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BHP Exam 4 > Hepatobiliary 1 > Flashcards

Hepatobiliary 1 Flashcards

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1
Q

Councilman bodies

A

necrotic, shrunken, eosinophilic hepatocytes following apoptosis

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2
Q

Where are councilman bodies found?

A

liver cell necrosis

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3
Q

hyperbilirubinemia

A

unconjugated bilirubin in blood like red cell destruction or abnormal hepatocyte metabolism

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4
Q

kernicterus (hyperbilirubinemia)

A

a bilirubin induced brain dysfunction

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5
Q

cirrhosis

A

diffuse involvement of whole liver by fibrosis

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6
Q

cirrhosis is caused by hepatocellular injury by

A

chronic hep B or chronic hep C, nonalcoholic fatty liver disease

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7
Q

what are less common causes of cirrhosis?

A

autoimmune disease or iron overload like deposition of glycogen or copper

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8
Q

What happens to the architecture of the liver in cirrhosis?

A
  • normal architecture is diffusely replaced by regenerated nodules of liver cells, separated by bands of fibrotic collagen
  • lack usual architecture of ordered sinusoids + central vein
  • micronodular vs. macronodular patterns
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9
Q

Is cirrhosis reversible?

A

irreversible and end stage of many processes

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10
Q

cirrhosis may lead to death from

A

progressive liver failure, portal hypertension, hepatocellular carcinoma

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11
Q

What is the most common type of liver cancer?

A

hepatocellular carcinoma

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12
Q

What is the most common intrahepatic cause of portal hypertension?

A

cirrhosis

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13
Q

etiology of cirrhosis

A

hemochromatosis + wilson disease

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14
Q

hemochromatosis

A
  • excessive iron accumulation in liver, pancreas, heart, pituitary, joints, + others
  • organ dysfunction
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15
Q

wilson disease

A
  • inadequate hepatic excretion of copper
  • excess copper accumulates in liver, brain, eyes
  • causes cirrhosis
  • kayser feischer rings
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16
Q

What are kayser feisher rings, seen in Wilson’s disease?

A

pathognomonic of cirrhosis, deposition of copper in corneal limbus, dark rings encircling the iris

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17
Q

What is the most common cause of chronic liver disease?

A

alcohol (toxic liver disease)

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18
Q

In toxic liver disease, what is the metabolic product that damages the liver?

A

aldehyde

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19
Q

nonalcoholic fatty liver disease is caused by

A

obesity, type 2 diabetes, hypertension, dyslipidemia

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20
Q

alcoholic liver disease; heavy drinkers develop

A

1 steatosis (90-100%)
2 alcoholic hepatitis (10-35%)- fever, jaundice, hepatomegaly, elevated AST, alkaline phosphatase, and ACT
3 alcoholic cirrhosis (8-20%)= portal hypertension, 10-20% develop carcinoma

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21
Q

alcoholic hepatitis (alcoholic liver disease)

A
  • associated w/ extreme fatty change + sometimes cirrhosis

- results from prolonged alcoholic abuse

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22
Q

histopathology of alcoholic hepatitis

A
  • swelling+ necrosis of hepatocytes
  • acute inflammation
  • formation of alcoholic pink hyaline (mallory bodies) in swollen hepatocytes
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23
Q

Are mallory bodies pathognomonic for alcoholic hepatitis?

A

No, not pathognomonic since also seen in Wilson disease, hepatocellular carcinoma, + biliary cirrhosis

24
Q

What is the most common manifestation of alcoholic liver disease?

A

steatosis

25
Q

3 primary manifestations of alcoholic liver disease

A

steatosis, hepatitis, and cirrhosis

26
Q

What is associated with right heart failure

A

chronic passive congestion

27
Q

What is nutmeg liver associated with?

A

chronic passive congestion

28
Q

nutmeg liver in chronic passive congestion

A

enlarged due to back pressure from systemic veins to hepatic veins, accentuation of the lobular pattern; variegated, mottled red

29
Q

budd chiari syndrome

A

hepatic vein thrombosis

30
Q

budd chiari syndrome (hepatic vein thrombosis)

A

rare; acute or insidious; may lead to hepatomegaly, ascites + death
-hepatic vein obstruction resulting in chronic congested liver , portal hypertension + jaundice

31
Q

What are the causes of budd chiari syndrome?

A

polycythemia, vera and myeloproliferative disorders, pregnancy, oral contraceptives, and hepatocellular carcinoma

32
Q

Is hepatocellular carcinoma (hepatoma) malignant?

A

Hepatomas are malignant!

33
Q

What is 80% of primary liver neoplasms?

A

hepatocellular carcinoma (hepatoma)

34
Q

hepatocellular carcinoma (hepatoma)

A

male predilection 3-8:1;

35
Q

What is hepatocellular carcinoma/hepatoma associated with?

A

associated w/ HBV and HCV infection, hepatitis, cirrhosis, nonalcoholic fatty liver disease, aflatoxin

36
Q

hepatocellular carcinoma (hepatoma) symptoms

A

abdominal pain, swelling, weight loss, weakness, jaundice, fever, loss of appetite

37
Q

hepatocellular carcinoma (hepatoma) death from

A

hemorrhage + liver failure

-5 yr survival= 16% (3% if distant metastasis)

38
Q

What is the most common malignancy of the liver?

A

mestastatic carcinoma

39
Q

Where does the metastasis of metastatic malignancy of the liver come from?

A

lung, colon, pancreas, or breast; multiple well circumscribed nodules in markedly enlarged liver

40
Q

most common site for gallstone formation (i.e. cholelithiasis)

A

gallbladder

41
Q

what is the most common cause of biliary tree disease?

A

gallstones

42
Q

gallstones come from constituents of bile which are

A

cholesterol, bilirubin (calcium bilirubinate) + calcium salts (phosphates, carbonates)

43
Q

when bile becomes supersaturated w/ cholesterol, this creates

A

cholesterol stones

44
Q

What causes cholesterol stones?

A

either too much cholesterol or insufficient bile salts to keep cholesterol in solution

45
Q

pigment stones come from

A

clumps of pigment derived from excess insoluble unconjugated bilirubin (*calcium bilirubinate + lesser amounts of calcium salts + mucoproteins *)

46
Q

when bile becomes supersaturated w/ bile pigment, this creates

A

pigment stones

47
Q

What percentage are gallstones in the biliary tract asymptomatic?

A

70-80%

48
Q

acute cholecystitis is when

A

gallstone obstructs gallbladder neck or cystic duct

49
Q

chronic cholecystitis is almost always accompanied by

A

cholelithiasis (formation of gallstones)

50
Q

chronic cholecystitis secondary gross changes

A

extensive calcification of wall (“porcelain gallbladder”)

-cystic outpouces in walls= rokitansky aschoff sinuses

51
Q

obstructive jaundice

A

obstruction of common bile duct

52
Q

obstructive jaundice=obstruction of common bile duct due to

A

1.gallstones (most often)
2. carcinoma of the pancreas
3 carcinoma of the ampulla of vater
4. carcinoma of the bile duct
5 fibrous stricture (often postoperative)

53
Q

Gross view of obstructive jaundice

A

liver is green, stained, enlarged

54
Q

malignancies of the gallbladder

A

adenocarcinoma of the gallbladder

55
Q

most common primary tumor of the gallbladder

A

adenocarcinoma of the gallbladder

56
Q

Adenocarcinoma of the gallbladder is usually associated w/

A

gallstones and/or chronic cholecystitis (inflammation of gallbladder)

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