4.05 Liver Pathology

Question 1

2 blood vessels supplying the liver

Answer 1

PORTAL VEIN (nutrients from small intestine) and HEPATIC ARTERY (oxygenated blood from general circulation)

Question 2

Hepatic adenomas with highest risk of malignant transformation.

Answer 2

Hepatic adenomas with B-catenin mutations

Question 3

Liver zone with the highest concentration of oxygen

Answer 3

Zone 1

Question 4

Characteristics of alcoholic steatohepatitis

Answer 4

Hepatocyte swelling and necrosis
Mallory-Denk bodies
Chicken-wire fibrosis

Question 5

Severe, zonal loss of hepatocytes

Answer 5

Confluent necrosis

Question 6

Principal cell involved in scar deposition

Answer 6

Hepatic stellate cells

Question 7

Takes up antigens in the liver and presents them to the lymphocytes

Answer 7

Kupffer cells and blood-derived dendritic cells

Question 8

Describe serum liver transaminase levels during clinical course of ACUTE LIVER FAILURE

Answer 8

Initially elevated

Eventually decreases due to parenchymal destruction and loss of viable hepatocytes

Question 9

Describe the estrogen levels in males with chronic liver failure

Answer 9

Chronic liver failure impairs estrogen metabolism. Males will present with hyperestrogenemia leading to hypogonadism and gynecomastia.

Question 10

4 clinical consequences of PORTAL HYPERTENSION

Answer 10

Ascites
Portosystemic shunts
Splenomegaly
Hepatic encephalopathy

Question 11

Most important predictor of chronicity of Hepatitis B

Answer 11

Age at diagnosis

Question 12

Hallmarks of Hepatitis C infection

Answer 12

Persistent infection

Chronic hepatitis

Question 13

Hepatitis D is dependent on which virus

Answer 13

HBV

Question 14

4 phases of acute symptomatic hepatitis with recovery

Answer 14

Incubation
Symptomatic preicteric
Symptomatic icteric
Convalescence

Question 15

Differentiate Type 1 and 2 AUTOIMMUNE HEPATITIS

Answer 15

Type 1:
Middle aged to older individuals
(+) ANA and ASMA, (+) Anti SLA/LP, AMA

Type 2:
Children and teenagers
(+) Anti-LKM-1 and ACL-1 antibodies

Question 16

T/F. Hepatocyte rosettes are a typical feature of AIH

Answer 16

T

Question 17

First sign of disease in AIH

Answer 17

Very severe hepatocyte injury with confluent necrosis with little scarring

Question 18

Most common drug causing ACUTE liver disease

Answer 18

Acetaminophen

Question 19

Most common hepatotoxin causing CHRONIC liver disease

Answer 19

Alcohol

Question 20

Clinical features of HEPATIC STEATOSIS

Answer 20

Hepatomegaly
Elevated bilirubin and alkaline phosphatase
Constitutional symptoms

Question 21

AST > ALT

ALT > AST

Answer 21

AST > ALT: Alcohol-induced liver disease

ALT > AST: Chronic liver disease

Question 22

What gene is mutated in WILSON’S DISEASE?

Answer 22

ATP7B

Question 23

Green to brown deposits of copper in the descemet membrane of the cornea

Answer 23

Keyser-Flescher rings

Question 24

Most common symptom of cholestatic disorder

Answer 24

Jaundice

Question 25

Differentiate UNCONJUGATED AND CONJUGATED HYPERBILIRUBINEMIA

Answer 25

Unconjugated: excessive production of bilirubin or reduced hepatic uptake Conjugated: deficiency in canalicular membrane transporters

Question 26

Lab markers of CHOLESTASIS

Answer 26

elevated ALP + GGT

Question 27

Charcot's triad

Answer 27

Fever and chills Jaundice RUQ pain

Question 28

Clinical presentation of NEONATAL CHOLESTASIS

Answer 28

Jaundice Dark urine Light/acholic stools Hepatomegaly

Question 29

When does BILIARY ATRESIA manifest?

Answer 29

Within first 3 months of life

Question 30

Differentiate PRIMARY BILIARY CIRRHOSIS and PRIMARY SCLEROSING CHOLANGITIS in terms of sexual predominance

Answer 30

Primary biliary cirrhosis: Female Primary sclerosing cholangitis: Male

Question 31

Describe the morphological appearance of PRIMARY SCLEROSING CHOLANGITIS

Answer 31

Histology: onion skin concentric scar | Beading appearance on radiograph

Question 32

Differentiate CAROLI DISEASE AND SYNDROME

Answer 32

Caroli disease: cystic disorder with ascending cholangitis | Caroli syndrome: cystic disorder with congenital hepatic fibrosis

Question 33

Most common benign liver tumor

Answer 33

Cavernous Hemangioma

Question 34

Diagnostic feature of HNF1-alpha inactivated adenomas

Answer 34

Absence of LFABP

Question 35

Diagnostic feature of Beta-catenin activated adenoma

Answer 35

Immunostain for B-catenin shows nuclear translocation

Question 36

Overexpressed by INFLAMMATORY ADENOMA

Answer 36

C-reactive protein | Serum amyloid A

Question 37

Most common malignant liver tumor of childhood

Answer 37

Hepatoblastoma

Question 38

Clinical features of HEPATOBLASTOMA

Answer 38

Activation of WNT signalling pathway Expression of FOXG1 Association with Beckwith-Wiedeman syndrome

Question 39

Cancer of the biliary tree arising from the extra/intrahepatic bile ducts. 2nd most common primary malignant liver tumor.

Answer 39

Cholangiosarcoma