XVI - The Liver, Gallbladder and Biliary Tree Flashcards Preview

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Flashcards in XVI - The Liver, Gallbladder and Biliary Tree Deck (102)
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32

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, p660

33

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, p661

34

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, p661

35

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, p662

36

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, p662

37

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, p664

38

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, p664

39

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, p664

40

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, p665

41

A distinctive variant of HCC, which occurs in young male and female adults (20-40 years of age) of equal incidence, no association with cirrhosis or other risk factors. usually consists of a single large, hard "scirrhous" tumor with fibrous bands coursing through it. Composed of well-differentiated polygonal cells growing in nests or cords and separated by parallel lamellae of dense collagen bundles.

Fibrolamellar carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed, p665

42

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, p668

43

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, p668

44

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, p668

45

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, p668

46

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, p669

47

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

Empyema of the gallbladder(TOPNOTCH)Robbins Basic Pathology, 8th ed, p669

48

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

Gangrenous cholecystitis(TOPNOTCH)Robbins Basic Pathology, 8th ed, p669

49

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, p669

50

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, p670

51

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, p671

52

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, p671

53

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, p672

54

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)

55

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

Primary Sclerosing Cholangitis(TOPNOTCH)

56

"Beading" of barium column in radiographs of the intrahepatic and extrahepatic biliary tree

Primary Sclerosing Cholangitis(TOPNOTCH)

57

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

Neonatal Cholestasis(TOPNOTCH)

58

What is the histological hallmark of irreversible liver damage?

Deposition of fibrous tissue(TOPNOTCH)

59

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

Hepatitis B(TOPNOTCH)

60

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

Hepatitis C(TOPNOTCH)

61

A characteristic feature of this type of viral hepatitis is the high mortality rate among pregnant women, approaching 20%

Hepatitis E(TOPNOTCH)