts
31
What are the 3 main varices that can result from portsystemic venous shunts?
hemorrhoids, esophageal varices, and caput madusae
32
Long-standing congestion can cause enlargement of what organ?
Spleen
33
What secondary things might be caused when a pt has congestive splenomegaly?
hypersplenism with various cytopenias
34
Bilirubin overproduction, hepatitis, and bile obstruction can all cause what condition?
Jaundice.
35
True or False: unconjugated bilirubin is insoluble in water at physiological pH and cannot be excreted in the urine.
True
36
This is the hemolytic disease of the newborn as a result of an accumulation of unconjugated bilirubin in the brain.
Kernicterus
37
So what form of bilirubin can be excreted in the urine because it's loosely bound to albumin?
Conjugated form
38
Almost every newborn develops what kind of hyperbilirubinemia?
mild unconjugated hyperbilirubinemia
39
Why can mild unconjugated hyperbilirubinemia in infants be exasterbated by breastfeeding?
cuz theres bilirubin-deconjugating enzymes in boob milk
40
This genetic hyperbilirubinemia is when a UGT1A1 absence causes colorless bile and serum unconjugated bilirubin reaches a very high level.
Crigler-Najjar Syndrome Type I
41
This genetic hyperbilirubinemia is a less severe form of CNS type I, where the UGT1A1 is reduced and can only form monoglucuronidated bilirubin.
Crigler-Najjar Syndrome Type II
42
What does a pt with Crigler-Najjar Syndrome Type I die of in 18 months?
Kericterus
43
This genetic hyperbilirubinemia is a benign condition where there is a mild, fluctuating hyperbilirubinemia because hepatic bilirubin-glucuronidating activity is only 30% of normal.
Gilbert syndrome
44
This AR hyperbilirubinemia is characterized by chronic conjugated hyperbilirubinemia from a defect in hepatocellular excretion of bilirubin glucuronides from the canalicular membrane.
Dubin-Johnson Syndrome
45
Why is the liver darkly pigmented in DJS?
from inclusions of bilirubin glucuronides in the cytoplasm of hepatocytes
46
This rare hyperbilirubinemia is characterized by asymptomatic conjugated hyperbilirubinemia, normal liver morphology, and chronic jaundice.
Rotor Syndrome.
47
This is a pathological condition of impaired bile formation and bile flow, causing an accumulation of bile pigment in the hepatic parenchyma
Chelestasis
48
Whether it's extra or intra-hepatic causation of cholestasis, what 2 serum enzymes are elevated?
alkaline phosphatase & γ-glutamyl transpeptidase (GGT)
49
What is the appearance of the hepatocytes when dropets of bile pigment accumulates within them?
Fine and foamy appearance (feathery degeneration)
50
Progressive Familial Intrahepatic Colestasis (PFIC) has what type of genetic inheritance?
AR
51
In PFIC-1, when do u get liver failure?
before adulthoold
52
What is the mutated gene in PFIC-1?
ATP8B1
53
True or False: there is decreased GGT activity in PFIC-1.
False. it's pretty much normal
54
What is the structure that is mutated in PFIC-2?
bile salt export pump
55
Which gene is mutated to cause PFIC-2?
ABCB11
56
True or False: there are normal levels of GGT in PFIC-2.
True
57
When do pt's progress to cirrhosis in PFIC-2 in their life?
in the first decade of life.
58
Which cancer are PFIC-2 pt's at risk for?
cholangiocarcinoma
59
Which gene is mutated to cause a defect in the protein MDR3 in PFIC-3?
ABCB4
60
True or False: there are normal levels of GGT in PFIC-3.
False. They are high.
61
Why are serum GGT levels high in PFIC-3?
because of an absence of secreted physphatidylcholine in the bile.
62
What is the cancer associated with HBV?
primary hepatocellular carcinoma
63
This the the name for the empty cytoplasm with scattered eosinophilic remnants in acute hepatitis.
Ballooning degeneration
64
Which calls undergo hypertrophy and hyperplasia as an inflammatory response in acute hepatitis?
Kupffer cells
65
What is the hallmark of chronic hepatitis?
deposition of fibrous tissue
66
This is a chronic and progressive form of hepatitis which is attributed to T-cell-mediated autoimmunity.
Autoimmune hepatitis
67
What 3 things can trigger an autoimmune hepatitis condition?
viral infections, drugs, and herbal products.
68
What are elevated in serum panels for autoimmune hepatitis?
IgG autoantibodies
69
This type of autoimmune hepatitis has a presence of ANA, SMA, AAA, and anti-SLA/LP antibodies.
Type 1 autoimmune hepatitis
70
What 2 things are present in type 2 autoimmune hepatitis?
ALKM-1 and ACL-1
71
Which WBC is present in the portal tracts and hepatic lobules in autoimmune hepatitis?
Plasma cells
72
Chronic drug-induced liver disease is histologically indistinguishable from what other disease?
chronic viral hepatitis
73
So how can u distinguish the 2?
serological markers for viral or drug induced hepatitis
74
What is the most common cause of drug induced acute liver failure?
Acetaminophen
75
This is a rare and potentially fatal syndrome of mitochondrial dysfxn of the liver, brain, and elsewhere after administration of aspirin
Reye syndrome
76
What types of pt's are at risk for reye syndrome?
kids
77
What is the histological appearance of the hepatocytes in reye syndrome?
extensive accumulation of fat droplets within hepatocytes
78
Hepatic steatosis, alcoholic hepatitis, and cirrhosis are all factors which make up which condtion?
alcholic liver disease
79
This is the condtion where there are clear macrovesicular globules that compress and displace the hepatocyte nucleus.
Hepatic steatosis
80
What is the morphology of the liver in hepatic steatosis?
leargy, heavy, yellow, and greasy
81
This condition is where there is hepatocyte swelling and necrosis from chemical injruy to hepatocytes, typically after binge drinking.
Acoholic hepatitis
82
What are the names of the scattered eosinophilic cytoplasmic clumps of cytoketatin within hepatocytes in alcholic hepatitis?
Mallory bodies
83
Which WBC surrounds the mallory bodies in alcholic hepatitis?
Neutrophils
84
True or False: in cirrhosis, the liver initially is large and fatty but then turns into a brown shrunken nonfatty light liver.
True.
85
What type of tissue gets laid down in cirrhosis to cause the "hobnail" appearance on the surface of the liver?
fibrous tissue
86
True or False: men are more susceptible to hepatic injury than women.
False. Women > men
87
True or False: African Americans are less susceptible to hepatic injury than men.
False. They are more.
88
Which gene can be mutated to cause a lack of intolerance to alcohol? (lol Asians)
ALDH
89
These are a group of condtions which have a presence of hepatic steatosis in individuals who do not consume alcohol or do so in small quantities.
Nonalcoholic fatty liver disease (NAFLD)
90
What is the progressive form of NAFLD called?
Non-alcoholic steatohepatitis (NASH)
91
Where do u see fibrosis in NASH?
portal tracts aroudn the terminal hepatic venules
92
This condition is characterized by excessive accumulation of body iron, most of which is depositied in the liver and the pancreas.
Hemochromatosis
93
What is the mechanism for the overload of Fe to cause hemochromatosis?
excessive iron absorption
94
This condtion is an accumulation of Fe in tissues, which occurs because of parental administration of Fe usually in the form of transfusions.
hemosiderosis
95
Which protein, which is encoded by the HAMP gene, is the main regulator of Fe absorption, which can cause hemocrhomatosis?
hepcidin
96
What does hepcidin do tot he cellulear Fe efflux channel ferroportin (FPN) to cause hemochromatosis?
binds to it and internalizes and proteolysis it
97
So if you lack hepcidin, what happens to Fe levels?
overload cuz the Fe efflux channels are never internalized and constantly spit Fe into the plasma.
98
What is the morphology of the liver in hemochromatosis?
golden-yellow hemosiderin granules are in the cytoplasm of hepatocytes. fibrosis. cirrhosis in a intensly pigmented liver
99
What is the triad of Sx in hemochromatosis?
hepatomegaly, skin pigmentation, and DM
100
This condition is an AR disorder where there is impaired Cu excretion into bile and a failure to incorporate Cu into ceruloplasmin.
Wilson disease
101
Where does Cu accumulate in Wilsons?
liver, brain, and eye mainly.
102
What is the fxn of ceruloplasmin?
used in the blood to carry Cu to the liver where it is degrades and the Cu is excreted in the bile.
103
What is the morphology of the lvier in Wilson disease?
steatosis with vacuolated nuclei (glycogen or water) and occasionally focal hepatocyte necrosis
104
Though Wilsons can look axactly like acute viral hepatitis, what is the different change in wilsons that isnt in acute viral hepatitis?
fatty change.
105
Will ceruloplasmin levels in Wilsons be high or low?
low
106
What is the name of the ring that forms aorudn the eyes in Wilsons?
Kayser-Fleisher rings
107
The defciciency in this protein can cause pulmonary emphysema as well as liver disease.
Alpha 1-antitrypsin (A1AT)
108
What are the types of inclusions in hepatocytes in A1AT deficiency?
Round-oval cytoplasmic globular inclusions, which are acidophilic, PAS+
109
At this age, 10-20% of individuals present with cholestatic jaundice in A1AT deficiency.
Newborns
110
This form of hepatitis has focal liver cell apoptosis and necrosis, giant cells, and a parenchymal pattern of injury, typicall in kids.
Neonatal hepatits
111
This intrahepatic biliary tract disease is characterized by a course fiberous septa that subdivide the liver in a jigsaw like pattern, and has feathery degeneration and formation of bile lakes.
Secondary biliary tract disease
112
What is the main cause of secondary biliary tract disease?
bile duct obstruction.
113
Which levels of serum proteins are high in secondary biliary tract disease?
conjugated hyperbiliruninemia, increased alk phos, bile acids, and cholesterol.
114
What are the Sx to secondary biliary tract disease?
prutitus, jaundic, malaise, dark urine, light stools, hepatosplenomegaly.
115
This intrahepatic biliary tract disease is characterized by autoimmune destruction of the bile ducts.
Primary biliary cirrhosis
116
Since the bile ducts are destroyed in primary biliary cirrhosis, what histological changes can u see?
noncaseating granulomatous inflmmation
117
This intrahepatic biliary tract disease is characterized by an uknown etiology that cuases periductal portal tract fibrosis, with an onion-like appearance of the ducts.
Primary Sclerosis Cholangitis
"Penn State Cries because of onions"
also, penn state is a cult. srsly.
118
In this condition, the larger ducts of the intrahepatic biliary tree are segmentally dilated and many contain inspissated (thickened) bile.
Caroli disease.
119
In this condition, R sided cardialc decompensation can cause an enlarged, tense, and cyanotic liver.
Passive congestion of the liver
120
In this condition, L sided cardiac failure or shock leads to hepatic hypoperfusion and hypoxia, leading to ischemic coagulative necrosis of hepatocytes.
Centrilobilar necrosis
121
In this condtion, a combination of hypoperfusion and retrograde congestion causes a mottled appearance reflexing hemorrhage and necrosis in the centrilobular regions (nutmeg).
Centrilobular hemorrhagic necrosis
122
This condition is when sinusoidal dilation occurs when efflux of hepatic blood is impeded and can lead to blood-filled cystic spaces
Peliosis hepatis
123
Peliosis hepatis is associated with what other conditions?
Cancer, TB, AIDS, post-transplant immunodeficiency, steroids, and rarely oral contraceptives.
124
This condition results from obstruction of 2 or more major hepatic veins producing liver enlargement, pain, and ascites, lading to hepatic dmg.
Budd-Chiari syndrome.
125
this is the condition where some of the small veins of the liver are obstructed, typically happeining within 3 wks of marrow transplantation.
Sinusoidal obstruction syndrome.
126
In this condition, lympohocytes attack the epithelial cells of the liver, resulting in hepatitis with necrosis of hepatocytes and bile duct epithelial cells.
acute graft-vs-host disease.
127
In acute graft-vs-host disease, when does the Sx occur after transplant?
10-50 days.
128
In chronic graft-vs-host disease, how many days after transplant can u get portal tract inflammation and bile duct destructin?
> 100 days
this is so horrible. omg im dying.
129
This is the condition which is characterized by maternal HTN, proteinuria, peripheral edema, coagulation abnormalities, and varying degrees of disseminated intravascular coagulation.
Pre-eclampsia
130
This subsection of pre-eclampsia is characterized by hemolysis, eleveated liver enzymes, and low platelets
HELLP
131
Women in their 3rd trimester are at risk for what condition, which can lead to hepatic failure, coma, and death?
Fatty liver
132
Case: a chick on oral contraceptives is having a cholecyststectomy and you notice a well-demarcated but poorly encapsulated nodule about 6cm in diameter. What is is?
focal nodular hyperplasia
133
Case: A young woman presents with cords and sheets of cells in an adenoma biopsy. Which complication could be life threatening for her?
Intraperitoneal Hemorrhage during pregnancy
134
This benign neoplasn is when a tumor of a blood vessel and appears as a dsicrete red/blue, soft nodule usually <2cm in diameter.
Cavernous hemangioma
135
THis benign neoplasm derives from hepatocytes, occurs more frequently in women who use contraceptives, and are yellow-tan nodules anywhere in the hepatic substance.
Hepatic adenomas
136
This is the most common liver tumor of young childhood.
Hepatoblastoma
137
What are the 3 forms of hepatocellular carcinomas?
unifocal mass, multifocal mass, diffusively infiltrative cancer.
138
What are the 3 risk factors for hepatocellualr carcinomas?
chronic hepatitis, cirrhosis, anatoxins from aspergillus
139
This is the 2nd most common HCC of the biliary tree, arising from bile ducts in and out of the liver.
Cholangiocarcinoma
140
This type of gallstone is made of crystalline cholesterol monohydrate, and occur with MURICANS.
Cholesterol stones
141
This type of gallstone is made of bilirubin Ca++ salts, and occur in non-muricans.
Pigment stones
142
Fat fertile females over forty get which type of gallstones?
Cholesterol stones.
143
What genetic disorder can u have mutated to cause cholesterol stones?
ATP-binding cassette (ABC) transporters
144
Which medical conditions predispose u to pigmented stones?
chronic hemolytic syndromes, biliary infections, ileal disease, CF
145
What are the 4 ways u can form cholesterol stones?
supersaturation, hypomotility, crystal nucleation, accetion within gallbladder mucous layer
146
the release of what enzymes cause unconjugated bilirubin to increase, leading to pigmented stones?
microbial beta-glucoronidases
147
What is the morphology of cholesterol stones?
pale yellow, round, glistening, can be severeal cm
148
What is the morphology of black pigmented stones?
small, numerous, hard, crumble, radiopaque (cuz of Ca++ and phosphate)
149
Under what conditions do u get brown stones?
in infected intrahepatic or extrahepatic ducts (black stones are when its sterile)
150
What is the morphology of brown pigmented stones?
pure Ca++ salts of unconj bilirubin, laminated, soft, greasy, radiolucent.
151
This type of acute cholecystitis is caused by chemical irritation and inflammation from gallbaldder obstruction in the absence of bacterial infection.
Acute calculous cholecystitis
152
In what pt population is Acute calculous cholecystitis common?
diabetics
153
This type of acute cholecystitis is caused by ischemia.
Acute acalculous cholecystitis
154
What is unique to the cystic artery to cause acute acalculous cholecystitis?
it has no collateral citculation, so anything that causes inflammation can obstrcut the duct.
155
What is the mophology of the gallbladder in acute cholecystitis?
large, thickened/edematous/hyperemic walls.
156
What are the Sx of acute cholecystitis?
progressive RUQ pain + fever, anorexia, tachycardia, N/V
157
True or False: in chronic cholecystitis, there still has to be obstruction of the gallbladder outflow to cause the pathology.
False. it is not a requisite.
158
What happenes to bile to cause chronic cholecysitits?
supersaturation
159
What are the outpouchings of the mucosal epithelium through the wall called in chronic cholecystitis?
Rokitansky-Aschoff sinuses
160
Extensive dystropic calcification can lead to a really hard gallbladder in chronic cholecystitis. What is this called?
porcelain gallbladder
161
This is the term for the presence of stones within the bile ducts of the biliary tree
Choledocholithiasis
162
Which groups of people get Choledocholithiasis more commonly?
Asians
lol ella
163
This is the term for the bacterial infection of the bile ducts.
Cholangitis
164
What are the 2 main etiologies for cholangitis?
Choledocholithiasis and Biliary strictures
165
Which gram stain are the bacteria that cause cholangitis?
gram -
166
This is the partial or complete extrahepatic biliary tree obstruction within the first 3 months of life.
Biliary atresia
167
The fetal form of biliary atresia comes from the aberrant development of what structure?
Extrahepatic biliary tree
168
The more common perinatal form of biliary atresia may be assocaited with what 2 factors?
viral infection or autoimmunity
169
Type III of biliary atresia is incorrectable because the obstruction of the bile ducts is above what?
The porta hepatis
170
What is the most common malignancy of the biliary tract?
gallbladder adenocarcinoma
171
What is the morphology of infiltrating gallbladder carcinomas?
poorly defined area of diffuse thickening and induration, deep ulceration, scirrhous
172
What is the morphology of exophylic gallbladder carcinomas?
growth into lumen, cauliflower mass, necrosis, hemorrhagic and ulceration of the fundus and neck.
173
Agensis of the pancreas can be a result of a mutation in which gene?
PDX1
174
What is the most common anomaly of the pancrea, where there isnt a fusion of the detal duct system of the dorsal and ventral pancreatic primordials.
Pancreas divisum.
175
Where does the pancreas drain now in pancreas divisum?
through the doral duct (of santorini) and small-baliber minor papilla
176
What is it called when pancreatic tissues get depositied in other organs?
ectopic pancreas
177
What is called when pancreatic tissue encircles the duodenum and can cause duodenal obstruction?
Annular pancreas
178
This condition is when there is inflammation with associated microvascular leakage, fat necrosis, proteolytic destruction of pareatic parencyma, and interstitial hemorrhage
Acute pancreatitis
179
What is the morphology of acute necrotizing pancreatitis?
red-black hemorrhage with yellow-white chalk foci of fat necrosis
180
What are the Sx to acute pancreatitis?
abdominal pain, anorexia, N/V
181
What serum enzymes are increased in acute pancreatitis?
amylase and lipase
182
This is inflammation of the pancreas with irreversible destruction of the exocrine parenchyma, fibrosis, and destruction of the endocrine parenchyma.
Chronic pancreatitis
183
What is the msot common cause of chronic pancreatitis?
long term alcohol abuse
184
What is the morphology of chronic pancreatitis?
parenchymal fibrosis, reduced # and size of acini with relative sparing of the islets of Langerhands, and variable dilation of pancreatic ducts.
185
What is the autoimmune destruction of the pancreas called?
Lymphoplasmacytic sclerosing pancreatitis
186
Case: you're doing a cholecystectomy and find a unilocar, thin-walled, glistening cyst on the pancreas. You also notice it has a thin fiberous capsule around it. What type of cyst is it?
Congenital cyst
187
What 2 AD diseases contribute to congenital cysts?
polycystic kidney disease and von Hippel-Lindau
188
This is a collection of necrotic-hemorrhagic material with enzymes but has NO epithelial lining on the pancreas.
Pseudocyst
189
Are congenital cysts and pseudocyts neoplastic or non-neoplastic?
non-neoplastic
190
These are benign cysts of glycogen-rich cuboidal cells surrounding small cysts containing clear, thin, straw-colored fluid .
serous cystadenomas
191
Serous cystadenomas look like what type of fruit?
Grapefruit
192
These cysts are assocaited with invastive carcinomas, arise in the body or tail, are large, and filled with thick mucin and lined by columnar muci-producing epithelium.
Mucinous cystic neoplasms
193
These are mucin-producing intraductal neoplasms, and are usually in the head of the pancreas.
Intraductal Papillary Mucinous Neoplasms (IPMNs)
194
These are large, well-circumscribed masses with solid and cystic componenets, which grow in solid sheets in the pancreas.
Solid-pseudopapillary neoplasm
195
Which genetic pathway does Solid-pseudopapillary neoplasms usually involve?
B-catenin/APC pathway
196
This is the condition where non-neoplastic epithelium develops into noninvasive lesions, which can then turn into invasive carcinomas of the pancreas.
Pancreatic cancer (infiltrating ductal adenocarcinomas of the pancreas)
197
What is the gene mutation to cause pancreatic cancers?
KRAS > p16/CDKN2A > TP53 > others
198
What is a big risk factor for pancratic cancer?
Smoking
199
What is the morphology of pancreatic cancer?
hard, stellate, gray-white, poorly defined masses that invade
200
This is the cancer that had prominant acinar cell differentiation, formation of zymogen granules and production of exocrine enzymes.
acinar cell carcinoma
201
This is the rare childhood cancer of the pancreas where there are squamous cell islands admixed with acinar cells.
Pancreatoblastoma
