Ch 16: Liver, Biliary Tract, & Pancreas Disorders

Question 1

What are councilman bodies?

Why are they named that?

Answer 1

Councilman hyaline body or apoptotic body, is an acidophilic (eosinophilic / pink-staining on H and E) globule of cells that represents a dying hepatocyte often surrounded by normal parenchyma. They are found in the liver of individuals suffering from viral hepatitis (acute), yellow fever, or other viral syndromes. It represents a hepatocyte that is undergoing necrosis/apoptosis. Liver biopsy of acute viral hepatitis typically shows panlobular lymphocytic infiltrates with ballooning hepatocytes (indicative of hepatocyte necrosis and hepatocyte apoptosis).They are named after American pathologist William Thomas Councilman, who discovered them.

Question 2

What is an H and E stain?

Answer 2

Hematoxylin and eosin stain or haematoxylin and eosin stain (H&E stain or HE stain) is one of the principal stains in histology. It is the most widely used stain in medical diagnosis and is often the gold standard; for example when a pathologist looks at a biopsy of a suspected cancer, the histological section is likely to be stained with H&E and termed “H&E section”, “H+E section”, or “HE section”. A combination of hematoxylin and eosin, it produces blues, violets, and reds.

Question 3

Where is the ampulla of Vater?

Answer 3

The ampulla of Vater is a conical structure at the confluence of the common bile duct (CBD) and the main pancreatic duct that protrudes at the major duodenal papilla into the medial aspect of the descending duodenum.

Question 4

In acute pancreatitis, occasionally, an upper abdominal mass due to the ________ ________ or a __________ may be palpated.

Answer 4

inflamed pancreas

pseudocyst

Question 5

Serum amylase and lipase are elevated—usually more than _ times the upper limit of normal—within 24 hours in 90% of cases.

Answer 5

three

Question 6

Lipase remains elevated ______ than amylase and is slightly more ________ for the diagnosis of acute pancreatitis.

Answer 6

longer

accurate

Question 7

In patients with clear evidence of acute pancreatitis, a _____ ___ _____ of more than 150 units/L (3 mkat/L) suggests biliary pancreatitis.

Answer 7

serum ALT level

Question 8

What are the Ranson criteria?

Answer 8

Criteria for assessing the severity of acute pancreatitis.

3 or more of the following predict a severe course complicated by pancreatic necrosis with a sensitivity of 60–80%.
  -Age over 55 years
  -White blood cell count > 16,000
  -Blood glucose > 200 
  -Serum lactic dehydrogenase > 350 
  -Aspartate aminotransferase > 250 

Development of the following in the first 48 hours indicates a worsening prognosis
  -Hematocrit drop of more than 10%
  -Blood urea nitrogen rise > 5
  -Arterial PO2 of < 60 mm Hg
  -Serum calcium of < 8
  -Base deficit over 4 mEq/L
  -Estimated fluid sequestration of > 6 L

Mortality rates correlate with the number of criteria present.  
Number of Criteria	Mortality Rate
     0–2	1%
     3–4	16%
     5–6	40%
     7–8	100%