Pathology of GIT: Liver

Question 1

fibrosis due to _______ starts from the central vein

Answer 1

alcoholic liver disease

Question 2

liver tumors most commonly metastasize to the ______

Answer 2

colon

Question 3

hepatic adenoma is associated with the use of _____ or _____

Answer 3

oral contraceptives or anabolic steroids

NORMAL AFP

Question 4

Hepatitis ___ and ____ are risk factors for developing HCC

Answer 4

hepatitis B and C

Question 5

↑ levels of _____ is seen in HCC

Answer 5

AFP

Question 6

which zone in the liver is closest to the central vein?

Answer 6

zone 3

Question 7

if a patients serum level show the presence of anti mitochondrial antibodies, what cholangiopathy should you be thinking

Answer 7

primary biliary cholangitis

Question 8

vascular diseases predominately affected zone ____ of the liver

Answer 8

zone 3

Question 9

global distribution of HCC is strongly related to the prevalence of _____ (virus) and highest frequencies are in _____, ____, and _____

Answer 9

HBV; Taiwan, Mozambique and China

Question 10

a common cause of central necrosis of the liver is __________ (drug)

Answer 10

acetaminophen (massive necrosis with little inflammation)

Question 11

what are some causes of macrovesicular steatosis in hepatic injury

Answer 11

• alcohol

- malnutrition

Question 12

what are some risk factors for non alcoholic fatty liver disease (NAFLD)

Answer 12

• obesity
• insulin resistance
• diabetes
• hyperlipidemia

Question 13

what are the two autoimmune cholangiopathies

Answer 13

• primary biliary cholangitis

- primary sclerosing cholangitis

Question 14

how would you treat autoimmune hepatitis?

Answer 14

give corticosteroids are soon as possible to prevent fulminant hepatitis

Question 15

describe the histological finding of cholangiocarcinoma

Answer 15

• follows bile duct system
• ducts are dilated with pale tissue around them
• irregular, atypical ducts surrounded by loose desmoplastic stroma

Question 16

what are some major features of portal hypertension?

Answer 16

• ascites
• splenomegaly (thrombocytopenia)
• esophageal/gastric varicies
• caput medusae

Question 17

copper deposits in the brain are typically deposited in the ___________ in Wilson’s disease

Answer 17

basal ganglia

Question 18

Wilson disease is a ________ (mode of inheritance) disease due to a mutation on ______ gene leading to _________

Answer 18

autosomal recessive disorder with a mutation on the ATP7 gene on chromosome 13 leading to toxic levels of copper in the liver, brain and eyes

Question 19

what are 3 genetic and metallic liver diseases that can cause chronic hepatitis?

Answer 19

• alpha 1 antitrypsin deficiency
• wilson disease
• hemochromatosis

Question 20

_______ is the most common tumor in the liver

Answer 20

hemangioma (non epithelial neoplasm)

Question 21

low levels of ________ is indicative of Wilson’s disease

Answer 21

ceruloplasmin (copper carrying protein)

Question 22

a diagnostic sign of focal nodular hyperplasia on CT/MRI is ________

Answer 22

central/focal scar

on H&E no mitosis or atypia

Question 23

which cholangiopathy has a strong association with IBD (ulcerative colitis) ?

Answer 23

primary sclerosing cholangitis

Question 24

________ is characterized by non necrotizing granulomatous destruction of small and medium sized bile ducts

Answer 24

primary biliary cholangitis

Question 25

describe the radialogical findings in someone with primary biliary cholangitis

Answer 25

normal, so must do biopsy to diangnose | beading is seen on radiology of primary sclerosing cholangitis

Question 26

mis-folded alpha 1 antitrypsin proteins are found in the ____ of the hepatocytes

Answer 26

ER

Question 27

on ERCP, you see dilation and beading of the biliary tree. what is the most likely diagnosis

Answer 27

primary sclerosing cholangitis

Question 28

________ antibodies are found in primary biliary cholangitis

Answer 28

anti- mitochondrial antibodies

Question 29

in what age group of patients do you usually see the fibrolamellar variant of HCC

Answer 29

younger age w/ no association with HBV or cirrhosis

Question 30

what conditions can you expect to see ↑ AFP levels

Answer 30

- HCC - yolk sac tumors - germ cell tumors - cirrhosis - pregnancy with fetal neural tube defects - massive liver necrosis

Question 31

classify the types of autoimmune hepatitis based on the antibodies found

Answer 31

type 1 adults: anti nuclear and anti smooth muscle antibodies type 2 children/teens: anti LKM (liver kidney microsomal type)

Question 32

presence of what marker is seen in primary sclerosing cholangitis

Answer 32

p-ANCA

Question 33

where is copper deposited in the eyes in Wilson's diseases

Answer 33

Descemet membrane of the cornea → Kayser Fleischer ring

Question 34

what are some risk factors for extra hepatic cholangiocarcinoma

Answer 34

- sclerosing cholangitis - gallstones - malformation of biliary system - chemicals: benzidine, nitrosamines - parasitic infections: clonorchis sinensis and opithorchis viverini

Question 35

HCC has a strong propensity for invading what structures in the liver?

Answer 35

vascular channels such as the portal vein or IVC

Question 36

mutations in _______ cause of hepatic adenoma has the most frequent associated with HCC (hepatocellular carcinoma)

Answer 36

mutations in β catenin

Question 37

Charcot's triad is used with regard to ascending cholangitis. what are the three common signs and symptoms

Answer 37

- Right upper quandrant pain - jaundice - fever

Question 38

which cholangiopathy has less inflammation and a layering form of fibrosis ("onion skin" lesion_

Answer 38

primary sclerosing cholangitis

Question 39

ALP/GGT tell you the function of _______

Answer 39

bile ducts ALP is ↑ in biliary obstruction look at GGT in kids but ALP is fine for adults

Question 40

_______ is the type of liver cirrhosis seen in hemochromatosis

Answer 40

micronodular liver cirrhosis

Question 41

HCC in children usually occur in conjunction with ______

Answer 41

occurs with a metabolic liver disease that can cause cirrhosis

Question 42

single hard tumor with fibrous bands transversing throughout it with well differentiated polygonal cells in cords/nests separated by fibrous septa is indicative of ______

Answer 42

fibrolamellar variant of HCC will also be green in color due to bile production by tumor

Question 43

what are the mutations associated with the different subtypes of hepatic adenoma and their presentation on histology

Answer 43

- mutation in hepatocyte nuclear factor 1 α = rich in fat and minimal risk for HCC - mutation in β catenin = cytologic atypica and high risk for HCC - mutation in IL-6 receptor pathway = sinusoidal dilation (look at CRP)

Question 44

primary sclerosing cholangitis mainly affects ______

Answer 44

extra hepatic and large intrahepatic ducts

Question 45

small and medium sized ducts are affected in ________

Answer 45

primary biliary cholangitis

Question 46

what are three characteristics of liver cirrhosis

Answer 46

- bridging fibrous septa - parenchymal nodules created by regeneration - diffuse involvement of the liver

Question 47

what are some causes of microvesicular steatosis in hepatic injury

Answer 47

- acute fatty liver of pregnancy - Reye syndrome - drugs

Question 48

what would you see on histology for HCC

Answer 48

- bile production by tumor cells (MAIN FEATURE)→ cytoplasmic inclusions and gives it a green color - usually cirrhosis in adjacent liver parenchyma - well differentiated to poorly differentiated

Question 49

describe the test you would do to stain for α1 antitrypsin deficiency in the hepatocytes

Answer 49

- add diastase with PAS because the cytoplasmic globules in the periportal hepatocytes are PAS positive and diastase resistant

Question 50

______ is a marker that is ↑ in hepatocellular carcinoma (HCC)

Answer 50

AFP (alpha fetoprotein)

Question 51

ALT/AST tell you the function of ________

Answer 51

hepatocytes; ALT is more specific for liver injury than AST

Question 52

alcohol usually causes _________ steatosis of hepatic injury

Answer 52

macrovesicular

Question 53

what liver diseases are AFP levels normal?

Answer 53

- fibrolamellar variant of HCC | - cholangiocarcinoma

Question 54

describe the symptoms of Reynaud's pentad

Answer 54

Charcot's triad (RUQ pain, jaundice, fever) + hypotension/shock + confusion