Rubins - combined Flashcards
- acidophilic (eosinophilic / pink-staining on H&E) globule of cells that represents a dying hepatocyte often surrounded by normal parenchyma.
- They are found in the liver of individuals suffering from viral hepatitis (acute), yellow fever, or other viral syndromes.
What are some diseases associated with chronic Hep B?
Manifestations due to circulating immune complexes which can cause
- serum sickness-like syndrome
- glomerulonephritis
- cryoglobulinemia
- polyarteritis nodos
Massive hepatic necrosis due to herpes virus. What is the most likely culprit? (A-E)
Hep B most likely to cause this. Other viruses are not associated with massive hepatic necrosis
Primary biliary sclerosis - classic presentation
- fatigue
- anorexia
- jaundice
- xanthomas of the skin
- pruritus
First 3 are liver findings
Last 2 are skin findings
Clinical hallmarks of advanced hereditary hemochromatosis? (3)
Presence of other diseases such as
- diabetes
- skin pigmentation
- cardiac failure
These globular inclusions are misfolded alpha1-antitrypsin proteins in hepatocytes. They stain red after PAS staining
Andersen disease
Glycogen storage disease type IV
Genetic disease caused by deficiency of glycogen-branching enzyme
- results in accumulation of abnormal glycogen (amylopectin) in the liver, muscle and other tissues
- failure to thrive and hepatosplenomegaly
- progressive hepatic fibrosis leading to cirrhosis and liver failure
Most common genetic porphyria
Porphobilinogen deaminase – autosomal dominant
Clinically: colicky abdominal pain and neuropsychiatric symptoms
Neonatal hepatitis - classic feature on histology
Giant cell formation
Clinically will present with prolonged cholestasis, inflammation and cell injury
Neonatal hepatitis - causes?
About 50% of the cases are discernible
- alpha1-antitrypsin deficiency (30%)
- chromosomal abnormalities
- intrauterine infections
- biliary atresia
Scleroderma
characterized by systemic fibrosis with deposition of collagen affecting most organs.
Unknown etiology
- Diffuse disease –> Progressive Sclerosis Scleroderma (PSS)
- More benign disease –> CREST syndrome
Staining:
- Anti-Scl-70 positive
- ANA positive
Scleroderma - PSS
PSS = Progressive Sclerosis Scleroderma
- rapid progression and early visceral iinvolvement
- skin
- swelling that starts at fingers and continues proximally
- “tightened” facial features
- Raynaud’s phenomenon
- polyarthralgia
- GI
- heartburn + dysphagia for solids and liquids
- reflux due to esophageal dysmotility
- due to smooth muscle conversion to collagen
- malabsorbtion + bacterial overgrowth
- loss of villi with diverticula formation
- heartburn + dysphagia for solids and liquids
- respiratory
- dyspnea (due to interstitial fibrosis)
- renal
- vasculitides, infarctions, malignant hypertension
Scleroderma - CREST syndrome
Calcinosis (subcutaneous calcifications)
Raynaud’s phenomenon
Esophageal dysfunction (due to LES sclerosis likely resulting in dysphagia)
Sclerodactyly
Telangiectasia
dyspepsia
indigestion
hiatal hernia - symptoms
- heart burn
- regurgitation
mainly attributed to the reflux of stomach contents due to incompetence of the LES
What kind of necrosis is seen with the ingestion of acids?
akaline solutions?
acid –> coagulative necrosis (of the esophagus)
alkaline –> liquefactive –> inflammation and saponification thereafter
- much more dangerous/insidious than acidic, b/c they are generally odorless and tasteless and therefore easily swallowed before protective reflexes come into play
reflux esophagitis
common complication of hiatal hernia
- thickening of the basal layer of the squamous epithelium
- extension of the papillae of the lamina propria
- increased number of neutrophils and lymphocytes
- areas of gastric reflux are susceptible to erosions and ulcers and appear as linear vertical streaks
Candida esophagitis
Commonplace in immunocompromised persons.
- pseudomembranes are formed composing of fungal mycelia, fibrin and necrotic debris
- involvement of deeper layers of esophageal wall can lead to disseminated candidiasis as well as fibrosis which can create esophageal strictures
Classical symptoms
- dysphagia
- odynophagia (pain on swallowing)
Occurs in
- immunocompromised
- diabetics
- those receiving antibiotic therapy
odynophagia
pain on swallowing