CPC: Pathology of Liver, Pancreas, and Gall Bladder

Question 1

Answer 1

normal liver.

Question 2

Answer 2

liver portal triad

Question 3

what’re the arrows of this liver slide pointing to and what cells do they contain

Answer 3

endothelial cells lined in between hepatocyte cords: these are sinusoids.

• they contain kupffer cells, specialized macrophages that are part of hte liver immune system.

Question 4

what’re the arrows pointing to and when would you see these cells?

Answer 4

these are apoptotic hepatocytes. Occurs in severe acute hepatitis/other inflammatory liver disease.

Question 5

Hepatocyte Injury and Regeneration

If injury overrides capacity of regeneration (single large injury (e.g. acetaminophen toxicity), chronic injury (e.g. hepatitis C or chronic alcoholism), scar formation occurs by ____ cell activation = fibrosis with an end result is ____

Answer 5

If injury overrides capacity of regeneration (single large injury (e.g. acetaminophen toxicity), chronic injury (e.g. hepatitis C or chronic alcoholism), scar formation occurs by stellate cell activation = fibrosis with an end result is CIRRHOSIS

Question 6

Answer 6

steatosis. caused by fatty liver disease.

many liver diseases can cause fatty liver; including

• NAFLD
• Alcohol liver
• drugs (corticoids, methotrexate)
• hepatitis C
• wilsons/hereditary causes
• TPN.

Question 7

Answer 7

steatohepatitis. there are little pockets of inflammation with neutrophils in it.

Question 8

how does NAFLD progress to cirrhosis.

Answer 8

fat laden hepatocytes are more sensitive to oxidative injury. Ocidative injury results in liver necrosis and inflammatory rection to it. activation of stellate cells leads to fibrosis/cirrhosis.

Question 9

Answer 9

steatohepatitis

Question 10

how does alcohol affect the liver?

Answer 10

• Alteration of fat oxidation pathways (due to NAD
depletion) results in fat accumulation

• Acetaldehyde (product of alcohol dehydrogenase
(ADH)) disrupts cytoskeleton and membrane
functioning

• Metabolism through CYP2E1 (non ADH) produced
reactive oxygen species, which cause hepatocyte
damage through membrane lipid peroxidation

• CYP2E1 induction affects metabolism of other
drugs/mediations

• Continuous damage leads to alcoholic hepatitis,
fibrosis, and cirrhosis

Question 11

Dx? (liver)

Answer 11

hereditary hemochromatosis.

Question 12

(liver)

Answer 12

A1At globule accumulation, causing alpha-1antitrypsin deficiency: abnormal folding and accumulation of A1AT leads to endoplasmic reticulum stress.

Question 13

T/F Hepatitis A and E cause chronic hepatitis

Answer 13

false. they only cause AcutE hepatitis, except in pregnant or immunocompromised hosts.

Question 14

which forms of hepatitis can be chronic?

Answer 14

B, C, D.

Question 15

Answer 15

cirrhotic liver– once there is established cirrhosis, it may be difficult or impossible to establish the etology based on biopsy findings.

Question 16

Answer 16

advanced fibrosis/cirrhosis.

Question 17

Answer 17

focal nodular hyperplasia– there is a central scar and the background is non-cirrhotic.

Question 18

Answer 18

subcapsular abscess.

Question 19

Answer 19

probably HCC. it has a cirrhotic background.

Question 20

Answer 20

multiple nodules. most likely multifocal hepatocellular carcinoma or metastatic disease.

Question 21

Answer 21

probably metastatic disase- multiple nodules in the liver but the background is non-cirrhotic so the masses probably didn’t originate in the liver.

Question 22

Answer 22

cholangiocarcinoma. based on location (its near where the GB should be)

Question 23

Answer 23

gall bladder. has folds to allow for distension.

Question 24

Answer 24

cholelithiasis

Question 25

cholescystitis: acute and chronic usually due to obstruction of the ___ or ___ duct by a stone

Answer 25

neck or cystic duct. if it is the common bile duct it’s cholangitis.

Question 26

Answer 26

gall bladder adenocarcinoma.

Question 27

Answer 27

normal exocrine pancreas.

Question 28

Answer 28

endocrine pancreas (arranged in islets)

Question 29

Answer 29

normal pancreas.

Question 30

Main etioogies behind acute pancreatitis

Answer 30

• gallstones
• alcohol
• overall, causes pancreatic duct obstruction, acinar cell injury, or defective intracellular transport of proenzymes

Question 32

Answer 32

highly inflammed pancreas, hemorrhagic and necrotic.

Question 33

Answer 33

Question 34

causes of chronic pancreatitis

Answer 34

• long term alcohol use
• long term duct obstruction due to stone or cancer
• autoimmune injury
• hereditary pancreatitis

Question 35

pancreas. what could this person be suffering from?

Answer 35

chronic pancreatitis

• fibrosis, atrophy, dilation of ducts with stones
• pseudocysts
• fat replacement/atrophy.

Question 36

presentation of pancreatic adenocarcinoma

Answer 36

• not veyr common but high mortality
• presents with painless jaundice
• often advanced at time of presentaiton
• can be diagnosed on biliary duct cytoogy
• treatment by whipple resection if amenable.

Question 37

Answer 37

pancreatic adenocarcinoma

Question 38

Answer 38

invasive glands indicative of pancreatic adenocarcinoma.

Question 39

Answer 39

atypical cytology with pleomorphic nuclei, loss of polarity, prominent nucleoli and mitoses indicates a malignancy. pancreatic adenocarcinoma.

normal ducts should look nice and organized;

Question 40

sample of gall bladder.

Answer 40

lots of neutrophils– probably an inflammation therefore cholecystitis