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Gastrointestinal Block > GI Liver Pathology > Flashcards

GI Liver Pathology Flashcards

1
Q

Pathogenesis of hepatocellular steatosis (alcohol, 3 things)

A

1) shunting toward lipid synthesis; making NADH 2) impaired assembly and secretion of lipoproteins 3) peripheral catabolism of fat (increase FFA in blood)

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2
Q

Pathology of alcoholic hepatitis (3 things)

A

1) Hepatocyte swelling and necrosis 2) Mallory-Denk bodies 3) Neutrophilic inflammation

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3
Q

Earliest pattern of hepatic fibrosis in alcoholic liver disease

A

Perivenular fibrosis

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4
Q

Liver enzymes in alcoholic liver dz

A

AST>ALT; 2:1 ratio or higher

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5
Q

Cause of death in alcoholic liver dz (5 things)

A

1) Coma 2) GI hemorrhage 3) infection 4) hepatorenal syndrome 5) hepatocellular carcinoma

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6
Q

Associated diseases with NAFLD

A

Metabolic syndrome

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7
Q

NASH

A

Subset of NAFLD with clinical features: elevated serum transaminases, hepatocyte injury

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8
Q

Features of pediatric NAFLD

A

1) more diffuse steatosis 2) portal more than central fibrosis 3) portal and parenchymal mononuclear infiltration

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9
Q

NASH vs. Alcoholic liver dz pathology

A

Same! (may have more portal fibrosis with NASH)

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10
Q

Budd-Chiari syndrome

A

Hepatic vein thrombosis with tender hepatomegaly, abdominal pain, and ascites

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11
Q

Inflammatory mediators of sepsis

A

Kupffer cells

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12
Q

Diseases leading to bile plugging up the canaliculi and hepatocytes, respectively

A

Canalicular cholestasis and hepatocellular cholestasis

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13
Q

Liver diseases of pregnancy (3)

A

1) HELLP syndrome 2) acute fatty liver of pregnancy 3) intrahepatic cholestasis of pregnancy (most common)

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14
Q

Pathogenesis of intrahepatic cholestasis

A

Epiallopregnanolone sulfate inhibition of farnesoid X receptor mediated bile efflux

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15
Q

Tx of intrahepatic cholestasis

A

Ursodeoxycholic acid

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16
Q

Toxic metabolite of Tylenol

A

N-acetyl-p-benzoquinoneimine (NAPQI)

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17
Q

Most susceptible part of liver in Tylenol overdose

A

Centrolobular hepatocytes (runs out of glutathione first)

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18
Q

Lobular metabolic gradient

A

Periportal gets most blood, centrolobular gets least

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19
Q

Zones of necrosis for acetaminophen, yellow fever/mushrooms, phosphorus, respectively

A

Central, midzone, and periportal

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20
Q

Pathology of acute viral hepatitis

A

1) swollen pale hepatocytes 2) portal and lobular infiltration by lymphcytes, macrophages, and plasma cells 3) Kupffer cell hypertrophy and hyperplasia 4) cholestasis

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21
Q

Viral hepatitis vs. autoimmune hepatitis

A

Autoimmune has more plasma cells

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22
Q

Manifestation of alcoholic hepatitis

A

1) bleeding (increased PT) 2) confusion 3) fever

23
Q

Conditions with macrovesicular steatohepatitis

A

Alcoholic hepatitis, NASH, glucocorticoids

24
Q

Conditions with microvesicular steatohepatitis

A

Acute fatty liver of pregnancy, Reye syndrome, hornet stings, alcoholic hepatitis (mixed with macrovesicular)

25
Q

Conditions with feathery degeneration

A

Biliary obstruction by stones, tumors or granulomas

26
Q

Councilman bodies

A

Eosinophilic apoptotic cells commonly seen with viral hepatitis

27
Q

Liver pathology in heart failure

A

Congestion, nutmeg liver, centrolobular necrosis

28
Q

Causes of direct jaundice

A

Obstruction, hepatitis, Dubin-Johnson

29
Q

Causes of indirect jaundice

A

Hemolysis, hepatitis, Gilbert

30
Q

Physiologic jaundice

A

Seen in neonates with immature liver up to 2 weeks old

31
Q

Biliary atresia

A

Inflammation and fibrosis of extrahepatic bile ducts

32
Q

Features of biliary atresia

A

Jaundice at 3-6 weeks, high GGT

33
Q

Alagille syndrome

A

Lack of intrahepatic bile ducts, jaundice, pruirits, and cholestasis plus developmental defects

34
Q

Mutation in Alagille syndrome

A

Mutation in JAGGED 1 gene

35
Q

Dubin-Johnson syndrome

A

Defective excretion of bilirubin conjugates; black pigmented lysosomes with epinephrine metabolites

36
Q

Gilbert syndrome

A

Deficiency of UGT - mild hyperbilirubinemia brought on by stress

37
Q

Primary biliary cirrhosis

A

Autoimmune cholestatic disease, FEMALES, presents with pruritis, fatigue, hepatomegaly, elevated ALP

38
Q

Pathology of primary biliary cirrhosis

A

Dense lymphocytic infiltrate in and around interlobular bile ducts, granulomas, and bile duct loss

39
Q

Ascending cholangitis

A

Infection of intrahepatic biliary ducts (acute - bacterial, chronic - parasites)

40
Q

Features of ascending cholangitis

A

Fever, chills, abdominal pain, jaundice; purulent bile distends bile ducts, liver abscesses

41
Q

Common primary sites for liver metastases

A

Colon, lung, breast, pancreas, stomach

42
Q

Two most common genetic mutations in hepatocellular carcinoma

A

Activation of beta-catenin and inactivation of p53

43
Q

Morphology of HCC

A

Unifocal, multifocal, or diffusely infiltrative (doesn’t show up on imaging)

44
Q

Most common benign tumor of the liver

A

Hemangioma

45
Q

Rare malignant epithelial neoplasm of liver in children

A

Hepatoblastoma

46
Q

Malignant epithelial neoplasm with biliary differentiation, arising from cholangiocytes

A

Cholangiocarcinoma

47
Q

Pathology of cholangiocarcinoma

A

Tan-white and firm lesions

48
Q

Urine odors for tyrosenemia, phenylketonuria, trimethylaminuria, isovalaric acidemia, and maple syrup urine dz, respectively

A

Boiled cabbage, Mousy or musty, Rotting fish, Sweaty feet, Maple syrup

49
Q

Pathogenesis of tyrosinemia

A

Fumaryl-aceto-acetase deficiency that leads to backup of tyrosine that injures the liver

50
Q

Pathogenesis of Gaucher’s disease

A

Beta-glucocerebrosidase deficiency, splenomegaly, Kupffer cells with expanded crinkled cytoplasm

51
Q

Glycogen storage disease type I (Von Gierke)

A

Glucose-6-phosphatase deficiency that results in glycogen accumulation in the liver, hepatomegaly, hypoglycemia

52
Q

Porphyrias

A

Defect in heme synthesis; acute or cutaenous; porphyria cutanea tarda has skin vesicles and bullae with sun exposure - more common in women; precipitated by drug, alcohol, smoking, steroids, oral contraceptives

53
Q

Acute Intermittent Porphyria

A

Urine can become dark/purple, urine test for porphobilinogen, give IV heme for Tx

54
Q

Pyloric stenosis

A

Few week old baby with immediate postprandial non-bilious projectile vomiting with olive-like mass in abdomen

Gastrointestinal Block (2 decks)

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