GI 3 Flashcards
Cirrhosis
Shrunken, atrophic liver (scarring then liver tries to regenerate, forming nodules)
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Cirrhosis
Blue collagen bands in trichome stain
Cirrhosis
Steatosis
Steatosis
Steatosis
Steatosis
Alcoholic Hepatitis
Typically involves neutrophils that infiltrate lobules
Alcoholic Hepatitis
Arrow: Mallory body
Aggregate of inflammatory cells *largely neutrophils
Alcoholic Hepatitis Mallory Body
Eosinophilic inclusion, composed mostly of filaments caused by damage to filaments to form cytokeratin
*EXAM*
Alcoholic Hepatitis
Mallory Hyaline Body
Alcoholic Liver Disease
Viral Hepatitis
Viral Hepatitis (Hemorrhagic)
Acute Viral Hepatitis
Viral Hepatitis
Viral Hepatitis
Acidophilic (Councilman) body (arrow)
A hepatocyte undergoing apoptosis
Viral Hepatitis
Balloon hepatocytes that are degrading
Viral Hepatitis B
Ground glass change - cytoplasm turns into smooth ground glass appearance due to viral replication
Viral Hepatitis
Viral Hepatitis
Hemochromatosis
Hemochromatosis
Excessive hemosiderin stores
Hemochromatosis
Hemochromatosis
Hemochromatosis
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Small tumors at periphery
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Metastatic Carcinoma
Metastatic Carcinoma
Metastatic Carcinoma
Metastatic Carcinoma
Metastatic Carcinoma
Metastatic Carcinoma
Cholelithiasis
Cholelithiasis
Cholelithiasis
Cholelithiasis
Cholelithiasis (Pigment Gallstones)
Indicative of chronic hemolysis
Choledocholithiasis
Acute cholecystitis
Acute cholecystitis
PMNs infiltrating mucosa
Chronic Cholecystitis
Chronic Cholecystitis
Chronic cholecystitis
Porcelain gallbladder
Porcelain Gallbladder
Adenocarcinoma of GB
Adenocarcinoma of GB
Adenocarcinoma of GB
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
White foci= fat necrosis due to fat digestion by lipase, releasing fatty acids that bind to calcium forming soaps (saponification)
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
Chronic Pancreatitis
Chronic Pancreatitis
Concretions and atrophy replaced by chronic scar tissue
Chronic Pancreatitis Pancreaticpseudocyst (no epithelial lining)
Chronic Pancreatitis Pancreatic pseudocyst
Pancreatic Carcinoma
Pancreatic Carcinoma
Pancreatic carcinoma
Pancreatic carcinoma
PancreaticCarcinoma
Pancreatic carcinoma
Pancreatic carcinoma
What is the definition of cirrhosis?
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
What is the traditional classification of cirrhosis (and its associated diseases)?
Macronodular (>3 mm)
- Viral hepatitis
- Alpha-1 antitrypisin deficiency
- Wilson’s Disease
Micronodular (<3 mm)
- Alcoholism
- Hemochromatosis
- Primary biliary cirrhosis
- Wilson’s Disease
What are some complications of cirrhosis?
Portal HTN
Esophageal varices
Ascites
Splenomegaly
Hepatic encephalopathy
Hepatocellular carcinoma
What is steatosis?
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)
What is alcoholic hepatitis?
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)
What is acute hepatitis characterized by?
Inflammation (mostly lymphocytic, with some neutrophils and eosinophils)
Lobular disarray
Ballooning degeneration
Acidophil (Councilman) bodies
May see bridging necrosis (severe cases)
How do you distinguish chronic from acute hepatitis?
Distinction from acute made clinically, not pathologically
Usually requires elevation of liver enzymes for >6 months (or persistently elevated viral load)
what is hereditary hemochromatosis?
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
How do you distinguish hemochromatosis from secondary hemosiderosis?
Quantitative irone analysis
Secondary hemosiderosis = iron overload where iron accumulation typically affects Kupffer cells
What are complications of hereditary hemochromatosis?
Cirrhosis
Hepatocellular carcinoma
Hypopituitarism, skin pigmentation, cardiac failure, DM, arthropathy, testicular atrophy
What are predisposing factors for hepatocellular carcinoma (hepatoma)?
Cirrhosis
Hep B and C
Thorotrast (formerly used as radiographic contrast agent)
Alcohol
Radiation
Alpha-1 antitrypsin deficiency
Hemochromatosis
What serum marker may be elevated in hepatocellular carcinoma?
Alpha feto-protein
What is the macroscopic and microscopic description of hepatocellular carcinoma?
Macro: single/multiple, may have bile staining
Micro: Atypical hepatocytes with nuclear pleomorphisms, thickened trabeculae (several layers thick), absent portal tracts
What is the prognosis of hepatocellular carcinoma?
Poor
10% 5-year survival
What is the most common malignant tumor of the liver?
Metastatic carcinoma
What are the most common primary sites for metastatic carcinoma?
GI tract, breast, and lung
Describe metastatic carcinoma
Usually multiple circumscribed nodules
Describe (macro and micro) the normal gall bladder
Macro: sac-like with thin wall and green mucosal lining
Micro: columnar epithelial lining, lamina propria, muscularis propria (no muscularis mucosae or submucosa)
What are the types of gallstones
Gallstones occur secondary to supersaturation of bile
only 10% of gallstones are pure
- cholesterol stones: pale, yellow, round/oval, single, radiolucent
- pigment stones (Ca2+ bilirubinate): black/brown, oval, multiple
Risk factors for cholesterol stones
Female, fat, >40, fertile
Drugs
GI disorders
What are some risk factors for pigment stones?
Chronic hemolysis
Certain infections (Bacteria - E. coli; Parasites - Clonorchis)
GI disorders
How do gallstones form
Secondary to supersaturation of bile
What is acute cholecystitis and how is it characterized?
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)
What is chronic cholecystitis and how is it characterized?
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)
What is an adenocarcinoma of the Gallbladder?
- How often does it occur?
- Who does it occur in most?
- Association with gallstones?
Rare malignancy that is more common in females
80-90% associated with gallstones
Most have invaded liver by time of diagnosis
Uniformly fatal
What is acute pancreatitis associated with?
80% of cases associated with gallstones or alcoholism
What is acute pancreatitis characterized by?
Diffuse edema, acute inflammation, hemorrhage, fat necrosis, fibrosis, calcification
20% mortality
Pathogenesis of acute pancreatitis
What is chronic pancreatitis?
Usually not associated with acute pancreatitis
Chronic inflammation, ductal ectasia, squamous metaplasia of ducts, calcification, fibrosis, stone formation, pseudocysts
What are some complications of acute pancreatitis?
Systemic organ failure, shock, ARDS, acute renal failure
DIC
Pancreatic abscess
Pancreatic pseudocyst
What are some complications of chronic pancreatitis?
Pseudocyst
Duct obstruction
Malabsorption, steatorrhea
Secondary diabetes
How common are ductal adenocarcinomas?
Where in the pancreas do most of these malignancies occur?
Pretty common
85% of all pancreatic malignancies
2/3 occur in head of pancreas
Describe a pancreatic adenocarinoma (macro/microscopically)
Macro: Infiltrative, firm, tan-white tumor
Micro: irregular ducts/glands lined by atypical cuboidal to columnar cells, desmoplastic stromal response
What are some complications of pancreatic adenocarcinoma?
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
What is the prognosis of pancreatic adenocarcinoma?
<20% of tumors at diagnosis are surgically resectable
Overall poor prognosis: 10% 1-year survival; 2% 5-year survival
What are some of the mutations associated wth pancreatico adenocarcinoma?
K-Ras, p16, p53, BRCA2, DPC4/SMAD4
