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MD4 Pathology > GI 3 > Flashcards

GI 3 Flashcards

1
Q
A

Cirrhosis

Shrunken, atrophic liver (scarring then liver tries to regenerate, forming nodules)

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2
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Cirrhosis

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3
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Cirrhosis

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4
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Cirrhosis

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5
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Cirrhosis

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6
Q
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Cirrhosis

Blue collagen bands in trichome stain

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7
Q
A

Cirrhosis

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8
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Steatosis

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9
Q
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Steatosis

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10
Q
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Steatosis

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11
Q
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Steatosis

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12
Q
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Alcoholic Hepatitis

Typically involves neutrophils that infiltrate lobules

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13
Q
A

Alcoholic Hepatitis

Arrow: Mallory body

Aggregate of inflammatory cells *largely neutrophils

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14
Q
A

Alcoholic Hepatitis Mallory Body

Eosinophilic inclusion, composed mostly of filaments caused by damage to filaments to form cytokeratin

*EXAM*

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15
Q
A

Alcoholic Hepatitis

Mallory Hyaline Body

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16
Q
A

Alcoholic Liver Disease

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17
Q
A

Viral Hepatitis

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18
Q
A

Viral Hepatitis (Hemorrhagic)

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19
Q
A

Acute Viral Hepatitis

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20
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21
Q
A

Viral Hepatitis

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22
Q
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Viral Hepatitis

Acidophilic (Councilman) body (arrow)

A hepatocyte undergoing apoptosis

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23
Q
A

Viral Hepatitis

Balloon hepatocytes that are degrading

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24
Q
A

Viral Hepatitis B

Ground glass change - cytoplasm turns into smooth ground glass appearance due to viral replication

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25
Q
A

Viral Hepatitis

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26
Q
A

Viral Hepatitis

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27
Q
A

Hemochromatosis

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28
Q
A

Hemochromatosis

Excessive hemosiderin stores

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29
Q
A

Hemochromatosis

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30
Q
A

Hemochromatosis

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31
Q
A

Hemochromatosis

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32
Q
A

Hepatocellular Carcinoma

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33
Q
A

Hepatocellular Carcinoma

Small tumors at periphery

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34
Q
A

Hepatocellular Carcinoma

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35
Q
A

Hepatocellular Carcinoma

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36
Q
A

Metastatic Carcinoma

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37
Q
A

Metastatic Carcinoma

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38
Q
A

Metastatic Carcinoma

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39
Q
A

Metastatic Carcinoma

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40
Q
A

Metastatic Carcinoma

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41
Q
A

Metastatic Carcinoma

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42
Q
A

Cholelithiasis

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43
Q
A

Cholelithiasis

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44
Q
A

Cholelithiasis

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45
Q
A

Cholelithiasis

46
Q
A

Cholelithiasis (Pigment Gallstones)

Indicative of chronic hemolysis

47
Q
A

Choledocholithiasis

48
Q
A

Acute cholecystitis

49
Q
A

Acute cholecystitis

PMNs infiltrating mucosa

50
Q
A

Chronic Cholecystitis

51
Q
A

Chronic Cholecystitis

52
Q
A

Chronic cholecystitis

53
Q
A

Porcelain gallbladder

54
Q
A

Porcelain Gallbladder

55
Q
A

Adenocarcinoma of GB

56
Q
A

Adenocarcinoma of GB

57
Q
A

Adenocarcinoma of GB

58
Q
A

Acute Pancreatitis

59
Q
A

Acute Pancreatitis

60
Q
A

Acute Pancreatitis

61
Q
A

Acute Pancreatitis

White foci= fat necrosis due to fat digestion by lipase, releasing fatty acids that bind to calcium forming soaps (saponification)

62
Q
A

Acute Pancreatitis

63
Q
A

Acute Pancreatitis

64
Q
A

Acute Pancreatitis

65
Q
A

Acute Pancreatitis

66
Q
A

Chronic Pancreatitis

67
Q
A

Chronic Pancreatitis

Concretions and atrophy replaced by chronic scar tissue

68
Q
A

Chronic Pancreatitis Pancreaticpseudocyst (no epithelial lining)

69
Q
A

Chronic Pancreatitis Pancreatic pseudocyst

70
Q
A

Pancreatic Carcinoma

71
Q
A

Pancreatic Carcinoma

72
Q
A

Pancreatic carcinoma

73
Q
A

Pancreatic carcinoma

74
Q
A

PancreaticCarcinoma

75
Q
A

Pancreatic carcinoma

76
Q
A

Pancreatic carcinoma

77
Q

What is the definition of cirrhosis?

A

Scarring of entire liver with 1) diffuse fibrosis 2) loss of lobular architecture 3) nodular regeneration

It is the end-stage of many chronic disorders, so it is difficult to determine precise etiology by histology alone

78
Q

What is the traditional classification of cirrhosis (and its associated diseases)?

A

Macronodular (>3 mm)

  • Viral hepatitis
  • Alpha-1 antitrypisin deficiency
  • Wilson’s Disease

Micronodular (<3 mm)

  • Alcoholism
  • Hemochromatosis
  • Primary biliary cirrhosis
  • Wilson’s Disease
79
Q

What are some complications of cirrhosis?

A

Portal HTN

Esophageal varices

Ascites

Splenomegaly

Hepatic encephalopathy

Hepatocellular carcinoma

80
Q

What is steatosis?

A

Increased storage of lipid in liver, resulting in yellow appearance (macroscopic) and cytoplasmic vacuoles (microscopic)

May be due to variety of causes (alcohol, DM, obesity, protein malnutrition, metabolic disorders)

81
Q

What is alcoholic hepatitis?

A

Develops in 20-25% of heavy drinks

Characterized by:

Inflammation and hepatocyte degeneration

Neutrophilic infiltrate

Steatosis

Mallory bodies (eosinophilic PAS +, corkscrew shaped intracytoplasmic stuctures made of intermediate filaments (keratin)

82
Q

What is acute hepatitis characterized by?

A

Inflammation (mostly lymphocytic, with some neutrophils and eosinophils)

Lobular disarray

Ballooning degeneration

Acidophil (Councilman) bodies

May see bridging necrosis (severe cases)

83
Q

How do you distinguish chronic from acute hepatitis?

A

Distinction from acute made clinically, not pathologically

Usually requires elevation of liver enzymes for >6 months (or persistently elevated viral load)

84
Q

what is hereditary hemochromatosis?

A

Hereditary hemochromatosis (Bronze diabetes)

Autosomal recessive disorder of iron metabolism (HFE gene, chromosome 6p)

1-2/1,000 and M:F = 7:1 (men present earlier in life)

Prussian blue stain for iron shows granular staining in hepatocytes

85
Q

How do you distinguish hemochromatosis from secondary hemosiderosis?

A

Quantitative irone analysis

Secondary hemosiderosis = iron overload where iron accumulation typically affects Kupffer cells

86
Q

What are complications of hereditary hemochromatosis?

A

Cirrhosis

Hepatocellular carcinoma

Hypopituitarism, skin pigmentation, cardiac failure, DM, arthropathy, testicular atrophy

87
Q

What are predisposing factors for hepatocellular carcinoma (hepatoma)?

A

Cirrhosis

Hep B and C

Thorotrast (formerly used as radiographic contrast agent)

Alcohol

Radiation

Alpha-1 antitrypsin deficiency

Hemochromatosis

88
Q

What serum marker may be elevated in hepatocellular carcinoma?

A

Alpha feto-protein

89
Q

What is the macroscopic and microscopic description of hepatocellular carcinoma?

A

Macro: single/multiple, may have bile staining

Micro: Atypical hepatocytes with nuclear pleomorphisms, thickened trabeculae (several layers thick), absent portal tracts

90
Q

What is the prognosis of hepatocellular carcinoma?

A

Poor

10% 5-year survival

91
Q

What is the most common malignant tumor of the liver?

A

Metastatic carcinoma

92
Q

What are the most common primary sites for metastatic carcinoma?

A

GI tract, breast, and lung

93
Q

Describe metastatic carcinoma

A

Usually multiple circumscribed nodules

94
Q

Describe (macro and micro) the normal gall bladder

A

Macro: sac-like with thin wall and green mucosal lining

Micro: columnar epithelial lining, lamina propria, muscularis propria (no muscularis mucosae or submucosa)

95
Q

What are the types of gallstones

A

Gallstones occur secondary to supersaturation of bile

only 10% of gallstones are pure

  1. cholesterol stones: pale, yellow, round/oval, single, radiolucent
  2. pigment stones (Ca2+ bilirubinate): black/brown, oval, multiple
96
Q

Risk factors for cholesterol stones

A

Female, fat, >40, fertile

Drugs

GI disorders

97
Q

What are some risk factors for pigment stones?

A

Chronic hemolysis

Certain infections (Bacteria - E. coli; Parasites - Clonorchis)

GI disorders

98
Q

How do gallstones form

A

Secondary to supersaturation of bile

99
Q

What is acute cholecystitis and how is it characterized?

A

Acute onset of symptoms, 90% associated with gallstones

Gallbladder often enlarged, tense

Fibrinous serosal exudates

May be hemorrhagic, filled with pus, or health with calcification (porcelain GB)

100
Q

What is chronic cholecystitis and how is it characterized?

A

Recurrent biliary colic or absence of prior acute cholecystitis, virtually always associated with gallstones

Wall thickened and fibrotic

Chronic inflammation

Entrapped epithelial crypts (Rokitansky-Aschoff sinuses)

101
Q

What is an adenocarcinoma of the Gallbladder?

  • How often does it occur?
  • Who does it occur in most?
  • Association with gallstones?
A

Rare malignancy that is more common in females

80-90% associated with gallstones

Most have invaded liver by time of diagnosis

Uniformly fatal

102
Q

What is acute pancreatitis associated with?

A

80% of cases associated with gallstones or alcoholism

103
Q

What is acute pancreatitis characterized by?

A

Diffuse edema, acute inflammation, hemorrhage, fat necrosis, fibrosis, calcification

20% mortality

104
Q

Pathogenesis of acute pancreatitis

A
105
Q

What is chronic pancreatitis?

A

Usually not associated with acute pancreatitis

Chronic inflammation, ductal ectasia, squamous metaplasia of ducts, calcification, fibrosis, stone formation, pseudocysts

106
Q

What are some complications of acute pancreatitis?

A

Systemic organ failure, shock, ARDS, acute renal failure

DIC

Pancreatic abscess

Pancreatic pseudocyst

107
Q

What are some complications of chronic pancreatitis?

A

Pseudocyst

Duct obstruction

Malabsorption, steatorrhea

Secondary diabetes

108
Q

How common are ductal adenocarcinomas?

Where in the pancreas do most of these malignancies occur?

A

Pretty common

85% of all pancreatic malignancies

2/3 occur in head of pancreas

109
Q

Describe a pancreatic adenocarinoma (macro/microscopically)

A

Macro: Infiltrative, firm, tan-white tumor

Micro: irregular ducts/glands lined by atypical cuboidal to columnar cells, desmoplastic stromal response

110
Q

What are some complications of pancreatic adenocarcinoma?

A

Primary effects:

  • Metastases (lung, liver, peritoneum)
  • Pancreatic carcinoma
  • Abdominal pain (peripheral lymphatic invasion)

Secondary effects:

  • Trousseau syndrome: Migratory peripheral thrombophlebitis (10-25%)
  • Courvosier gallbladder: painless jaundice, dilated gallbladder
  • Weight loss
  • Obstructive jaundice
111
Q

What is the prognosis of pancreatic adenocarcinoma?

A

<20% of tumors at diagnosis are surgically resectable

Overall poor prognosis: 10% 1-year survival; 2% 5-year survival

112
Q

What are some of the mutations associated wth pancreatico adenocarcinoma?

A

K-Ras, p16, p53, BRCA2, DPC4/SMAD4

MD4 Pathology (6 decks)

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