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2: GI2 Exam 2 > 20: Liver + Some Gallbladder Pathology > Flashcards

20: Liver + Some Gallbladder Pathology Flashcards

1
Q

HBx Ag in Hepatitis B + what it indicates

A

X protein - is a transcription transactivator - indicates HBV-related HCC

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2
Q

Avg weight of the liver

A

1500 g

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3
Q

Organization of liver parenchyma

A

Separated into lobules, composed of six acini, with three zones from exterior to interior (next to central vein)

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4
Q

Two types of blood that mix in the liver

A

Portal venous blood + hepatic arterial blood

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5
Q

What type of cells are Kupffer cells and stellate cells?

A

Kupffer: monocytic
Stellate: fat-containing myofibroblastic

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6
Q

Path of bile from hepatocytes to terminal bile ducts

A

Hepatocytes -> bile canaliculi -> canals of Hering -> bile ductules -> terminal bile ducts

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7
Q

Two causes of direct hyperbilirubinemia (rest of the things are typically indirect)

A
  1. Canalicular membrane transporter deficiency (Dubin-Johnson, Rotor syndrome)
  2. Impaired bile flow from duct obstruction or autoimmune cholangiopathies
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8
Q

Normal range for conjugated and unconjugated bilirubin in blood

A
  1. Conjugated: 0.1-0.3 mg/dL

2. Unconjugated: 0.2-0.9mg/dL

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9
Q

What is frequently the first or only sign of liver disease

A

Abnormal lab tests

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10
Q

If GGT is normal, what is likely?

A

Liver disease is not likely

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11
Q

Elevated AST:ALT with a 2:1 ratio is classic for what?

A

Alcoholic hepatitis

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12
Q

Why is GGT important to test for along with ALP?

A

Bc ALP can be elevated in both liver and bone disease

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13
Q

Testing PT vs albumin gives a picture of what?

A

PT: acute changes
Albumin: chronic changes

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14
Q

Gamma globulins are increased in acute or chronic liver processes?

A

Chronic

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15
Q

Four general patterns when assessing liver function tests and what they present with

A
  1. Acute hepatitis: elevated ALT/AST
  2. Cirrhosis: decreased albumin + elevated gamma globulins and PT
  3. Chronic hepatitis: acute hep + cirrhosis findings
  4. Obstructive liver disease/cholestasis: elevated ALP and bilirubin
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16
Q

Pattern of death seen in acute toxic or ischemic injuries to the liver

A

Coagulation necrosis

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17
Q

What does an apoptotic cell on histo look like?

A

Mass of intensely eosinophilic cytoplasm

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18
Q

Major cell involved in scar deposition in liver

A

Hepatic stellate cell

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19
Q

What vitamin do hepatic stellate cells store?

A

Vitamin A

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20
Q

Two major mechanisms of liver regeneration

A
  1. Proliferation of remaining hepatocytes

2. Repopulation from progenitor cells

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21
Q

Three types of things that can active stellate cells

A
  1. Cytokines like TNF-a
  2. Altered interaction with ECM
  3. Toxins and ROS
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22
Q

Two mechanisms of how hepatocyte loss turns into dense fibrous septa in chronic liver disease

A
  1. Collapse of reticulin framework

2. Deposition of collagen by myofibroblasts

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23
Q

What type of nodules are a predominant feature in most cirrhotic liver

A

Regenerative nodules

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24
Q

Most sever type of liver disease

A

Liver failure (chronic or acute)

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25
What % functional capacity must be lost in liver before failure signs appear?
80-90%
26
Major zone where necrosis occurs in acetaminophen OD
Zone 3
27
What cell type produces factor 8?
Liver sinusoidal endothelial cells
28
Is cirrhosis a diagnosis?
No, its a response to injury
29
Five things that give points on the Child-Turcotte-Pugh calculator for chronic liver failure
1. Bilirubin 2. Albumin 3. Ascites 4. Encephalopathy 5. INR
30
What causes itching?
Cholestasis
31
Which viral hepatitides can cause chronic infection in order from most to least likely
1. Hep C 2. Hep B 3. Hep D (as a superinfection) 4. Hep E (immunocompromised only) 5. Hep A: never
32
Best indicator of chronicity of Hep B
Age at time of infection
33
RFs for progression in Hep C
1. Older age 2. Males 3. EtOH use 4. Immunosuppressive drugs 5. Hep B or HIV co-infection 6. Insulin resistance, DM, obesity, and metabolic syndrome
34
Three major sx of a liver abscess
Fever, RUQ pain, tender hepatomegaly
35
Examples of parasitic infections of the liver
1. Malaria 2. Schistosomiasis 3. Strongyloides 4. Cryptosporidium 5. Leishmaniasis 6. Echinococcus 7. Amebiasis 8. Flukes like clonorchis sinensis
36
What pattern of hepatic injury do anabolic steroids, Abx, and ART cause?
Cholestatic
37
What pattern of injury does acetaminophen cause?
Hepatocellular necrosis
38
What pattern of injury is caused by: ethanol, corticosteroids, methotrexate, total parenteral nutrition, aspirin (Reye syndrome)
Fatty liver disease
39
What neoplasm is caused by vinyl chloride?
Angiosarcoma
40
What % of alcoholics will develop cirrhosis?
10-15%
41
What CYP is involved with alcohol breakdown at high concentrations?
CYP2E1
42
Main enzyme that breaks down alcohol
Alcohol dehydrogenase
43
Most common cause of chronic liver disease in the US
HAFLD
44
NASH
Non-alcoholic steatohepatitis; NAFLD with steatohepatic injury similar to those seen in alcoholic hepatitis
45
Fibrosis on liver histo
Spider web of peri cellular collagen around the central vein
46
Histo differences in pediatric NAFLD
More diffuse steatosis, portal fibrosis (rather than central), no ballooned hepatocytes
47
Typical Fe stores in humans vs when hemochromatosis starts to manifest
Typical: 2-6g Hemochromatosis: 20g+
48
What gene encodes hepcidin?
HAMP
49
Function of a1-antitrypsin
Inhibits proteases - particularly neutrophil elastase, cathespin G - neutrophil things
50
Most commonly diagnosed inherited hepatic disorder in infants and children
A1-antitrypsin deficiency
51
Lymphocytic infiltrate in liver in AIH
CD4 and CD8 T cells -> activate B cells to produce autoAbs
52
Combination of which four features helps lead to diagnosis of autoimmune hepatitis
1. Exclude other etiologies 2. AutoAbs 3. Elevation of serum IgG 4. Supportive histo findings on liver biopsy
53
Specific Abs in PBC
Anti-mitochondrial Abs against E2 component of pyruvate dehydrogenase complex
54
In diagnosing PBC, two of the following must be present (3 things)
1. Elevated ALP for 6+ months 2. Anti-mitochondrial Abs 3. Characteristic histological findings
55
Classic Ab found in PSC
pANCA
56
What condition often occurs in association with fibropolycystic disease of the liver?
Poly cystic renal disease
57
Caroli disease
Multi focal cystic dilation of large intrahepatic bile ducts
58
Caroli syndrome
Caroli disease + congenital hepatic fibrosis
59
Classic triad seen in Budd-Chiari syndrome
Hepatomegaly + abd pain + ascites
60
Common site of complication from transplant of BM, kidney, and other solid organs
Liver, as a graft-vs-host reaction
61
Most common cause of jaundice in pregnancy
Viral hepatitis
62
Why are liver infarcts pretty rare?
Dual blood supply thru hepatic artery and portal vein
63
Most common cause of small portal vein branch obstruction
Schistosomiasis
64
Most common benign neoplasm of the liver
Cavernous hemangioma of the liver
65
Most common liver tumor of early childhood
Hepatoblastoma
66
Most common primary malignancy of hepatocytes
HCC
67
Biliary adenocarcinoma
Tumor arising from extrahepatic bile ducts
68
Metastatic liver malignancy
Far more common than primary hepatic neoplasia
69
Common primary sources that metastasize to the lungs
Colon, breast, lung, pancreas
70
What part of the embryo gut do the gallbladder and biliary system come from?
Foregut
71
How much bile can the liver secrete per day?
1L
72
Capacity of the gallbladder
50 mL
73
What hormone causes gallbladder to contract and release bile + cause sphincter of Oddi to relax?
CCK
74
Most common gallbladder anomaly
Folded fundus -> creates a Phrygian cap
75
Gallstone ileus / Bouveret syndrome
Large gallstone erodes directly into an adjacent loop of SI -> intestinal obstruction
76
Are gallbladder gangrene and perforation ore common in calculous or acalculous cholecystitis
Acalculous
77
Complications of both acute and chronic cholecystitis
1. Bacterial superinfection 2. Gallbladder perforation 3. Gallbladder rupture 4. Biliary fistula 5. Aggravation of pre-existing medical illness
78
Most common malignancy of extrahepatic biliary tract
Carcinoma of the gallbladder
79
Other names for idiopathic retroperitoneal fibrosis
1. Sclerosing retroPeritonitis 2. Ormond disease 3. IgG4 disease
80
Three major tumors of peritoneum
1. Mesothelioma** 2. Desmoplastic small round cell tumor 3. Metastases

2: GI2 Exam 2 (12 decks)

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