XVI - The Liver, Gallbladder and Biliary Tree Flashcards Preview

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Flashcards in XVI - The Liver, Gallbladder and Biliary Tree Deck (153):
1

Marked cell enlargement with irregularly clumped cytoplasm showing large, clear space

Ballooning degeneration (TOPNOTCH) Robbins Basic Pathology, 8th ed,. 633

2

Multiple tiny fat droplets that do not displace the nucleus which appear in such conditions as alcoholic liver disease, Reye syndrome, and acute fatty liver of pregnancy.

Microvesicular steatosis Robbins Basic Pathology, 8th ed, p. 633

3

A single large fat droplet that displaces the nucleus seen in alcoholic liver disease or in the livers of obese or diabetic individuals.

Macrovesicular steatosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 633

4

Diffuse, foamy, swollen appearance to the hepatocyte caused by retained biliary material.

Feathery degeneration(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 633

5

Poorly stained mummified hepatocytes

Coagulative necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 633

6

Isolated hepatocytes become shrunken, pyknotic, and intensely eosinophilic.

Apoptosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 633

7

Hepatocyte necrosis is distributed immediately around the central vein, extending into the midzonal area in the setting of ischemia and several drug and toxic reactions.

Centrilobular necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 633

8

A pattern of nonrhythmic, rapid extension-flexion movements of the head and extremities, best seen when the arms are held in extension with dorsiflexed wrists, seen in patients with hepatic encephalopathy.

Asterixis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 635

9

A diffuse process characterized by bridging fibrous septa, in the form of delicate bands or broad scars around multiple adjacent lobes, and the conversion of normal liver architecture into structurally abnormal nodules, encircled by fibrotic bands. Liver architecture is disrupted.

Liver Cirrhosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 635

10

Presence of ground-glass hepatocytes, a finely granular, eosinophilic cytoplasm and sanded nuclei, shown by electron microscopy

Hepatitis B infection(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 645

11

Necrotic cells appear to have dropped out with collapse of the sinusoidal collagen reticulin framework where the cells have disappeared; scavenger macrophage aggregates mark sites of dropout.

Hepatocyte cytolysis (in viral hepatitis)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 647

12

Hepatocytes shrink, become intensely eosinophilic, and have fragmented nuclei; effector T cells may be present in the immediate vicinity.

Hepatocyte apoptosis (in viral hepatitis)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 647

13

The hallmark of serious liver damage

Fibrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 647

14

May occur as solitary or multiple lesions, ranging from millimeters to massive lesions, many centimeters in diameter. They are generally produced by gram-negative bacteria such as Escherichia coli and Klebsiella sp.

Pyogenic (bacterial) hepatic abscesses (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 648

15

Liver is enlarged, soft, yellow and greasy. Lipid accumulates to the point of creating large clear macrovesicular globules, compressing and displacing the nucleus to the periphery of the hepatocyte.

Hepatic Steatosis (Fatty Liver)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 649

16

Eosinophilic, cytoplasmic inclusions characteristic of alcoholic hepatitis.

Mallory bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 650

17

Almost always accompanied by a brisk sinusoidal and perivenular fibrosis; occasionally periportal fibrosis may predominate.

Alcoholic hepatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 650

18

Liver is yellow-tan, fatty, and enlarged, usually weighing over 2 kg. Over the span of years it is transformed into a brown, shrunken, nonfatty organ, sometimes weighing less than 1 kg.

Alcoholic Cirrhosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 650

19

Pattern of cirrhosis in viral hepatitis.

Macronodular(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 650

20

Pattern of cirrhosis in alcoholic hepatitis.

Micronodular(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 650

21

The liver may shrink to 500 to 700 gm and become transformed into a limp, red organ covered by a wrinkled, overly large capsule. Necrotic areas have a muddy red, mushy appearance with blotchy bile staining. Complete destruction of hepatocytes in contiguous lobules leaves only a collapsed reticulin framework and preserved portal tracts.

Massive hepatic necrosis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 653

22

Golden-yellow granules in the cytoplasm of periportal hepatocytes, which stain blue with the Prussian blue stain.

Hemosiderin(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 655

23

Green to brown deposits of copper in Descemet membrane in the limbus of the cornea.

Kayser-Fleischer rings (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 656

24

Excessive copper deposition in the liver causing hepatic changes ranging from mild fatty change to massive liver necrosis. In the brain, injury affects the basal ganglia, demonstrating atrophy and cavitation. Kayser-Fleischer rings are characteristic.

Wilson disease(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 655

25

Hepatocytes with round to oval cytoplasmic globular inclusions which are strongly positive in a periodic acid-Schiff stain. By electron microscopy they lie within smooth, and sometimes rough, endoplasmic reticulum.

Alpha-1 antitrypsin Deficiency(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 657

26

A rare disease characterized by microvesicular fatty change in the liver and encephalopathy. Microscopy of hepatocellular mitochondria reveals pleomorphic enlargement and electron lucency of the matrices, with disruption of cristae and loss of dense bodies.

Reye syndrome / "mitochondrial hepatopathies" (TOPNOTCH)Robbins Basic Pathology, 8th ed, p658

27

A chronic, progressive, and often fatal cholestatic liver disease, characterized by a nonsuppurative destruction of small and medium-sized intrahepatic bile ducts florid duct leesion. On cut surface, the liver is hard, with a finely granular appearance, with extraordinary yellow-green pigmentation.

Primary biliary cirrhosis (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 659

28

A chronic cholestatic disorder, characterized by progressive fibrosis and destruction of extrahepatic and large intrahepatic bile ducts. Affected portal tracts show concentric periductal onion-skin fibrosis and a modest lymphocytic infiltrate. Progressive atrophy of the bile duct epithelium leads to obliteration of the lumen, leaving behind a solid, cordlike fibrous scar.

Primary sclerosing cholangitis (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 660

29

Liver is slightly enlarged, tense, and cyanotic, with rounded edges. Microscopically, there is congestion of centrilobular sinusoids. With time, centrilobular hepatocytes become atrophic, resulting in markedly attenuated liver cell cords. Liver fibrosis mostly "centrilobular".

Passive congestion of the liver secondary to right-sided heart failure.(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 660

30

Hepatocytes in the central region of the lobule undergo ischemic necrosis. The liver takes on a variegated mottled appearance, reflecting hemorrhage and necrosis in the centrilobular regions, alternating with pale midzonal areas, known traditionally as the "nutmeg" liver.

Passive congestion of the liver secondary to left-sided heart failure.(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 661

31

A rare condition wherein there is primary dilation of sinusoids, impeding hepatic blood efflux. Associated with exposure to anabolic steroids, OCP's and danazol.

Peliosis hepatis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 661

32

Results from the thrombosis of two or more major hepatic veins and is characterized by hepatomegaly, weight gain, ascites, and abdominal pain. The liver is swollen, is red-purple, and has a tense capsule. The affected hepatic parenchyma reveals severe centrilobular congestion and necrosis.

Budd-Chiari syndrome (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 662

33

Caused by toxic injury to sinusoidal endothelium. Damaged endothelial cells slough off and create emboli that block blood flow. Accompanied by passage of red blood cell into the space of Disse, proliferation of stellate cells, and fibrosis of terminal branches of the hepatic vein.

Sinusoidal Obstruction Syndrome (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 662

34

Well-demarcated but poorly encapsulated lesion, consisting of hyperplastic hepatocyte nodules with a central fibrous scar. Appears in noncirrhotic livers and may reach up to many centimeters in diameter. It occurs in response to local vascular injury.

Focal nodular hyperplasia (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 664

35

These appear in cirrhotic livers, are larger than surrounding cirrhotic nodules but do not display atypical features. Contains more than one portal tract, have an intact reticulin framework, and do not seem to be precursors of malignant lesions.

Macroregenerative nodules (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 664

36

These are lesions larger than 1 mm in diameter that appear in cirrhotic livers. Considered to be precursors of hepatocelluar cancers, are often monoclonal, and may contain chromosome aberrations similar to those present in liver cancers.

Dysplastic nodules (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 664

37

May appear grossly as (1) a unifocal, usually massive tumor, (2) a multifocal tumor made of nodules of variable size or (3) a diffusely infiltrative cancer, permeating widely and sometimes involving the entire liver, blending imperceptibly into the cirrhotic liver background.

Primary Hepatocellular Carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 665

38

A distinctive variant of HCC, which occurs in adults (

Fibrolamellar carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed, p. 873

39

Gallbladder stones that are mostly radiolucent, ovoid and firm; can occur singly but most often there are several, with faceted surfaces resulting from apposition to one another. They are pale yellow but w/ increasing proportions of CaCO3, phosphates and bilirubin, they turn gray-white to black and radiopaque.

Cholesterol stones (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 668

40

May arise anywhere in the biliary tree and are trivially classified as black and as brown. Contain calcium salts of unconjugated bilirubin and lesser amounts of other calcium salts, mucin glycoproteins, and cholesterol.

Pigment stones(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 668

41

A type of pigment stone found in sterile gallbladder bile, usually small and present in large quantities and crumble easily. 50% to 75% are radiopaque.

Black pigment stones (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 668

42

A type of pigment stone found in infected intrahepatic or extrahepatic ducts. Tends to be single or few in number and are soft with a greasy, soaplike consistency that results from the presence of retained fatty acid salts released by the action of bacterial phospholipases on biliary lecithins. Contains calcium soaps, and are radiolucent.

Brown pigment stones(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 668

43

Gallbladder is usually enlarged (twofold to threefold) and tense, and it assumes a bright red or blotchy, violaceous to green-black discoloration, imparted by subserosal hemorrhages. The gallbladder lumen is filled with a cloudy or turbid bile that may contain fibrin, blood, and frank pus.

Acute cholecystitis (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 669

44

Condition wherein the exudate contained in the gallbladder is composed virtually of pure pus.

Empyema of the gallbladder(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 669

45

Severe cholecystitis wherein the GB is transformed into a green-black necrotic organ.

Gangrenous cholecystitis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 669

46

The gallbladder may be contracted, of normal size, or enlarged. Presence of stones in the absence of inflammation is diagnostic.

Chronic cholecystitis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 669

47

Defined as a complete obstruction of bile flow caused by destruction or absence of all or part of the extrahepatic bile ducts.

Biliary atresia (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 670

48

Appears as a poorly defined area of diffuse thickening and induration of the gallbladder wall that may cover several square centimeters or involve the entire gallbladder, scirrhous and very firm in consistency.

Infiltrating pattern of gallbladder carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 671

49

This pattern of GB carcinoma grows into the lumen as an irregular, cauliflower mass, but at the same time it invades the underlying wall.

Exophytic pattern of gallbladder carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 671

50

Appear typically with an abundant fibrous stroma (desmoplasia) explaining their firm, gritty consistency. Most exhibit clearly defined glandular and tubular structures lined by somewhat anaplastic cuboidal to low columnar epithelial cells. Bile pigment and hyaline inclusions are not found within the cells.

Cholangiocarcinomas (TOPNOTCH)Robbins Basic Pathology, 8th ed, p. 672

51

Morphology: Characterized by fibrosing cholangitis of bile ducts, with a lymphocytic infiltrate, and progressive atrophy of the bile duct epithelium, and obliteration of the lumen

Primary Sclerosing Cholangitis(TOPNOTCH)

52

Morphology: Concentric periductal fibrosis or Onion-Skin fibrosis with solid, cordlike fibrous scar.

Primary Sclerosing Cholangitis(TOPNOTCH)

53

Morphology: Panlobular giant cell transformation of hepatocytes and formation of hepatocyte "rosettes"

Neonatal Cholestasis(TOPNOTCH)

54

What is the histological hallmark of irreversible liver damage?

Deposition of fibrous tissue(TOPNOTCH)

55

"Ground Glass Hepatocytes" are seen in what type of Viral Hepatitis?

Hepatitis B(TOPNOTCH)

56

What type of viral hepatitis frequently show lymphoid aggregates within portal tracts?

Hepatitis C(TOPNOTCH)

57

What is the most common liver tumor of young childhood?

Hepatoblastoma(TOPNOTCH)

58

What are the most common benign neoplasm in the liver?

Hemangiomas(TOPNOTCH)

59

These benign neoplasms tend to occur in young women who have used oral contraceptives and regress on discontinuance of their use.

Liver cell Adenoma(TOPNOTCH)

60

Rokitansky- Aschoff sinuses are structures seen in what organ?

Gallbladder(TOPNOTCH)

61

What is the most common congenital anomaly of the gallbladder?

Presence of Phrygian Cap (folded fundus)(TOPNOTCH)

62

What is the tetralogy of cholesterol stone formation?

1. Supersaturation of bile with cholesterol2. Gallbladder hypomotility3. Cholesterol nucleation4. Hypersecretion of GB mucus(TOPNOTCH)

63

AKA Strawberry Gallbladder

Cholesterolosis(TOPNOTCH)

64

Acute calculous cholecystitis is most commonly precipitated by what condition?

Obstruction of the neck or cystic duct by a Gallbladder stone(TOPNOTCH)

65

Morphology: Prominence of Rokitansky-Aschoff sinuses

Chronic Cholecystitis(TOPNOTCH)

66

What is the most common cause of cholangitis?

Choledocholithiasis(TOPNOTCH)

67

True or False. Gallstones are seen in 60%-90% of Carcinoma of the Gallbladder.

True(TOPNOTCH)

68

What is the most common growth pattern of Gallbladder carcinoma? Infiltrating or Exophytic?

Infiltrating(TOPNOTCH)

69

These are tumors arising from the part of the common bile duct between the cystic duct junction and the confluence of the right and left hepatic ducts at the liver hilus

Klatskin tumors(TOPNOTCH)

70

Morphology: feathery degeneration and focal detergent dissolution of hepatocytes, giving rise to bile lakes filled with cellular debris and pigment

Cholestasis(TOPNOTCH)

71

What does unrelieved cholestasis lead to?

Portal tract fibrosis(TOPNOTCH)

72

What is the outcome of 85% of Acute Hepatitis infection?

Chronic Hepatitis(TOPNOTCH)

73

These inclusions are a characteristic but not specific feature of alcoholic liver disease.

Mallory bodies(TOPNOTCH)

74

Morphology: macrovesicular steatosis, involving most regions of the hepatic lobule. The intracytoplasmic fat is seen as clear vacuoles.

Alcoholic liver disease(TOPNOTCH)

75

What zone of the liver if particularly vulnerable of ischemic injury and number of drug and toxic reactions?

Centrilobular zone(TOPNOTCH)

76

What zone of the liver is particularly affected in eclampsia?

Periportal zone(TOPNOTCH)

77

At least how many percent of the liver must be damaged before hepatic failure ensues?

at least 80%(TOPNOTCH)

78

What are the 4 major consequences of portal hypertension?

Ascites, formation of portosystemic venous shunts, congestive splenomegaly, and hepatic encephalopathy(TOPNOTCH)

79

Ascites becomes clinically detectable at what amount?

500 ml(TOPNOTCH)

80

Morphology: portal tract expansion with inflammatory cells and fibrous tissue and interface hepatitis with spillover of inflammation into the adjacent parenchyma. Lymphoid aggregates can also be seen.

Chronic Viral Hepatitis C(TOPNOTCH)

81

Morphology: liver biopsy shows steatosis, multifocal parenchymal inflammation, Mallory hyaline, hepatocyte death, and sinusoidal fibrosi

Steatohepatitis or Nonalcoholic Steatohepatitis(TOPNOTCH)

82

In Hemochromatosis, what is the most common site of hemosiderin deposition?

Liver(TOPNOTCH)

83

What are the 3 clinical features of Hemochromatosis?

Deposition of hemosiderin, cirrhosis, and pancreatic fibrosis(TOPNOTCH)

84

Morphology: characterized by the presence of round to oval cytoplasmic globular inclusions in hepatocytes, which in routine H and E stains are acidophilic and indistinctly demarcated from the surrounding cytoplasm

A1 antitrypsin deficiency(TOPNOTCH)

85

Morphology: characterized by coarse fibrous septae that subdivide the liver in a jigsaw like pattern

Secondary biliary cirrhosis(TOPNOTCH)

86

Morphology: florid duct lesion

Primary Biliary Cirrhosis(TOPNOTCH)

87

The combination of hypoperfusion and retrograde congestion acts synergistically to generate what type of necrosis in the liver?

Centrolobular hemorrhagic necrosis(TOPNOTCH)

88

Morphology: periportal sinusoids contain fibrin deposits with hemorrhage into the space of Disse, leading to periportal hepatocellular coagulative necrosis

Pre-Eclampsia/Eclampsia(TOPNOTCH)

89

Type of liver transplant rejection : severe obliterative arteritis of small and larger arterial vessels results in ischemic changes in the liver parenchyma

Chronic Rejection(TOPNOTCH)

90

Type of liver transplant rejection: infiltration of a mixed population of inflammatory cells into portal tracts, bile ducts, and hepatocyte injury and endothelitis

Acute cellular rejections(TOPNOTCH)

91

What do you call the small tubular channels that are sometimes burried within the gallbladder wall adjacent to the liver?

Ducts of Luschka(TOPNOTCH)

92

What is the most common congenital anomaly seen in the Gallbladder?

A folded fundus or so called phrygian cap(TOPNOTCH)

93

Gross morphology: the mucosal surface of the gallbladder is studded with minute yellow flecks

Strawberry Gallbladder(TOPNOTCH)

94

What type of pigment stones are generally seen in infected intrahepatic or extra hepatic ducts?

Brown pigment stones(TOPNOTCH)

95

Gross morphology: GB is shrunken, nodular, and chronically inflamed with foci of necrosis and hemorrhage

Xanthogranulomatous cholecystitis(TOPNOTCH)

96

Hallmarks of HCV infection

Persistent infection and chronic hepatitis (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 834

97

Defining histologic feature of chronic viral hepatitis

Mononuclear portal infiltration (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 837

98

Diagnostic hallmark of Hepatitis B; these are cells with ER swollen by HBsAg

Ground-glass hepatocytes(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 837

99

Characteristic feature of alcoholic hepatitis which present as clumped, amorphous, eosinophilic material in ballooned hepatocytes. May also be present in Wilson disease and in chronic biliary tract disease.

Mallory-Denk bodies (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 843

100

Deeply eosinophilic staining apoptotic hepatocytes seen in acute and chronic hepatitis.

Acidophilic bodies (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 823

101

The principal cell type involve in scar deposition in the liver

Hepatic stellate cell(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 823

102

Associated with encephalopathy and coagulopathy that occurs within 26 weeks of initial liver injury in the absence of pre-existing liver disease, caused by massive hepatic necrosis

Acute liver failure(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 825

103

Most common intrahepatic cause of portal hypertension

Cirrhosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 828

104

Most frequent mode of transmission of HBV in high prevalence regions

Transmission during childbirth(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 832

105

Most frequent mode of transmission of HBV in low prevalence regions

Unprotected sex and IV drug abuse(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 832

106

Serologic marker detected during window period of HBV infection

IgM anti-HBc antibody(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 833

107

Best predictor of chronicity of HBV infection

Age at the time of infection(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 833

108

Most common risk factor for HCV infection

IV drug abuse(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 834

109

Type of viral hepatitis associated with metabolic syndrome

Hepatitis C virus infection (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 835

110

Type of viral hepatitis implicated in the high mortality rate among pregnant women

Hepatitis E Virus infection(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 835

111

Main inflammatory cells in both acute and chronic viral hepatitis

T cells(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 839

112

Type of autoimmune hepatitis most often seen in middle-aged women and is most characteristically associated with antinuclear and anti-smooth muscle antibodies

Type 1 autoimmune hepatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 840

113

Type of autoimmune hepatitis most often seen in children or teenager and is associated with anti-liver kidney microsomal autoantibodies

Type 2 autoimmune hepatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 840

114

Predominant cells and characteristic component of inflammatory infiltrate in biopsy specimens showing autoimmune hepatitis

Plasma cells(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 840

115

Most common hepatotoxin causing acute liver failure

Acetaminophen(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 841

116

Most common hepatotoxin causing chronic liver disease

Alcohol(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 841

117

Characterized by hepatocyte swelling and necrosis, Mallory-Denk bodies, neutrophilic reaction, fibrosis, perisinosoidal scar in the space of Disse of the centrilobilar region

Alcohol Hepatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 843

118

Micronodular cirrhosis described for end-stage alcoholic liver disease due o long-term alochol use

Laennec cirrhosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 843

119

Volume threshold for the developmet of alcoholic liver disease

80gm/day of alcohol(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 845

120

Most common site of hemosiderin deposition

Liver(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 848

121

An autosomal disorder caused by mutation of ATP7B gene resulting in impaired copper excretion into bile and failure to incorporate copper into ceruloplasmin

Wilson Disease(TOPNOTCH)Robbins Basic Pathology, 9th ed, p. 849

122

Presents with movement disorders (tremor, chorea, tremor),rigid dystonia, psychiatric symptoms, hemolytic anemia, green to brown deposits in Descemet membrane in the limbus

Wilson Disease(TOPNOTCH)Robbins Basic Pathology, 9th ed, p. 849

123

Most sensitive and accurate test for Wilson disease

Increase in hepatic copper content(TOPNOTCH)Robbins Basic Pathology, 9th ed, p. 850

124

Most specific screening test for Wilson Disease

Increased urinary excretion of copper copper content(TOPNOTCH)Robbins Basic Pathology, 9th ed, p. 850

125

Most characteristic laboratory finding in primary biliary cirrhosis

Antimitochondrial antibodies(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 858

126

Mechanism of physiologic jaundice of the newborn

Impaired bilirubin conjugation(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 853

127

Hereditary unconjugated hyperbilirubinemia caused by severe UGT1A1 deficiency and is fatal around the time of birth

Crigler-Najjar syndrome type 1(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 853

128

An autosomal recessive disorder caused by impaired biliary excretion of bilirubin glucoronides due to mutation in canalicular multidrug resistance protein 2(MRP2)

Dubin-Johnson syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 854

129

Most common cause of bile duct obstruction in adults

Extrahepatic cholelithiasis(gallstones)(TOPNOTCH)Robbins Basic Pathology,9th ed., p. 854

130

Histologic hallmark: influx of periductular neutrophils directly into the bile duct epithelium and lumen

Ascending cholangitis(TOPNOTCH)Robbins Basic Pathology,9th ed., p. 854

131

Most common form of cholestasis of sepsis wherein bile plugs within predominantly centrilobular canaliculi

Canalicular cholestasis(TOPNOTCH)Robbins Basic Pathology,9th ed., p. 855

132

Disorder of intrahepatic gallstone formation leading to repeated bouts of ascending cholangitis; has pigmented calcium bilirubinate stones in distended intrahepatic bile ducts

Hepatolithiasis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 856

133

Presents with neonatal cholestasis, normal birthweight and postnatal weight gain, initially normal stools change to acholic stools.

Biliary atresia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 857

134

Morphology: Inflammation and fibrosing stricture of the hepatic or common bile ducts; cirrhosis develops within 3-6 mos of birth if uncorrected

Biliary atresia(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 857

135

Florid duct lesion by liver biopsy, elevated alkaline phosphatase and gamma-glutamyltransferase, hypercholesterolemia,

Primary biliary cirrhosis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 858

136

Presents with characteristic beading on radiographs of intrahepatic and extrahepatic biliary tree; strong association with IBD particularly ulcerative colitis

Primary biliary cirrhosis(TOPNOTCH)Robbins Basic Pathology, 9th ed. P. 861

137

Presents most often in children before age 10 as jaundice, recurrent abdominal pain, symptoms that are typical of biliary colic; caused by congenital dilations of CBD

Choledochal cyst(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 861

138

Presents with liver enlargement, pain, and ascites due to obstruction of two or more hepatic veins.

Budd-Chiari syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 863

139

Most important premalignant lesions for cholangiocarcinoma

Biliary intraepithelial neoplasias(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 874

140

Most common malignancy of the extrahepatic biliary tract

Carcinoma of the gallbladder(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 879

141

Most important risk factor for gallbladder cancer

Gallstones(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 879

142

Atrophic, chronically obstructed, often dilated gallbladder, containing clear secretions

Hydrops of the gallbladder(TOPNOTCH)

143

Patients with chronic hemolytic anemias, severe ileal dysfunction or bypass, and bacterial contamination of the biliary tree are at risk for developing what kind of gallbladder stones?

Pigment stones(TOPNOTCH)

144

In severe form of this condition, patient presents with micronodular cirrhosis, diabetes mellitus, and abnormal skin pigmentation.

Hemochromatosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 847

145

A 28 year old man with a history of IV drug abuse develops jaundice and malaise. Which of the following liver biopsy findings particularly suggests a hepatitis C infection? (A) ballooning degeneration of hepatocytes (B) ground glass appearance of hepatocyte cytoplasm, with "sanded" nuclei (C) bile duct proliferation and lymphoid aggregate formation (D) tangled skeins of pink cytoplasmic inclusions in degenerating hepatocytes, with neutrophilic infiltrates

bile duct proliferation and lymphoid aggregate formation (TOPNOTCH)Robbins Basic Pathology, 8th ed, p646-647

146

A 25 year old medical intern draws blood from a chronic hepatitis B patient sustains a needlestick injury. He forgets to consult the infection control unit, and develops jaundice 2 months later. A biopsy of his liver will show (A) hemosiderin-laden periportal hepatocytes ((B) ground glass appearance of hepatocyte cytoplasm, with "sanded" nuclei (C) bile duct proliferation and lymphoid aggregate formation (D) tangled skeins of pink cytoplasmic inclusions in degenerating hepatocytes, with neutrophilic infiltrates

ground glass appearance of hepatocyte cytoplasm, and "sanded" nuclei (TOPNOTCH)Robbins Basic Pathology, 8th ed, p646-647

147

A 45 year old male during a drinking spree gets into a fight, and is stabbed. A medicolegal autopsy is performed. Given his chronic alcoholism, his liver will likely show (A) hemosiderin-laden periportal hepatocytes (B) ground glass appearance of hepatocyte cytoplasm, with "sanded" nuclei (C) bile duct proliferation and lymphoid aggregate formation (D) tangled skeins of pink cytoplasmic inclusions in degenerating hepatocytes, with neutrophilic infiltrates

tangled skeins of pink cytoplasmic inclusions in degenerating hepatocytes (Mallory bodies), with neutrophilic infiltrates (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 649-650

148

Which of the following is most likely to have nonalcoholic fatty liver disease? (A) 28 year old overweight man with dyslipidemia and family history of Type 2 DM (B) 14 year old student with alpha thalassemia with history of multiple blood transfusions since childhood (C) 33 year old teacher on his 1st month of taking anti-Koch's medication (D) 44 year old architect with a 30 pack year smoking history

28 year old overweight man with dyslipidemia and family history of Type 2 DM (insulin resistance) (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 654

149

A 40 year old man with beta thalassemia and long history of blood transfusions dies of congestive heart failure. At autopsy, his liver, heart, and pancreas appear dark brown. Histologic examination of his liver shows hepatocytes with golden brown cytoplasmic granules. These granules will stain with (A) prussian blue (B) rhodanine (C) periodic acid schiff (D) hematoxylin

Prussian blue (iron stain)(TOPNOTCH)Robbins Basic Pathology, 8th ed, p 654-655

150

Patients with hemochromatosis have a 200-fold higher risk of developing which malignancy compared to the normal population?

hepatocellular carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 656

151

A 30 year old male with inflammatory bowel disease develops jaundice. On hepatic ultrasound, there are strictures and beading of the large bile ducts, and pruning of the small bile ducts. A liver biopsy showed portal tracts with concentric periductal onion-skin fibrosis, and a modest lymphocytic infiltrate. In five years, he has a 10 to 15% chance of developing (A) colorectal carcinoma (B) hepatocellular carcinoma (C) cholangiocarcinoma (D) hepatic lymphoma

cholangiocarcinoma (primary sclerosisng cholangitis) (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 659

152

In which of the following conditions is Budd-Chiari syndrome most likely? (A) Christmas disease (B) von Willebrand disease (C) Factor VIII deficiency (D) pregnancy

pregnancy (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 662

153

Which of the following is a risk factor for the development of cholangiocarcinoma? (A) primary sclerosing cholangitis (B) exposure to the radiologic agent Thorotrast (C) infection with Clonorchis (D) all of the above

all of the above (TOPNOTCH)Robbins Basic Pathology, 8th ed, p 671