CPC: Pathology of Liver, Pancreas, and Gall Bladder Flashcards
normal liver.
liver portal triad
what’re the arrows of this liver slide pointing to and what cells do they contain
endothelial cells lined in between hepatocyte cords: these are sinusoids.
- they contain kupffer cells, specialized macrophages that are part of hte liver immune system.
what’re the arrows pointing to and when would you see these cells?
these are apoptotic hepatocytes. Occurs in severe acute hepatitis/other inflammatory liver disease.
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 ____
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
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.
steatohepatitis. there are little pockets of inflammation with neutrophils in it.
how does NAFLD progress to cirrhosis.
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.
steatohepatitis
how does alcohol affect the liver?
• 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
Dx? (liver)
hereditary hemochromatosis.
(liver)
A1At globule accumulation, causing alpha-1antitrypsin deficiency: abnormal folding and accumulation of A1AT leads to endoplasmic reticulum stress.
T/F Hepatitis A and E cause chronic hepatitis
false. they only cause AcutE hepatitis, except in pregnant or immunocompromised hosts.
which forms of hepatitis can be chronic?
B, C, D.
cirrhotic liver– once there is established cirrhosis, it may be difficult or impossible to establish the etology based on biopsy findings.
advanced fibrosis/cirrhosis.
focal nodular hyperplasia– there is a central scar and the background is non-cirrhotic.
subcapsular abscess.
probably HCC. it has a cirrhotic background.
multiple nodules. most likely multifocal hepatocellular carcinoma or metastatic disease.
probably metastatic disase- multiple nodules in the liver but the background is non-cirrhotic so the masses probably didn’t originate in the liver.
cholangiocarcinoma. based on location (its near where the GB should be)
gall bladder. has folds to allow for distension.
cholelithiasis
