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Pathology > Hepatobiliary- Exam II > Flashcards

Hepatobiliary- Exam II Flashcards

1
Q

Describe the structure of the liver:

A

“Classic lobule”
- roughly hexagonal

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2
Q

The liver consists of stacks of ____ with intervening ___

A

hepatocyte plates; sinusoidal spaces

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3
Q

The center of the lobule is a ___ , into which the ___ drain

A

central vein (venule); sinusoids

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4
Q

Where do the sinusoids drain?

A

into the central venules

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5
Q

The liver structure is roughly hexagonal with ____ at the angles of the hexagon

A

portal triads

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6
Q

Contains connective tissue with terminal branches of the hepatic artery, portal, as well as a bile duct:

A

portal triads at the angles of the hexagon

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7
Q

What do the portal triads at the angles of the hexagon contain? (5)

A
  1. connective tissue with terminal branches of the hepatic artery
  2. portal vein
  3. bile duct
  4. lymphatic vessels
  5. nerves
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8
Q

Where does blood enter the liver?

A

hepatic artery and the portal vein

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9
Q

Branches of what vessels travel in the portal triads?

A

hepatic artery and portal vein

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10
Q

Blood from the triads enters the ___, where it is mixed, and flows to the ____.

A

hepatic sinusoids; central veins

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11
Q

Central veins drain into ____ which drain into the ____

A

sublobular veins; hepatic vein

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12
Q

Label the following image:

A

A: Hepatic vein
B: Hepatic artery
C: Portal vein
D: Common bile duct
E: Gallbladder

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13
Q

Hepatocyte functions include: (5)

A
  1. protein synthesis
  2. oxidation & conjugation of drugs/toxins/etc.
  3. lipid metabolism
  4. carbohydrate metabolism
  5. bile production (an exocrine secretion)
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14
Q

What proteins are hepatocytes responsible for producing?

A
  1. albumin & other transport proteins
  2. clotting factors
  3. lipoproteins (especially VLDL)
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15
Q

How do hepatocytes function in oxidation and conjugation of drugs, toxins, & etc.?

A

makes substances not easily excreted by the kidney more hydrophilic, to enhance excretion

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16
Q

Hepatocytes function to make substances not easily excreted by the kidney more hydrophilic, to enhance excretion through what three processes?

A
  1. hydroxylation
  2. carboxylation
  3. conjugation
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17
Q

Describe the lipid metabolism function of hepatocytes:

A

stores or breaks down fatty acids from plasma; as well as the synthesis and uptake of cholesterol

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18
Q

In the hepatocytes function of carbohydrate metabolism, they either convert glucose to ___ for carb storage; or break down glycogen to ___ for energy usage

A

glycogen; glucose

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19
Q

Hepatocytes produce bile (and exocrine secretion) which contains ______ which aid in ____

A

bile salts; emulsifying lipids in the GI tract

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20
Q

What function of the hepatocyte is being described below?

production of albumin and other transport proteins, clotting factors, lipoproteins (especially VLDL)

A

Protein synthesis

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21
Q

What function of the hepatocyte is being described below?

Makes substances not easily excreted by the kidney more hydrophilic, to enhance excretion via hydroxylation, carboxylation, & conjugation:

A

Oxidation & conjugation of drugs, toxins, etc.

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22
Q

What function of the hepatocyte is being described below?

Stores or breaks down fatty acids from plasma; synthesis and uptake of cholesterol

A

Lipid metabolism

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23
Q

What function of the hepatocyte is being described below?

Either converts glucose to glycogen for carbohydrate storage, or breaks down glycogen to glucose for energy usage

A

carbohydrate metabolism

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24
Q

What function of the hepatocyte is being described below?

Contains bile salts which aid in emulsifying lipids in the GI tract:

A

bile production (an exocrine secretion)

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25
Q

Hepatocyte injury describes either ___ or ___ changes

A

reversible or non-reversible

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26
Q

What hepatocyte injury is being described?

accumulation of fat (steatosis) &/or accumulation of bilirubin

A

reversible changes

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27
Q

What hepatocyte injury is being described?

Necrosis and/or apoptosis

A

Non-reversible

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28
Q

Liver hepatocyte necrosis may follow ___ and may be single cell death or it can be zonal or regional

A

hypoxia/ischemia

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29
Q

Necrosis that may follow hypoxia/ischemia may be : (3)

A
  1. single cell death
  2. zonal
  3. regional (confluent necrosis)
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30
Q

Regional necrosis of the liver may be termed:

A

confluent necrosis

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31
Q

Necrosis or apoptosis of the hepatocytes of the liver may follow: (3)

A
  1. viral infection
  2. toxin exposure
  3. inflammatory conditions
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32
Q

By dividing hepatocytes near the site of injury , or in more severe injuries by dividing stem cells:

A

regeneration

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33
Q

Describe the process of liver regeneration:

A

occurs via dividing hepatocytes near the site of injury, or in more severe injuries by dividing stem cells

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34
Q

Most often a result of chronic liver injury:

A

scar formation

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35
Q

Scar formation of the liver may progress to:

A

cirrhosis

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36
Q

Situation in which the liver is made up of nodules of regenerating hepatocytes surrounded by dense bands of collagen

A

liver cirrhosis

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37
Q

Acetaminophen ingestion, autoimmune hepatitis, acute viral hepatitis, and other drugs/toxins may result in:

A

acute liver failure

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38
Q

Describe the clinical features of acute liver failure:

A

presents with nausea/vomiting, jaundice, fatigue, followed by encephalopathy & coagulation defects

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39
Q

If a patient presents with nausea/vomiting, jaundice, fatigue, followed by encephalopathy & coagulation defects you would most likely diagnose them with:

A

acute liver failure

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40
Q

Yellow coloration of the skin due to bilirubin retention and cholestasis:

A

jaundice

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41
Q

Discoloration of the sclera:

A

icterus

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42
Q

symtoms ranging from behavioral abnormalities to confusion, stupor, coma, and death:

A

hepatic encephalopathy

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43
Q

What is hepatic encephalopathy believed to be caused by:

A

elevated ammonia levels (impairs neuronal function and causes cerebral edema)

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44
Q

What can be seen in the following images?

A

icterus

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45
Q

What can be seen in the following image?

A

jaundice

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46
Q

Bruising and bleeding associated with liver failure:

A

coagulopathy

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47
Q

In patients without pre-existing renal disease, acute liver failure can result in decreased renal perfusion, leading to decreased urine output:

A

hepatorenal syndrome

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48
Q

Chronic liver failure is characterized by: (3)

A
  1. cirrhosis
  2. portal hypertension
  3. ascites
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49
Q

diffuse transformation of the lier into regenerative hepatocyte nodules surrounded by bands of dense fibrous connective tissue (essentially scar)

A

cirrhosis

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50
Q

Most common causes of chronic liver failure worldwide include: (4)

A
  1. chronic hep B
  2. chronic hep C
  3. nonalcoholic fatty liver disease (NAFLD)
  4. alcohol-related liver disease
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51
Q

____ does not indicate the presence of a specific disease; it is a common final pathway of a number of chronic liver diseases

A

cirrhosis

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52
Q

Not all chronic liver diseases result in ____ and not all cirrhosis results in ____

A

cirrhosis; end-stage liver disease

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53
Q

Increased portal vascular resistance; portosystemic shunts may develop (e.g. esophageal varices)

A

portal hypertension

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54
Q

Esophageal varices is an examples of ____ that may be caused by ____

A

portosystemic shunt; portal hypertension

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55
Q

Increase in fluid in the peritoneal space, arises primarily due to portal hypertension:

A

ascites

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56
Q

Viral hepatitis may be caused by:

A

hepatotropic viruses A, B, C, D, and E

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57
Q

Hepatitis A:

  1. Usually ___ & ___
  2. Caused by:
  3. ___ root of transmission
  4. Symptoms include:
  5. Infection persists for:
  6. (does/does not) cause chronic hepatitis
  7. diagnosis:
A
  1. benign & self-limited
  2. ingestion of contaminated food/water
  3. fecal-oral
  4. fever, fatigue, n/v, decreased appetite, and jaundice
  5. 2-12 weeks
  6. does not
  7. detection of IgM antibodies
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58
Q

Hepatitis B:

  1. Describe the clinical course
  2. HBV-associated chronic hepatitis incurs and elevated risk for:
  3. ____ people worldwide have chronic Hep B infections
  4. Prevalence is greater in the regions of:
  5. ___ transmission
  6. describe vaccine effectiveness:
  7. diagnosis:
A
  1. clinical course varies widely
  2. hepatocellular carcinoma
  3. 2 billion
  4. africa and asia
  5. parenteral
  6. approximately 95% effective
    7.detection of HBsAg; anti-HBcA:, HBV DNA by PCR
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59
Q

The clinical course of Hep B varies widely, including:

A
  1. acute hepatitis with clearance and recovery
  2. non-progressive chronic hepatitis
  3. progressive chronic hepatitis leading to cirrhosis
  4. fulminant hepatitis with massive liver necrosis
  5. asymptomatic carrier state
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60
Q

HBV-associated chronic hepatitis insures an elevated risk for:

A

hepatocellular carcinoma

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61
Q

Label the following image from top to bottom:

A
  • subclinical disease
  • acute hepatitis
  • chronic hepatitis
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62
Q

Label the following image from top to bottom:

A
  • recovery
  • fulminant hepatitis
  • recovery
  • cirrhosis
  • hepatocellular carcinoma
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63
Q

Label the following image from top to bottom:

A
  • death or transplant
  • death or transplant
64
Q

How is a typical presentation of hepatocytes in hep B infection?

A

ground glass appearance

65
Q

Hepatitis C:

  1. Affects approximately ____ people worldwide
  2. ___ route of transmision
  3. Acute infection is generally asymptomatic in ___% of cases, but ___% of case develop persistent, chronic infections, leading to cirrhosis in about ___ % over 2-3 decades
  4. Those that develop cirrhosis from hep C are at an increased risk of:
  5. Diagnosis:
  6. Treatment:
A
  1. 170 million
  2. parenteral
  3. 85%; 80-90%; 20%
  4. hepatocellular carcinoma
  5. HCV RNA (qualitative & quantitative tests available)
  6. treatable with antiviral combination therapy (can cure 95% of infections)
66
Q

If a liver biopsy shows chronic inflammation of a portal tract, this is a typical sign that it is:

A

Hep C infection

67
Q

Hepatitis D:

  1. Dependent on ___ for its life cycle to progress
  2. ____ route of transmission
  3. Diagnosis:
  4. Describe coinfection
  5. Describe superinfection:
A
  1. HBV
  2. parenteral
  3. detecting HDV RNA
  4. clinically indistinguishable from HBV infection, usually self-limited
  5. HBV carrier exploded to HDV, resulting in either severe acute hepatitis or exacerbation of chronic HBV
68
Q

What may result from an HBV carrier being exposed to HDV?

A

Superinfection- resulting in either severe acute hepatitis or exacerbation of chronic HBV

69
Q

Clinically what two types of hepatitis are indistinguishable:

A

HBV and HDV

70
Q

Hepatitis E:

  1. ____ transmitted (____)
  2. clinically produces:
  3. ____ with ____ reservoirs
  4. Diagnosis:
A
  1. enterically (fecal-oral)
  2. acute, self-limited hepatitis
  3. zoonotic; animal reservoirs
  4. IgM, HEV, RNA
71
Q

Aise from liver infections being caused by hepatitis viruses (A, B, C, D, E); liver infections may also be caused by:

A
  1. bacteria
  2. parasites
72
Q

Describe a liver infection caused by bacteria:

A

Ascending infections involving the biliary tract (usually gut flor)

73
Q

The seeding of bacteria in a liver in infection is via:

A

blood

74
Q

What two types of liver infection-causing bacteria are responsible for seeding via blood?

A
  1. S. aureaus
  2. Salmonella typhii
75
Q

If a liver infection is caused by bacteria, the result may be:

A

an abscess

76
Q

Describe some parasitic causes of a liver infection:

A
  1. worms (schistosomiasis, liver flukes, ehincococcus)
  2. entamoeba histolytica
77
Q

List the following features that are seen with the chronic, progressive disorder of autoimmune hepatitis:

A
  1. presence of autoantibodies
  2. responds to immunosupression
  3. may have a genetic presdisposition
  4. may be associated with other autoimmune diseases
78
Q

Autoimmune hepatitis can be described as:

A

a chronic progressive disorder

79
Q

Autoimmune hepatitis is associated with the presence of autoantibodies, list some examples:

A

antinuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA)

80
Q

Autoimmune hepatitis responds to immunosuppression resulting in:

A

remission in 90% of patients (even those with cirrhosis)

81
Q

Describe the morphology associated with autoimmune hepatitis: (2)

A
  1. necrosis and inflammation (especially plasma cells)
  2. may lead to cirrhosis
82
Q

List the patterns of liver injury associated with drugs and toxins:

A
  1. fatty change (micro vesicular or macro vesicular)
  2. fibrosis
  3. cholestasis
  4. necrosis
83
Q

Fatty changes in the liver (microvesicular or macrovesicular) may be due to:

A

alcohol, methotrexate, or tetracycline

84
Q

Fibrosis of the liver may be due to:

A

alcohol or methotrexate

85
Q

Cholestasis of the liver may be due to:

A

Chlorpromazine

86
Q

Necrosis of the liver may be due to:

A

acetaminophen, carbon tetrachloride, mushroom toxins (amanita phalloides- “death cap”)

87
Q

Drug reactions that cause injury to the liver may be predictable (____) or unpredictable (____)

A

intrinsic; idosyncratic

88
Q

An example of a predictable (intrinsic) drug reaction in the liver=

A

acetaminophen

89
Q

An example of an unpredictable (idiosyncratic) drug reaction in the liver=

A

chlorpromazine

90
Q

Both feature varying degrees of steatosis, steatohepatitis and gradually increasing fibrosis which may eventually progress to cirrhosis:

A

fatty liver disease (alcohol and non-alcohol related)

91
Q

Symptoms and lab abnormalities that develop in the setting of an already-fatty liver (malaise, anorexia, upper abdominal discomfort)

A

steatohepatitis

92
Q

List some examples of steatohepatitis:

A

malaise, anorexia, upper abdominal discomfort

93
Q

Condition of the liver that is becoming increasingly common, associated with type II DM, obesity, hyperlipidemia, and hypertension:

A

NAFLD

94
Q

Alcohol-related fatty liver disease is caused by:

A

excessive ethanol consumption

95
Q

Cause of more than 60% of chronic liver disease in western countries:

A

excessive ethanol consumption

96
Q

In liver disease caused by excessive ethanol consumption, 40-50% of deaths are ultimately caused by:

A

cirrhosis

97
Q

Metabolic liver diseases include: (3)

A
  1. hemochromatosis
  2. Wilson disease
  3. Alpha-1 anti-trypsin deficiency
98
Q

Metabolic liver disease characterized by excessive absorption of iron, deposited in the liver, pancreas, heart, and other organs

A

Hemochromatosis

99
Q

Hemochromatosis may be ___ , especially in ____

A

acquired; transfusion-dependent patients

100
Q

Although hemochromatosis may be acquired, it is usually ____ characterized by:

A

hereditary; loss or impairment of regulatory control of intestinal iron absoprtion

101
Q

Mutation of the ___ gene is the most common mutation causing hereditary hemochromatosis

A

HFE gene

102
Q

In hemochromatosis, we see tissue deposition of ___ leading to gradually increasing ____.

A

hemosiderin; fibrosis

103
Q

In hemochromatosis, iron deposition in other organs can lead to ___ and ____ of other organs, in addition to changes in ___.

A

fibrosis & atrophy; skin pigmentation

104
Q

An autosomal recessive disease characterized by loss of function mutation of ATP7B, leading to impaired copper excretion in oil and failure to incorporate copper into ceruloplasmin:

A

Wilson disease (metabolic liver disease)

105
Q

Wilson disease is caused by a ____ mutation in the ____ gene

A

loss-of-function; ATP7B

106
Q

In Wilson disease, there is an increased amount of ___ In circulation that causes ____

A

unbound copper; hemolysis

107
Q

What disease is characterized by an accumulation of toxic levels of copper in organ, mostly the liver, brain and eye:

A

wilson disease

108
Q

Discuss the morphology seen with Wilson disease:

A

Variable morphology in the liver such as fatty change, hepatitis (acute or chronic), and ultimately cirrhosis

Kayser-Fleishcer rings in the eye (which are despots of copper in the limbus of the cornea)

109
Q

Deposits of copper in the limbus of the cornea is seen in ____ disease. What is this called?

A

Wilson Disease (metabolic liver disease); Kayser-Fleischer rings

110
Q

What can be seen in the following image?

A

Kayser-Fleischer rings

111
Q

Acute/chronic liver disease or neuropsysiciatric signs may be the presenting features of what metabolic disease?

A

wilson disease

112
Q

How is Wilson disease diagnosed?

A
  • decreased serum ceruloplasmin
  • increased hepatic copper content
  • increased urine copper
113
Q

How is wilson disease treated?

A
  • copper chelation therapy & zinc-based therapy (inhibits copper uptake in the gut)
114
Q

Why might zinc-based therapy be utilized to treat Wilson disease?

A

because zinc inhibits copper uptake in the gut

115
Q

Metabolic liver disease that is autosomal recessive, characterized by mutations resulting in misfiling and loss of function of alpa-1AT, which normally inhibits proteases (particularly neutrophil proteases)

A

alpha-1 anti-trypsin deficiency

116
Q

Alpha-1 anti-trypsin deficiency is an autosomal recessive disorder, with mutations resulting in misfiling and loss of function of alpha-1AT. What does alpha-1AT normally function to do?

A

Normally inhibits proteases (particularly neutrophil proteases)

117
Q

alpha-1AT is synthesized mainly by:

A

hepatocytes

118
Q

Alpha-1AT is mainly synthesized by hepatocytes, but the abnormal form accumulates in the hepatocytes resulting in:

A

apoptosis

119
Q

Alpha-1AT is mainly synthesized by hepatocytes, but the abnormal form accumulates in the hepatocytes resulting in apoptosis.

Before they die, hepatocytes accumulates _____ which may progress to ___ and eventually ___

A

cytoplasmic globular inclusions; hepatitis; cirrhosis

120
Q

Clinically, the only effective treatment for severe cases of alpha-1 anti-trypsin deficiency is:

A

liver transplant

121
Q

In alpha-1 anti-trypsin deficiency, the ___ is also often involved resulting in ___. (especially if ___)

A

lung; emphysema; patient smokes

122
Q
  • Focal nodular hyperplasia
  • Cavernous hemangioma
  • Hepatocellular adenoma

These are all:

A

benign hepatic tumors

123
Q
  • Hepatocellular carcinoma (HCC)
  • metastatic tumors to the liver (much more common)

These are all:

A

malignant hepatic tumors

124
Q

What type of hepatic tumor is being described below? Is this benign or malignant?

  • may be single or mutliple
  • develop in non-cirrhotic liver
  • though to result from focal chronic hypoperfusion of an area of the liver, resulting in scarring and compensatory hyperperfusion leading to focal hepatocyte hyperplasia
  • most common in younger women (ages 20-50)
A

focal nodular hyperplasia; benign

125
Q

_____ can microscopically resemble cirrhosis, but it is actually a focal lesion:

A

Focal nodular hyperplasia

126
Q

What type of hepatic tumor is being described below? Is this benign or malignant?

  • usually arises in non-cirrhotic liver
  • most common in reproductive age women
  • stimulated by estrogen
  • sheets of sheets of hepatocytes, normal to atypical
  • rare cases progress to malignancy
A

hepatocellular adenoma

127
Q

Why is hepatocellular adenoma most common in reproductive women?

A

because it is stimulated by estrogen

128
Q

-What type of hepatic tumor is being described below?

  • Most common liver benign liver tumor
  • Tumors of benign blood vessels
  • variably dilated
A

cavernous hemangioma

129
Q

In hepatocellular adenoma, the mass may sometimes be:

A

hemmorhagic

130
Q

What type of hepatic tumor is being described below? Is this benign or malignant?

  • incidence varies widely throughout the world (highest in Eastern Asia and sub-saharan Africa)
  • Exposure to HBV and aflatoxin (aspergillus flavus) markedly cause an increased risk
  • incidence in western countries rising, mainly due to increase HCV
  • Chronic liver diseases (particular in a background of cirrhosis) are the most common setting for this tumor to develop
  • Main risk factors include: HBV, HCV, aflatoxin exposure , and increasingly NAFLD
A

hepatocellular carcinoma; malignant

131
Q

Inferior and adherent to the liver:

A

gallbladder

132
Q

The function of the gallbladder is to:

A

concentrate, store, and excrete bile

133
Q

The gallbladder receives dilute bile from the:

A

common hepatic duct

134
Q

In response to hormones from enteroendocrine cells (for example cholecystokinin), or to parasympathetic stimulation, the gallbladder:

A

contracts, and delivers bile to the duodenum via the cystic duct and the common bile duct

135
Q

The gallbladder delivers bile to the duodenum via:

A

cystic duct and common bile duct

136
Q

The gallbladder delivers bile to the duodenum in response to:

A

hormones from enteroendocrine cells or to parasympathetic stimulation

137
Q

Label the following image:

A

A: pyloric valve
B: stomach
C: pancreas
D: pancreatic duct
E: duodenum
F: common bile duct
G: gallbladder
H: cystic duct

138
Q

Layers of the gallbladder wall include: (4)

A
  1. mucosa
  2. muscularis externa
  3. connective tissue/adventitia
  4. serosa
139
Q

The gallbladder mucosa contains:

A

epithelium and lamina propria

140
Q

The gallbladder mucosa contains occasional ___ near the neck

A

mucous glands

141
Q

The gallbladder mucosa surface epithelium is:

A

simple columnar

142
Q

The gallbladder mucosa surface epithelium is simple columnar that resembles:

A

intestinal absorptive cells

143
Q

The gallbladder mucosa surface epithelium is simple columnar with ____ complexes, ______, and _____ surrounding intercellular spaces

A

apicolateral junctional complexes; short microvilli; complex lateral plications

144
Q

Gallstones are also termed:

A

cholelithiasis

145
Q

Gallstones affect:

A

10-20% of adults in US

146
Q

The two main types of gallstones include:

A

cholesterol stones & pigment (bile salt) stones

147
Q

Cholesterol stone risk factors include: (4)

A
  1. dyslipidemia
  2. female
  3. insulin resistance
  4. gallbladder stasis
148
Q

Pigment stone risk factors include: (3)

A
  1. chronic hemolysis (malaria & sickle cell)
  2. biliary infection
  3. various GI disorders (including crohns disease)
149
Q

What can be seen in the following image?

A

cholesterol stones

150
Q

What can be seen in the following image?

A

pigment stones

151
Q

Gallstones (cholelithiasis) may result in:

A

acute or chronic cholecystitis

152
Q

Gallbladder carcinoma occurs at _____ age, with slight ____ predominance

A

older age; female

153
Q

At the time of diagnosis of gallbladder carcinoma, the gallbladder is usually not:

A

resectable

154
Q

The mean 5-year survival for gallbladder carcinoma is approximately:

A

5-12%

155
Q

Gallbladder carcinoma is thought to arise primarily in background of:

A

chronic gallbladder inflammation

156
Q
A

Pathology (24 decks)

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