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CS4: Exam 3 > 34/36: Liver Pathology II - Carnevale > Flashcards

34/36: Liver Pathology II - Carnevale Flashcards

1
Q

presentation of primary biliary cirrhosis

A

pts present with fatigue and itching and progresses over 10-15 yrs presenting with progressive jaundice

pruritus
jaundice
steatorrhea
osteomalacia/osteoporosis
xanthomas
portal hypertension
hepatic failure
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2
Q

lab results primary biliary cirrhosis diagnosis

A

increased AMA, anti M2, IgM, AP5’NT/GGT, cholesterol

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3
Q

risk factors for primary sclerosing cholangitis

A

fibrous obliterative cholangitis
M>F
less than 50 yo
ulcerative colitis

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4
Q

s/s primary sclerosing cholangitis

A 
jaundice
pruritus
WL
abdominal pain
cholangitis 
liver failure
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5
Q

lab results that diagnose primary sclerosing cholangitis

A 
increase all of the following:
AP
GGt
5NT
ALT/AST
ANA, anti SMAb
pANCA
globulins

ERCP (endoscopic retrograde cholangiography shows beaded sclerosis)

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6
Q

complications of primary sclerosing cholangitis

A 
chronic cholestasis
cholangitis
secondary biliary cirrhosis
liver failure
cholangiocarcinoma
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7
Q

condition in which the patients own immune system attacks the liver causing inflammation and liver cell death

A

autoimmune hepatitis

  • a chronic and progressive condition but may present acutely and be confused
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8
Q

autoantibodies: ANA, SMA, anti-LKM1

no viral markers, no AMA

increased globulines/IgG

A

autoimmune hepatitis

associated with other autoimmune disease as well

increase association with HLA DR4

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9
Q

which zone is affected by hepatic injury first?

A

zone 3 - centrilobular regions usually affected first because less oxygen here

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10
Q

phase I biotransformation is associated with… phase II is associated with

A

P450

glutathione S transferase
glucuronyl transferase

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11
Q

drug-induced liver disease morphology

tetracycline
methotextrate
acetaminophen
isoniazid
 halothane
amiodarone
steroids
erythromycin
A 
microsteatosis
macrosteatosis
necrosis
hepatitis
hepatitis
fibrosis  
clholestasis
cholestasis
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12
Q

alcoholic liver disease develops in man who consumes… and woman who consumes…

A

greater than 80 g/day (6 pack)

greater than 40 g/day

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13
Q

liver
fatty change
perivenular fibrosis

A

steatosis

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14
Q 
liver
liver cell necrosis
inflammation
mallory bodies
fatty change
A

hepatitis

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15
Q

liver
fibrosis
hyperplastic nodules

A

cirrhosis

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16
Q

foal lytic necrosis
mallory bodies
megamitochondria

indicate…

A

alcoholic hepatitis

longer abuse will see central hyaline sclerosis or chicken wire fibrosis or bridging fibrosis

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17
Q

clinical s/s alcoholic steatohepatitis

A 
fever
leukocytosis
jaundice
increased AST and ALT less than 500 IU/L
increased AP

AST/ALT ratio greater than 2

18
Q

in the end stage alcoholic the proximate cases of death are…

A

hepatic coma
massive GI hemorrhage
infection
hepatorenal syndrome following a bout of alcoholic hepatitis

19
Q

nonalcoholic steatohepatitis NASH causes (3)

A

insulin related/metabolic syndrome
drug hepatoxicity
pregnancy

20
Q

inherited disorder that increases the amount of iron that the body absorbs from the gut

A

hereditary hemochromatosis

most cases are caused by mutations in the HFE gene

21
Q

lab results hereditary hemochromatosis

A 
increased 
serum Fe greater than 300 mg/dL
transferrin saturation greater than 2X
serum ferritin 2X
hepatic Fe index greater than 2
22
Q

if transferrin saturation and ferritin concentrations are high…

A

genetic testing for hemochromatosis is warranted

pt who are either homozygous for C282Y or heterozygous for C282y and H63D have hereditary hermochromatosis

23
Q

complications of hemochromatosis

A 
hypopituitarism
skin pigmentation
cardiac failure
hepatocellular carcinoma
cirrhosis
diabetes
arthropathy
testicular atrophy
24
Q

hereditary disease that causes the body to retain copper

A

wilson’s disease

pts have decreased ceruloplasmin and excessive deposition of copper

w/o tx can cause severe brain damage, liver failure and death

25
Q

kaiser-fleischer rings =

A

wilson disease

also see
decreased serum ceruloplasmin less tahn 20 mg/dl

and increased hepatic copper above 250 and increased urinary copper above 100

26
Q

describe alpha antitrypsin defiicency

A

autosomal recessive
primary liver metabolic diasea
primary genetic liver diseas in children
2nd cause of liver transplantation in children

27
Q

alpha-antitrypsin deficiency diagnosis

A

low serum alphaAT

abnormal electrophoretic alpha AT

liver biopsy

28
Q

risks of liver cell adenomas

A

may rupture in pregnancy and may harbor hepatocellular carcinoma

29
Q

risk factors hepatocellular carcinoma

A 
cirrhosis
alcoholism
HBV, HCV
hereditary hemochromatosis
alphaAT deficiency
30
Q

s/s hepatocellular carcinoma

A 
painful hepatomegaly
abdominal mass
weight loss
portal/hepatic vein thrombosis
hemorrhagic ascites
heaptic failure
massive bleeding
31
Q

AFP above what is diagnositc of hepatocellular carcinoma>

A

1000

32
Q

malignant primary tumor of the bile duct epithelium

A

cholangiocarcinoma

33
Q

risk factors for cholangiocarcinoma

A

primary sclerosing cholangitis
thorotrast
liver flukes

34
Q

*** most common malignant tumor of the liver

A

metastatic tumors

common primary sites are GI tract, breast, lung, pancreas, and melanoma

35
Q

three types of gallstones

A 
cholesterol stones (biliary hypersecretion of cholesterol/supersaturation o f bile with cholesterol) 
pigmented stones ( bilirubin calcium salts)
mixed
36
Q

four contributing factors for cholelithiasis

A

supersaturation
gallbladder hypmotility
crystal nucleation
accretion within the gallbladder mucous layer

37
Q

usual microscopic appearance of chronic cholecystitis

A

collagen in wall (scarring)
lymphocytes
plasma cells
macrophages

38
Q

acute epigastric pain with radiation to the back

A

acute pancreatitis

39
Q

laboratory findings of acute pancreatitis

A

elevation of serum amylase during first 24 hrs

rising serum lipas levels w/i 72-96 hrs

hypocalcemia may result from precipitation of calcium soaps in fat ecrosis – poor prognosis

40
Q
  • clinical triad of chronic pancreatitis
A

diabetes
steatorrhea
calcifications

along with permanent impairement of function and irreversible morphologic changes

most commonly caused by alcohol ingestion

41
Q

where do most carcinomas of pancreas arise?

A

head

all arise from ductal epithelium

CS4: Exam 3 (14 decks)

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