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T2 - Phase 2 - Systems Modules (III) > GI - Hepatic Disease > Flashcards

GI - Hepatic Disease Flashcards

1
Q

How much does the average healthy liver weigh?

A

1.5 Kg

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2
Q

70% of hepatic blood flow comes from what vessel?

(I.e. the hepatic artery or portal vein?)

A

The portal vein

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3
Q

How many liver segments are there?

A

8

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4
Q

True/False.

Each hepatic segment has its own vascular and biliary pedicle and venous drainage.

A

True.

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5
Q

For small tumors of the liver, one would do a ______________ resection.

A

For small tumors of the liver, one would do a subsegmental (wedge) resection.

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6
Q

For large tumors of the liver, one would do a ______________.

A

For large tumors of the liver, one would do a segmentectomy.

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7
Q

Zone ____ of the liver surrounds the portal tract (closest to vascular supply).

Zone ____ is the intermediate section.

Zone ____ is nearest the terminal hepatic venule.

A

Zone 1 of the liver surrounds the portal tract (closest to vascular supply).

Zone 2 is the intermediate section.

Zone 3 is nearest the terminal hepatic venule.

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8
Q

Zone 1 of the hepatic lobules is known as the ________ zone.

Zone 2 of the hepatic lobules is known as the ________ zone.

Zone 3 of the hepatic lobules is known as the ________ zone.

A

Zone 1 of the hepatic lobules is known as the periportal zone.

Zone 2 of the hepatic lobules is known as the mid-zonal zone.

Zone 3 of the hepatic lobules is known as the centrilobular zone.

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9
Q

Which zone of the hepatic lobule is most at-risk for ischemic necrosis?

A

Zone 3

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10
Q

Hepatic lymph is created where?

A

The space of Disse

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11
Q

What are the main stages of chronic liver injury?

A

Fibrosis –>

Cirrhosis –>

Failure

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12
Q

Name a few causes of central/lobular hepatic fibrosis.

A

Alcohol;

NASH (non-alcoholic steatohepatitis);

ischemia: venous outflow obstruction, Budd-Chiari syndrome (blocked hepatic veins), CHF, veno-occlusive disease (sinusoidal obstruction syndrome)

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13
Q

Name a few causes of hepatic portal fibrosis.

A

Biliary and chronic hepatitis

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14
Q

What is the size that distinguishes a micronodular vs. a macronodular cirrhotic liver?

A

3 mm

(> is macro; < is micro)

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15
Q

Alcoholic hepatitis is typically ______nodular.

A

Alcoholic hepatitis is typically micronodular.

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16
Q

What is compensated cirrhosis?

A

A cirrhotic liver with preserved function

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17
Q

What is decompensated cirrhosis?

A

A cirrhotic liver with complications (e.g. portal hypertension, ascites, DIC, hepatic encephalopathy, etc.)

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18
Q

Which is more common, acute or chronic cirrhosis?

A

Chronic

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19
Q

Most biliary tree injury leading to hepatitis arises from what etiologies?

A

Congenital;

obstructive;

autoimmune

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20
Q

What length of time is typically used to differentiate acute from chronic liver disease?

A

6 months

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21
Q

What hepatic change is here described?

Eosinophilia, cell swelling / rupture, potential blebbing

A

Hepatic necrosis

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22
Q

How do hepatocyte acidophilic bodies appear?

A

Councilman bodies, apoptotic hepatocytes, very eosinophilic

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23
Q

What hepatic change is here described?

Cells become large w/ pale cytoplasm

A

Ballooning degeneration

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24
Q

What hepatic change is here described?

Cytoplasmic inclusions of intermediate filaments (not specific for liver disease)

A

Mallory’s hyaline

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25
Q

Fatty liver disease of pregnancy, tetracycline toxicity, and Reye’s syndrome are all associated with ____________ hepatic steatosis.

A

Fatty liver disease of pregnancy, tetracycline toxicity, and Reye’s syndrome are all associated with microvesicular hepatic steatosis.

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26
Q

Alcoholic and non-alcoholic liver disease are both associated with ____________ hepatic steatosis.

A

Alcoholic and non-alcoholic liver disease are both associated with macrovesicular hepatic steatosis.

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27
Q

Which is the most common benign hepatic tumor?

(Note: it is typically an asymptomatic, incidental finding characterized by blood-filled vascular channels; it may be surgically resected if causing hemorrhage.)

A

Cavernous hemangioma

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28
Q

Which is the second most common benign hepatic tumor?

A

Focal nodular hyperplasia

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29
Q

Zone ______ – where blood flow enters the liver lobule (six portal triads at hexagonal points).

Zone ______ – where blood flow exits the liver lobule (via a single central hepatic vein).

A

Zone 1 – where blood flow enters the liver lobule (six portal triads at hexagonal points).

Zone 3 – where blood flow exits the liver lobule (via a single central hepatic vein).

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30
Q

What is cirrhosis?

A

Diffuse fibrosis

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31
Q

What is hepatic steatosis?

A

Fatty liver change

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32
Q

_______ hepatitis is characterized by no fibrosis.

A

Acute hepatitis is characterized by no fibrosis.

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33
Q

Acute hepatitis (no fibrosis) is characterized by spotty injury focused in the liver _________ (_________).

A

Acute hepatitis (no fibrosis) is characterized by spotty injury focused in the liver lobules (parenchyma).

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34
Q

Hepatitis A is associated with which type of hepatitis (acute or chronic)?

A

Acute

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35
Q

Are drug reactions, toxins, and vascular insults associated with acute or chronic hepatitis?

A

Either!

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36
Q

Name a few etiologies associated most with chronic hepatitis and not acute.

A

Hepatitis B and C;

metabolic or developmental defects;

autoimmune reactions

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37
Q

What are the primary hepatocellular markers?

A

AST and ALT

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38
Q

What are the primary bile duct and canalicular markers?

A

Gamma-glutamyltransferase and ALP

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39
Q

Mallory hyaline bodies are deposits of _____________.

A

Mallory hyaline bodies are deposits of intermediate filaments (e.g. keratin).

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40
Q

Mallory hyaline bodies are deposits of intermediate filaments (e.g. keratin) most associated with liver disease of what etiology?

A

Alcoholic-related

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41
Q

In approaching liver histology, what respective stains can be used in marking each of the following?

Iron

Copper

Fat

A

Prussian blue (iron)

Rhodanine (copper)

Oil red O (fat)

42
Q

Describe the difference between macro- and micro-vesicular hepatosteatosis.

A
43
Q

Acute hepatitis is more likely to be characterized by __________ inflammation.

Chronic hepatitis is more likely to be characterized by __________ inflammation.

A

Acute hepatitis is more likely to be characterized by central/lobular inflammation.

Chronic hepatitis is more likely to be characterized by portal inflammation.

44
Q

Portal fibrosis is most associated with what etiologies?

A

Biliary fibrosis;

chronic hepatitis

45
Q

Central/lobular fibrosis is most associated with what etiologies?

A

Alcohol / NASH / ischemia / venous outflow obstruction

46
Q

Transplantation is not needed for cirrhotic livers unless what?

A

Unless severe complications are present

(e.g. ascites, variceal hemorrhage, coagulopathy, hepatic failure, etc.)

47
Q

What is the gold standard for diagnosis of non-alcoholic fatty liver disease (non-alcoholic steatohepatitis)?

A

Liver biopsy

48
Q

Non-alcoholic fatty liver disease (non-alcoholic steatohepatitis) is typically ________-related with a negative history of _________ use.

A

Non-alcoholic fatty liver disease (non-alcoholic steatohepatitis) is typically obesity-related with a negative history of alcohol use.

49
Q

Cirrhosis results from chronic hepatitis (> ___ months).

A

Cirrhosis results from chronic hepatitis (> 6 months).

50
Q

What is stage 0 of chronic hepatitis?

1?

2?

3?

4?

A

No fibrosis

Periportal fibrosis

Septal fibrosis

Bridging fibrosis

Cirrhosis

51
Q

What is the ‘grade’ of cirrhosis?

A

Level of inflammatory activity

52
Q

What is the ‘stage’ of cirrhosis?

A

The level of fibrosis

53
Q

Cirrhotic nodules are chunks bordered by ___________ connecting central veins.

A

Cirrhotic nodules are chunks bordered by fibrous tissue connecting central veins

54
Q

What veins join to become the portal vein?

A

IMV, SMV, splenic vein, coronary v.

55
Q

Where does the fluid in ascites come from?

A

Fluid ‘sweating’ off of Gleason’s capsule

56
Q

Hepatic lymph is produced in what space?

A

The space of Disse (as fluid leaves the sinusoids)

57
Q

What is the proximal cause of hepatorenal syndrome?

A

Portal hypertension and resultant splanchnic vessel dilatation

(resulting in hypotension + excessive angiotensin-renin activation + renal failure)

58
Q

How do portal hypertension and the resultant splanchnic vessel dilatation cause hepatorenal syndrome?

A

The resulting hypotension leads to:

excessive angiotensin-renin activation + renal failure

59
Q

Ammonia from the gut is converted to __________ in the liver.

A

Ammonia from the gut is converted to glutamate in the liver.

60
Q

Hepatic encephalopathy is due to a build-up of ___________.

A

Hepatic encephalopathy is due to a build-up of ammonia.

61
Q

What two tissues are most affected by hyperammonemia?

A

(1) Brain (swelling / astrocyte damage);
(2) muscles most affected

62
Q

Name three of the effects of hyperestronism as a result of chronic cirrhosis (one of which is unique to males).

A

Spider angiomata;

palmar erythema;

gynecomastia

63
Q

Is alcoholic hepatitis associated with micro- or macronodular cirrhosis?

A

Micronodular

64
Q

Is alcoholic hepatitis associated with micro- or macrovesicular steatosis?

A

Both/either

65
Q

Alcoholic hepatitis is associated with __________ (physical finding) and __________ (painless/tender) hepatomegaly.

A

Alcoholic hepatitis is associated with jaundice and tender hepatomegaly.

66
Q

Virtually all alcoholics have _______ ______ (hepatic condition).

A

Virtually all alcoholics have fatty liver.

67
Q

While virtually all alcoholics have steatosis, 1/3 develop __________ and 1/6 develop __________.

A

While virtually all alcoholics have steatosis, 1/3 develop hepatitis and 1/6 develop cirrhosis.

68
Q

Is Wilson’s disease associated with micro- or macronodular cirrhosis?

A

Micronodular

69
Q

Is Wilson’s disease associated with micro- or macrovesicular steatosis?

A

Macrovesicular

70
Q

Wilson’s disease is associated with a mutation in which gene?

A

ATP7B

71
Q

Is alcoholic hepatitis associated with micro- or macrovesicular steatosis?

A

Both/either

72
Q

The hepatic inclusions seen in alpha-1 antitrypsin deficiency stain positive for what?

A

Diastase + PAS

73
Q

A congenital lack of __________ in the duodenal cells may lead to unchecked iron uptake and increased likelihood for developing hemochromatosis.

A

A congenital lack of hepcidin in the duodenal cells may lead to unchecked iron uptake and increased likelihood for developing hemochromatosis.

74
Q

Hemochromatosis is associated with a mutation in what gene?

A

C282Y

75
Q

Most iron is absorbed via ________-mediated transport in the ________.

A

Most iron is absorbed via hepcidin-mediated transport in the duodenum.

76
Q

Name a few etiologies associated with acute renal failure.

A

Idiopathic;

drug-induced (e.g. acetaminophen);

Amanita phalloides mushrooms (death caps)

77
Q

What is the most common benign hepatic tumor?

A

Cavernous hemangiomas

78
Q

Although hepatic cavernous hemangiomas typically follow a benign course and are only discovered incidentally, what are two dangerous complications that may arise?

A

DIC;

rupture (and hemorrhage)

79
Q

What is the second most common benign hepatic tumor?

A

Focal nodular hyperplasia

(NOT a neoplasm)

80
Q

Focal nodular hyperplasia (a hepatic tumor) is most common in what demographic?

A

Young-ish females

81
Q

What is the etiology of hepatic focal nodular hyperplasia?

A

Local hyper-perfusion due to presence of an anomalous artery

82
Q

_________________ (hepatic tumors) are typically solitary and occur in young women.

A

Hepatocellular adenomas are typically solitary and occur in young women.

83
Q

_________ _________ increase risk of hepatocellular adenoma development.

A

Steroid hormones increase risk of hepatocellular adenoma development.

84
Q

Hepatocellular adenomas can be very dangerous for rupture and/or malignant transformation in cases of what?

A

Preeclampsia or HELLP syndrome

85
Q

_____% of women with hepatocellular adenomas have some abdominal mass symptom like pain.

A

50% of women with hepatocellular adenomas have some abdominal mass symptom like pain.

86
Q

Describe the characteristic morphology of hepatocellular adenomas.

A

Lacking portal triads

87
Q

True/False.

Hepatocellular adenomas can be HIF-1alpha-related, inflammatory (gp130 and IL-6 overactivation), beta-catenin-associated, or unclassified.

A

True.

88
Q

What is the most common primary malignancy of the liver?

A

Hepatocellular carcinoma

89
Q

True/False.

Hepatocellular carcinomas are typically HCV-related; can also be HBV, alcoholism, aflatoxins, etc.

A

False.

Hepatocellular carcinomas are typically HBV-related; can also be HCV, alcoholism, aflatoxins, etc.

90
Q

What three methods can be used in diagnosing hepatocellular carcinomas?

A

CT imaging;

serum AFP;

serum glypican-3

91
Q

True/False.

Hepatocellular carcinomas always present as solitary tumors.

A

False.

They may spread intra-hepatically and present as multiple tumors.

92
Q

Name the treatments for the following categories of hepatocellular carcinomas:

Small –

Large –

Metastatic –

A

Small – resection

Large – ablation

Metastatic – drugs (regorafenib, sorafenib)

93
Q

___________ hepatocellular carcinomas are a subtype that present in young, non-cirrhotic adults and are easily treated with simple resection.

A

Fibrolamellar hepatocellular carcinomas are a subtype that present in young, non-cirrhotic adults and are easily treated with simple resection.

94
Q

____________ development is associated with vinyl chloride exposure.

A

Angiosarcoma development is associated with vinyl chloride exposure.

95
Q

The most common cause of hepatic tumors are from what?

A

Metastases

(colorectal, melanoma, breast, lung, etc.)

96
Q

Cholangiocarcinomas are ________ (rare/common) and occur in the ___________ (location).

A

Cholangiocarcinomas are rare and occur in the biliary tree.

97
Q

Are cholangiocarcinomas most commonly intra-hepatic, hilar, or extra-hepatic?

A

Hilar

98
Q

Name a few inciting etiologies associated with cholangiocarcinoma development.

A

Primary sclerosing cholangitis;

inflammatory bowel disease (ulcerative colitis or Crohn’s)

choledochal cysts

Clonorchis sinensis

99
Q

What two imaging techniques are used in diagnosing cholangiocarcinomas?

A

ERCP; EUS

100
Q

True/False.

Cholangiocarcinomas are typically made of adenocarcinoma-like cells, but there are also subtypes that are mixed between hepatocellular carcinoma and cholangiocarcinoma cells.

A

True.

101
Q

What pediatric hepatic neoplasm is seen in the first five years of life, my be epithelial/fetal or mesenchymal, and often portends a poor prognosis?

A

Hepatoblastoma

102
Q

Name some of the S/Sy of a hepatoblastoma in a pediatric patient.

A

Anemia, thrombocytosis, elevated AFP

T2 - Phase 2 - Systems Modules (III) (14 decks)

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