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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
Q

What % functional capacity must be lost in liver before failure signs appear?

A

80-90%

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26
Q

Major zone where necrosis occurs in acetaminophen OD

A

Zone 3

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27
Q

What cell type produces factor 8?

A

Liver sinusoidal endothelial cells

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28
Q

Is cirrhosis a diagnosis?

A

No, its a response to injury

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29
Q

Five things that give points on the Child-Turcotte-Pugh calculator for chronic liver failure

A
  1. Bilirubin
  2. Albumin
  3. Ascites
  4. Encephalopathy
  5. INR
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30
Q

What causes itching?

A

Cholestasis

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31
Q

Which viral hepatitides can cause chronic infection in order from most to least likely

A
  1. Hep C
  2. Hep B
  3. Hep D (as a superinfection)
  4. Hep E (immunocompromised only)
  5. Hep A: never
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32
Q

Best indicator of chronicity of Hep B

A

Age at time of infection

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33
Q

RFs for progression in Hep C

A
  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
Q

Three major sx of a liver abscess

A

Fever, RUQ pain, tender hepatomegaly

35
Q

Examples of parasitic infections of the liver

A
  1. Malaria
  2. Schistosomiasis
  3. Strongyloides
  4. Cryptosporidium
  5. Leishmaniasis
  6. Echinococcus
  7. Amebiasis
  8. Flukes like clonorchis sinensis
36
Q

What pattern of hepatic injury do anabolic steroids, Abx, and ART cause?

A

Cholestatic

37
Q

What pattern of injury does acetaminophen cause?

A

Hepatocellular necrosis

38
Q

What pattern of injury is caused by: ethanol, corticosteroids, methotrexate, total parenteral nutrition, aspirin (Reye syndrome)

A

Fatty liver disease

39
Q

What neoplasm is caused by vinyl chloride?

A

Angiosarcoma

40
Q

What % of alcoholics will develop cirrhosis?

A

10-15%

41
Q

What CYP is involved with alcohol breakdown at high concentrations?

A

CYP2E1

42
Q

Main enzyme that breaks down alcohol

A

Alcohol dehydrogenase

43
Q

Most common cause of chronic liver disease in the US

A

HAFLD

44
Q

NASH

A

Non-alcoholic steatohepatitis; NAFLD with steatohepatic injury similar to those seen in alcoholic hepatitis

45
Q

Fibrosis on liver histo

A

Spider web of peri cellular collagen around the central vein

46
Q

Histo differences in pediatric NAFLD

A

More diffuse steatosis, portal fibrosis (rather than central), no ballooned hepatocytes

47
Q

Typical Fe stores in humans vs when hemochromatosis starts to manifest

A

Typical: 2-6g
Hemochromatosis: 20g+

48
Q

What gene encodes hepcidin?

A

HAMP

49
Q

Function of a1-antitrypsin

A

Inhibits proteases - particularly neutrophil elastase, cathespin G - neutrophil things

50
Q

Most commonly diagnosed inherited hepatic disorder in infants and children

A

A1-antitrypsin deficiency

51
Q

Lymphocytic infiltrate in liver in AIH

A

CD4 and CD8 T cells -> activate B cells to produce autoAbs

52
Q

Combination of which four features helps lead to diagnosis of autoimmune hepatitis

A
  1. Exclude other etiologies
  2. AutoAbs
  3. Elevation of serum IgG
  4. Supportive histo findings on liver biopsy
53
Q

Specific Abs in PBC

A

Anti-mitochondrial Abs against E2 component of pyruvate dehydrogenase complex

54
Q

In diagnosing PBC, two of the following must be present (3 things)

A
  1. Elevated ALP for 6+ months
  2. Anti-mitochondrial Abs
  3. Characteristic histological findings
55
Q

Classic Ab found in PSC

A

pANCA

56
Q

What condition often occurs in association with fibropolycystic disease of the liver?

A

Poly cystic renal disease

57
Q

Caroli disease

A

Multi focal cystic dilation of large intrahepatic bile ducts

58
Q

Caroli syndrome

A

Caroli disease + congenital hepatic fibrosis

59
Q

Classic triad seen in Budd-Chiari syndrome

A

Hepatomegaly + abd pain + ascites

60
Q

Common site of complication from transplant of BM, kidney, and other solid organs

A

Liver, as a graft-vs-host reaction

61
Q

Most common cause of jaundice in pregnancy

A

Viral hepatitis

62
Q

Why are liver infarcts pretty rare?

A

Dual blood supply thru hepatic artery and portal vein

63
Q

Most common cause of small portal vein branch obstruction

A

Schistosomiasis

64
Q

Most common benign neoplasm of the liver

A

Cavernous hemangioma of the liver

65
Q

Most common liver tumor of early childhood

A

Hepatoblastoma

66
Q

Most common primary malignancy of hepatocytes

A

HCC

67
Q

Biliary adenocarcinoma

A

Tumor arising from extrahepatic bile ducts

68
Q

Metastatic liver malignancy

A

Far more common than primary hepatic neoplasia

69
Q

Common primary sources that metastasize to the lungs

A

Colon, breast, lung, pancreas

70
Q

What part of the embryo gut do the gallbladder and biliary system come from?

A

Foregut

71
Q

How much bile can the liver secrete per day?

A

1L

72
Q

Capacity of the gallbladder

A

50 mL

73
Q

What hormone causes gallbladder to contract and release bile + cause sphincter of Oddi to relax?

A

CCK

74
Q

Most common gallbladder anomaly

A

Folded fundus -> creates a Phrygian cap

75
Q

Gallstone ileus / Bouveret syndrome

A

Large gallstone erodes directly into an adjacent loop of SI -> intestinal obstruction

76
Q

Are gallbladder gangrene and perforation ore common in calculous or acalculous cholecystitis

A

Acalculous

77
Q

Complications of both acute and chronic cholecystitis

A
  1. Bacterial superinfection
  2. Gallbladder perforation
  3. Gallbladder rupture
  4. Biliary fistula
  5. Aggravation of pre-existing medical illness
78
Q

Most common malignancy of extrahepatic biliary tract

A

Carcinoma of the gallbladder

79
Q

Other names for idiopathic retroperitoneal fibrosis

A
  1. Sclerosing retroPeritonitis
  2. Ormond disease
  3. IgG4 disease
80
Q

Three major tumors of peritoneum

A
  1. Mesothelioma**
  2. Desmoplastic small round cell tumor
  3. Metastases

2: GI2 Exam 2 (12 decks)

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