Pathology - Liver and Gallbladder Flashcards
(131 cards)
1
Q
Which carries more blood? Portal vein or hepatic artery?
A
Portal vein (65%)
2
Q
Which serum markers can be used for hepatic integrity?
A
AST/ALT
3
Q
Which plasma enzymes can be used for biliary function?
A
Alk phos, serum GGT
4
Q
What are Counsilman bodies?
A
Apoptotic hepatocytes - also called acidophil bodies
5
Q
What features show evidence of stem cell activation?
A
Ductular Reaction
6
Q
Which stage of regeneration involves stem cells? Early or late?
A
LATE - hepatocytes work early
7
Q
What are stellate cells in charge of?
A
Scar formation in the liver - but can also store Vitamin A
8
Q
Definition of liver failure:
A
loss of > 80% of hepatocytes
symptoms don’t show until > 90% so this is a problem
9
Q
What is classified as acute liver failure?
A
encephalopathy, coagulopathy, occurs within 26 weeks of initial injury
10
Q
Major morphological feature of acute liver failure due to NSAIDs?
A
Massive hepatic necrosis (liver is very small)
11
Q
Characteristic time when ductular reaction doesn’t take place when it should:
A
Acetaminophen toxicity - inflammation happens too quickly
12
Q
What causes hepatic encephalopathy?
A
Elevated serum ammonia
13
Q
What is hepatorenal syndrome?
A
When liver failure patients have unexplained kidney failure too
14
Q
Lab results for acute liver failure:
A
very high AST and ALT
15
Q
Morphology of cirrhosis:
A
regenerative parenchymal nodules - does NOT mean they are precancerous
16
Q
What is cryptogenic cirrhosis?
A
cirrhosis without an apparent cause
17
Q
How can you tell when regression of cirrhosis is happening?
A
Compaction of scars - possible but very rare
18
Q
Signs of impending death with chronic liver failure:
A
hepatic encephalopathy bleeding from esophageal varices bacterial infection (Kupffer cell dysfunction)
19
Q
Signs unique to chronic liver failure:
A
Pruritis - some people scratch all the way to bone!
hyperestrogenemia - causes palmar erythema, spider angioma, hypogonadism ad gynecomastia
20
Q
Almost all cases of portal hypertension are caused by?
A
CIRRHOSIS
21
Q
What are the major clinical consequences of portal hypertension?
A
ascites
portosystemic venous shunts (no filtration)
congestive splenomegaly
hepatic encephalopathy
22
Q
What are some types of portosystemic shunts?
A
Rectal hemorrhoids
esophageal varices
caput medusa
23
Q
40% of people with advanced cirrhosis will die from?
A
Bleeding due to esophageal varices
24
Q
Weird clinical feature of hepatopulmonary syndrome?
A
hypoxia and dyspnea while STANDING
25
Viral causes of chronic liver failure
HBV, HCV, and HDV
26
When is viral hepatitis infectivity greatest?
During the incubation period
27
Most common viruses causing acute liver failure?
HAV and HEV
28
What is cryoglobulinemia and what causes it?
Blood freezes at cold temperatures
| Caused by HCV only
29
Which hepatitis viruses have kidney effects?
HBV and HCV
30
When might you see "hepatic dropout"?
Acute viral hepatitis
31
Plasma cell count is very high in the acute stage of which virus?
HepA
32
Which virus/stage shows ground glass hepatocytes?
Chronic Hep B
33
Which virus/stage shows extensive fatty change and lymphoid follicles?
Chronic Hep C
34
Who is most susceptible for contracting Hep A?
Places with poor sanitation, usually children
| 50% of people in the US have been exposed
35
How do you know if a patient with Hep A is in active infection or has an old infection?
```
IgM = active, acute infection
IgG = old infection
```
36
Which HBV antibodies can be found during the window period?
IgM Ab only
37
What's the difference in antibody detection between an acute and chronic HBV infection?
Acute: HBsAg, HBeAg, HBV DNA, and IgM (Anti-HBc)
Chronic: HBsAg, HBeAg, HBV DNA for 6+ months, and IgG (Anti-HBe)
38
Which protein in the HBV virus is responsible for causing HCC?
HBx
39
What is another name for the HBV virion?
Dane Particle
40
What is the best predictor for HBV chronicity?
AGE - children have shorter/milder disease process
41
When is a patient considered cured of HCV?
No detectable HCV RNA in blood for 6 months after treatment
42
Which test is most reliable for active HCV infection?
Persistently elevated ALT/AST
| follow up test would be HCV RNA
43
Which key protein in HCV allows it to evade antibodies?
E2 envelope protein
44
Where is HDV most common?
Amazon basin
45
Which virus has a high mortality rate in pregnant women?
HEV
46
Which hepatitis viruses increase risk for HCC?
Hep B and Hep C
47
What is ascending colangitis?
Bile obstruction allows bacteria to invade and cause infection
48
Which tapeworm is associated with hydatid cysts/calcifications?
Echinococcus (sheep tapeworm)
49
How do you differentiate the types of autoimmune hepatitis?
Type 1: > 40 yrs, ANA and ASMA +
| Type 2: < 20 yrs, Anti-LKM+, worse prognosis
50
#1 cause of chronic liver disease in the US;
ALCOHOL
51
#1 cause of acute liver failure requiring transplant:
Acetaminophen
52
What is predictable/intrinsic hepatotoxicity?
Means that the one agent (like acetaminophen) causes disease in some way in every person
53
3 major patterns in alcoholic liver disease:
hepatocellular steatosis
steatohepatitis
steatofibrosis
54
What is the morphology of steatohepatitis?
painful hepatomegaly
| Mallory-Denk bodies
55
What else is Mallory-Denk bodies found in?
non-alcoholic fatty liver disease
alcoholic liver disease
wilson disease
chronic biliary tract disease
56
What is the morphology for steatofibrosis?
Increased activity of stellate cells and portal fibroblasts to create a chicken wire fence look
Over time - progresses to Laennec cirrhosis
57
Which ethnicities are more susceptible to alcoholic liver disease?
African Americans and Asians
58
Difference in lab values between alcoholic hepatitis and nonalcoholic liver disease?
Alcoholic: AST/ALT is characteristically 2:1
Nonalcoholic: ALT is higher
59
Most common metabolic liver disease?
Nonalcoholic fatty liver disease (NAFLD)
60
Diagnostic feature of NAFLD?
>5% of hepatocytes filled with triglycerides
61
Clinical presentation of NAFLD?
Often presents with glucose > 100 (prediabetic or diabetic)
| almost always asymptomatic
62
Cause of death in NAFLD?
Heart disease
63
Most common genetic mutation in hemochromatosis?
HFE
64
Typical patient in hemochromatosis?
40-50 years, 7x more likely to be male if symptomatic
65
Clinical signs of iron overload:
micronodular cirrhosis (100%)
diabetes type 2 (80%)
abnormal skin pigmentation
cardiomyopathy
66
Of the HFE mutations, which is more severe?
C282Y >>> H63D
67
When hemochromatosis is juvenile, which genes are affected?
HAMP & HJV
68
Staining done for hemochromatosis?
Prussian blue - shows golden granules of iron
69
Morphology characteristics of hemochromatosis?
hemosidern deposition
cirrhosis
pancreatic fibrosis
THERE IS NO INFLAMMATION
70
Treatment for hemochromatosis?
Phlebotomy
71
Gene affected in Wilson's disease?
ATP7B
72
Specific tests for Wilson's?
Urine copper +
Hepatic copper +
Serum ceruloplasmin --
73
Stains for detecting copper:
Rhodamine or Orceine
74
Typical patient for Wilson's:
Mean age = 12 years old
| may see neural changes and keyser rings, hemolytic anemia
75
What condition is associated with cutaneous necrotizing panniculitis?
A1AT deficiency, PiZZ genotype
76
Major differences between conjugated and unconjugated bilirubin?
Conjugated: excreted in urine if levels get too high
Unconjugated: never excreted in urine, causes tissue injury at high levels
77
Which syndromes are due to conjugated bilirubin?
Dubin-Johnson and Rotor
78
Which syndrome is fatal and due to unconjugated bilirubin?
Crigler-Najar Type 1
79
Which syndrome leads to a black liver?
Dubin-Johnson
80
Gene activity in Crigler-Najar Type 1?
UGT1A1
81
What happens in cholestasis?
Bile builds up in the liver cause bright green plugs (feathery degeneration)
82
Lab findings in cholestasis?
GGT +
| Alk phos +
83
Most common cause of large bile duct obstruction?
Adults: gallstones
Children: primary biliary atresia
84
Which organisms are more common in immune-mediated liver damage?
gram negatives
85
What is primary hepatolithiasis?
formation of gallstones inside the LIVER
| potentially leads to cholangiocarcinoma
86
Common causes of perinatal biliary atresia?
Viral infection (CMV, rotavirus, reovirus) and autoimmune
87
What does fetal biliary atresia usually present with?
Situs inversus
88
Clinical presentation of biliary atresia in a newborn:
acholic stools, normal birthweigh, more common in females
89
Special features of primary biliary cirrhosis (PBC)?
middle-aged white woman
AMA + (mitochondrial)
florid duct lesions
liver may be cirrhotic AND enlarged
treatment: oral ursodeoxycholic acid
90
Associated disease with PBC?
Sjogren's Syndrome
91
Associated disease with PSC?
Inflammatory bowel syndrome
92
Special features of primary sclerosis cholangitis (PSC)?
string of beads pattern on imaging
almost all have UC
pANCA +
onion skin fibrosis (tombstone scars)
93
How is PSC diagnosed?
By radiology! (unique)
94
Who is most likely to get choledochal cysts?
females less than 10 years old
95
Structural abnormalities of the biliary tree are caused by?
Abnormal persistence of pieces of the ductal plate
96
What does an Infarct of Zahn look like?
Distinctive red and blue lined pattern due to intrahepatic PV obstruction
97
What effect does a schistosomiasis infection have on hepatic circulation?
Small portal vein branch disease
98
Peliosis hepatis
Blood-filled cysts due to impaired efflux of blodd
99
What defines Budd-Chiari syndrome?
Obstruction of at least 2 hepatic veins - liver swells, looks red/purple
100
What is a common liver autopsy finding, especially in heart failure?
systemic venous congestion and centrilobular necrosis (nutmeg liver)
101
Most common cause of jaundice in pregnant women?
Viral hepatitis
102
Most liver conditions dealing with pregnancy show up when?
Third trimester
103
Differences between focal nodular hyperplasia and nodular regenerative hyperplasia?
FNH: healthy young adult, single mass lesion (yellow)
NRH: associated disease condition, entire liver is covered in nodules, leads to portal HTN
104
Most common benign neoplasm of the liver?
Cavernous hemangioma
105
What causes an increased risk for hepatocellular adenoma?
OCPs and anabolic steroids (30-40x)
106
Most common hepatocellular adenoma caused by OCPs?
HNF1-alpha -- lowest risk for malignancy
107
Conditions associated with hepatoblastoma?
Children < 3 years
Wnt pathway and FOX-G1 mutations
FAP (B-catenin mutation) or Beckwith-Wiedemann Syndrome
108
More than 85% of HCC comes from?
Chronic HepB infection or aflatoxin exposure
| Also: Hep C and alcohol
109
Clinical presentation of HCC?
Patient more than likely presents with underlying liver disease
AFP + blood test
110
Most common genetic mutations leading to HCC?
B-catenin and TP53
111
What type of morphology in a precancerous lesion might lead us to think it's turning malignant?
nodule-in-nodule growth
112
Which changes are more severe in HCC?
Small cell >>> large cell
| high grade dysplasia >>> low grade
113
HCC usually metastasizes to where?
Liver first, then heart - new onset portal HTN
114
Rare substype of HCC: patients < 35 years, single large hard tumor, increased number of mitochondria, no identifiable underlying diseases
Fibrolamellar caricnoma
115
Cause of death in HCC:
```
#1 = cachexia
Others: esophagel varices, liver failure, hepatic coma
```
116
Cholangiocarcinoma (CCA) can be intrahepatic or extrahepatic, differences?
Intra: mortality rate = 100% in 6 months
Extra: Klatskin tumors, 85% mortality in 2 years
117
Morphology of CCA:
Biliary intraepithelial neoplasia (BilIN)
almost always adenocarcinomas (Mucin +)
desmoplastic
118
Common sites of primary tumors that metastasize to the liver?
Colon, breast, lung
| The only clinical sign is usually hepatomegaly
119
Most common gallbladder anomaly?
Phyrgian cap deformity
120
Risk factors for a cholesterol gallstone:
Gene: ABCG8
| 5 F's: female, fertile, fat, fair-skinned, family history
121
Predisposing factors for bilirubin stones:
chronic anemia, ileal bypass surgery, ascending cholangitis, SICKLE CELL
122
Clinical presentation of gallstones:
Waxing and waning of biliary cholic
| pain spreads to shoulder and back
123
What is Bouveret syndrome?
large stone pushes itself through the gallbladder wall and into the intestine
124
Patients at risk for calculous cholecystitis?
Diabetics with gallstones
125
What causes acalculous cholecystitis?
ischemic injury to the gallbladder
| presents with high incidence of necrosis/gangrene because it's hard to catch early
126
Who gets chronic cholecystitis?
People with gallstones who were not treated surgically
127
Morphology changes in chronic cholecystitis?
Rokitansky-Aschoff sinuses (pockets of gallbladder mucosa), may proceed to porcelain gallbladder
128
Most common type of cancer in the gallbladder?
adenocarcinoma
129
Typical clinical presentation for gallbladder cancer:
most are women, commonly Native Americans
95% have history of gallstones
5-year mortality = 90%
130
Genetic mutations in gallbladder cancer?
ERBB2 oncogene mutation
131
Most common site of metastasis in gallbladder cancer?
Portal-hepatic lymph nodes
