Hepatobiliary 1 Flashcards
Councilman bodies
necrotic, shrunken, eosinophilic hepatocytes following apoptosis
Where are councilman bodies found?
liver cell necrosis
hyperbilirubinemia
unconjugated bilirubin in blood like red cell destruction or abnormal hepatocyte metabolism
kernicterus (hyperbilirubinemia)
a bilirubin induced brain dysfunction
cirrhosis
diffuse involvement of whole liver by fibrosis
cirrhosis is caused by hepatocellular injury by
chronic hep B or chronic hep C, nonalcoholic fatty liver disease
what are less common causes of cirrhosis?
autoimmune disease or iron overload like deposition of glycogen or copper
What happens to the architecture of the liver in cirrhosis?
- 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
Is cirrhosis reversible?
irreversible and end stage of many processes
cirrhosis may lead to death from
progressive liver failure, portal hypertension, hepatocellular carcinoma
What is the most common type of liver cancer?
hepatocellular carcinoma
What is the most common intrahepatic cause of portal hypertension?
cirrhosis
etiology of cirrhosis
hemochromatosis + wilson disease
hemochromatosis
- excessive iron accumulation in liver, pancreas, heart, pituitary, joints, + others
- organ dysfunction
wilson disease
- inadequate hepatic excretion of copper
- excess copper accumulates in liver, brain, eyes
- causes cirrhosis
- kayser feischer rings
What are kayser feisher rings, seen in Wilson’s disease?
pathognomonic of cirrhosis, deposition of copper in corneal limbus, dark rings encircling the iris
What is the most common cause of chronic liver disease?
alcohol (toxic liver disease)
In toxic liver disease, what is the metabolic product that damages the liver?
aldehyde
nonalcoholic fatty liver disease is caused by
obesity, type 2 diabetes, hypertension, dyslipidemia
alcoholic liver disease; heavy drinkers develop
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
alcoholic hepatitis (alcoholic liver disease)
- associated w/ extreme fatty change + sometimes cirrhosis
- results from prolonged alcoholic abuse
histopathology of alcoholic hepatitis
- swelling+ necrosis of hepatocytes
- acute inflammation
- formation of alcoholic pink hyaline (mallory bodies) in swollen hepatocytes
Are mallory bodies pathognomonic for alcoholic hepatitis?
No, not pathognomonic since also seen in Wilson disease, hepatocellular carcinoma, + biliary cirrhosis
What is the most common manifestation of alcoholic liver disease?
steatosis
3 primary manifestations of alcoholic liver disease
steatosis, hepatitis, and cirrhosis
What is associated with right heart failure
chronic passive congestion
What is nutmeg liver associated with?
chronic passive congestion
nutmeg liver in chronic passive congestion
enlarged due to back pressure from systemic veins to hepatic veins, accentuation of the lobular pattern; variegated, mottled red
budd chiari syndrome
hepatic vein thrombosis
budd chiari syndrome (hepatic vein thrombosis)
rare; acute or insidious; may lead to hepatomegaly, ascites + death
-hepatic vein obstruction resulting in chronic congested liver , portal hypertension + jaundice
What are the causes of budd chiari syndrome?
polycythemia, vera and myeloproliferative disorders, pregnancy, oral contraceptives, and hepatocellular carcinoma
Is hepatocellular carcinoma (hepatoma) malignant?
Hepatomas are malignant!
What is 80% of primary liver neoplasms?
hepatocellular carcinoma (hepatoma)
hepatocellular carcinoma (hepatoma)
male predilection 3-8:1;
What is hepatocellular carcinoma/hepatoma associated with?
associated w/ HBV and HCV infection, hepatitis, cirrhosis, nonalcoholic fatty liver disease, aflatoxin
hepatocellular carcinoma (hepatoma) symptoms
abdominal pain, swelling, weight loss, weakness, jaundice, fever, loss of appetite
hepatocellular carcinoma (hepatoma) death from
hemorrhage + liver failure
-5 yr survival= 16% (3% if distant metastasis)
What is the most common malignancy of the liver?
mestastatic carcinoma
Where does the metastasis of metastatic malignancy of the liver come from?
lung, colon, pancreas, or breast; multiple well circumscribed nodules in markedly enlarged liver
most common site for gallstone formation (i.e. cholelithiasis)
gallbladder
what is the most common cause of biliary tree disease?
gallstones
gallstones come from constituents of bile which are
cholesterol, bilirubin (calcium bilirubinate) + calcium salts (phosphates, carbonates)
when bile becomes supersaturated w/ cholesterol, this creates
cholesterol stones
What causes cholesterol stones?
either too much cholesterol or insufficient bile salts to keep cholesterol in solution
pigment stones come from
clumps of pigment derived from excess insoluble unconjugated bilirubin (*calcium bilirubinate + lesser amounts of calcium salts + mucoproteins *)
when bile becomes supersaturated w/ bile pigment, this creates
pigment stones
What percentage are gallstones in the biliary tract asymptomatic?
70-80%
acute cholecystitis is when
gallstone obstructs gallbladder neck or cystic duct
chronic cholecystitis is almost always accompanied by
cholelithiasis (formation of gallstones)
chronic cholecystitis secondary gross changes
extensive calcification of wall (“porcelain gallbladder”)
-cystic outpouces in walls= rokitansky aschoff sinuses
obstructive jaundice
obstruction of common bile duct
obstructive jaundice=obstruction of common bile duct due to
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)
Gross view of obstructive jaundice
liver is green, stained, enlarged
malignancies of the gallbladder
adenocarcinoma of the gallbladder
most common primary tumor of the gallbladder
adenocarcinoma of the gallbladder
Adenocarcinoma of the gallbladder is usually associated w/
gallstones and/or chronic cholecystitis (inflammation of gallbladder)
