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Pathology > Hepatobiliary Pathology > Flashcards

Hepatobiliary Pathology 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

hepatocytes plates; sinusoidal spaces

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3
Q

The center of the lobule is a _______, into which the ______ drain

A

central vein (venue); sinusoids

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4
Q

Where do the sinusoids drain?

A

Into the central venule

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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 vein, 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 angle of the hexagons 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 from?

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 & portal vein

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10
Q

Blood from the triads enter 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

sub lobular 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 & conjugation of drugs, toxins, and 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 exerted 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 & 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

Heptocytes produce bile (an 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 & 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

Carbohydate 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 describe either _____ or ____ changes

A

reversible or non-reversible

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26
Q

What type of hepatocytes injury is being described:

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

A

Reversible changes

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27
Q

What type of hepatocytes injury is being described:

Necrosis and/or apoptosis

A

Non-reversible changes

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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

Cirrhhosis

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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 injestion, 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 and coagulation defects

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39
Q

If a patient presents with nausea/vomiting, jaundice, fatigue, followed by encephalopathy and coagulation defects you would most likely diagnosis 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

Symptoms ranging from behavior 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 & 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 & 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 liver 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

An esophageal varice is an example of a _____ and may result from _____

A

Portosystemic shunt; portal hypertension

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55
Q

Increased 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, & E

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57
Q

Hepatitis A:

  1. Usually ____ & ____
  2. caused by:
  3. ____ route of transmission
  4. symptoms include:
  5. infections 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, 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 incures an 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. varies widely
  2. hepatocellular carcinoma
  3. 2 billion
  4. africa & asia
  5. parenteral
  6. approximately 95% effective
  7. detection of HBsAg, anti-HBcAg, HBV DNA by PCR
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59
Q

The clinical course of hepatitis B varies widely, including:

A
  1. Acute hepatitis with clearance & recovery
  2. nonprogresssive 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 incurs 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

What 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 transmission
  3. Acute infection is generally asymptomatic in _____ % of cases but ____% of cases develop persistent, chronic infections - leading to cirrhosis in about ___% over 2 to 3 decades
  4. Those that develop cirrhosis from hep C are at an increased risk of ______
  5. Diagnosis:
  6. Treatment:
A
  1. 170 million people
  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 lifecycle to progress
  2. ____route of transmisison
  3. Diagnosis:
  4. Describe coinfection:
  5. Describe superinfection:
A
  1. HBV
  2. Parenteral
  3. Detecting HDV RNA
  4. clincial indistinguishable form HBV infection, usually self-limited
  5. HBV carrier exposed 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 & HDV

70
Q

Hepatitis E:

  1. ______ transmission (_____)
  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

Aside 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 flora)

73
Q

The seeding of bacteria in a liver infection is via:

A

blood

74
Q

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

A
  1. S. Aureus
  2. Salmonella Type
75
Q

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

A

An abscess

76
Q

Describe some parasite causes of liver infection:

A
  1. worms (Shistosomiasis, liver flukes, echinococcus)
  2. entameoba histolytica
77
Q

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

A
  1. presence of autoantibodies
  2. responds to immunosuppression
  3. may have a genetic predisposition
  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 & 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 (microvesicular or marovesicular)
  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

Acetominophen, 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; idiosyncratic

88
Q

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

A

Acetominophen

89
Q

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

A

Chloropromazine

90
Q

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

A

Fatty liver disease (alcohol & 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 example of steatohepatitis:

A

-malaise
-anorexia
-upper abdominal discomfort

93
Q

Condition of the liver that is becoming increasingly common, associated with type II diabetes, 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 death 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 & 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 absorption

101
Q

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

A

HFE

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 and atrophy; skin pigmentation

104
Q

An autosomal recessive disease characterized by loss of function mutation of ATP7B, leading to impaired copper excretion in bile 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 increase 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 organs, 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-Fleischer rings in the eye (which are deposits 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 sen in the following image:

A

Kayser-Fleischer rings

111
Q

Acute/chronic liver disease or neuropsychiatric signs be the presenting features of what metabolic liver 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 misfolding and loss of function of alpha-1-AT 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 misfolding and loss of function of alpha-1AT. What is 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 accumulate _______ which may progress to _____ and eventually _____

A

Cytoplasmic globular inclusions; hepatitis & eventually cirrhosis

120
Q

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

A

Liver transplant

121
Q

In cases of alpha-1AT deficiency, the _____ is also often involved resulting in _____ (especially if ____)

A

lung; emphysema; (especially if the patient smokes)

122
Q

-focal nodular hyperplasia
-cavernous hemangioma
-hepatocellular adenoma

These are all:

A

Bengin 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 multiple
-Develop in non-cirrhotic liver
-Though to result from focal chronic hypo perfusion 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; benign

127
Q

Why is hepatocellular adenoma most common in reproductive age women?

A

because it is stimulated by estrogen

128
Q

What type of hepatic tumor is being described below.

  • most common benign liver tumor
    -tumors of benign blood vessels, variably dilated
A

Cavernous hemangioma

129
Q

In hepatocellular adenoma, the mass may sometimes be ______

A

hemorrhagic

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 & Subsahara Africa)
-exposure to HBV and aflatoxin (aspergillus flavus_ markedly caused increased risk
-incidence in western countries rising mainly due to increased HCV
-chronic liver diseases (particularly 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 & 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 & the common bile duct

135
Q

The delivers bile to the duodenum via:

A

cystic duct & 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 dict
G- gallbladder
H- cystic duct

138
Q

Layers of the gallbladder wall include: (4)

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

The gallbladder mucosa contains ___ and ____

A

epithelium & 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 intracellular spaces

A

apicolateral junctional complexes; short microvilli; complex lateral plications

144
Q

Gallstones are also termed:

A

Cholelithiasis

145
Q

Gallstones affect ______ adults in the US

A

10-20%

146
Q

The two main types of gallstones include:

A

cholesterol gallstone & pigment (bile salt) stone

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 Crohn 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

Gall stones (cholelithiasis) may result in:

A

acute and/or chronic cholecystitis

152
Q

Gallbladder carcinoma occurs at a ____ 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 (28 decks)

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