Hepatobiliary Tract Flashcards

Question

Granulomas

Answer 1

sulfonamides, phenbutyzone, etc

Answer 2

high dose chemotherapy, bush teas, oral contraceptives, numerous other agents, anabolic steroids, tamoxifen

Answer 3

oral contraceptives, anabolic steroids, thorotrast, vinyl chloride

Answer 4

Leading cause of liver pathology Morph: hepatic steatosis (fatty liver): microvesicular lipid droplets within hepatocytes with moderate or chronic alcohol intake --> chronic turns to macrovesicular lipid droplets displacing nucleus, liver enlarged, soft, greasy, yellow --> sx: hepatomegaly - alcoholic hepatitis: ballooning degeneration and hepatocyte necrosis with mallory body formation neutrophilic reaction --> sx: malaise, anorexia, tender hepatomegaly --> injury from acetaldehyde, induction of CYP450, impaired metabolism of methionine, alcohol caloric food source, alcohol mediated release of bacterial endotoxin - alcoholic cirrhosis: irreversible, fatty and enlarged to brown, shrunken, and nonfatty Path: women, AA

Answer 5

Diffuse process of fibrosis and nodular regeneration with variable degree of disorganization of the lobular architecture Cause: alcohol abuse, viral hepatitis, non-alcoholic steatohepatitis with biliary disease and hemochromatosis less frequent Morph: bridging fibrosis linking portal tracts, parenchymal nodules, disruption of hepatic parenchymal architecture Path: hepatocyte death, extracellular matrix deposition and vascular reorganization - collagen in space of disse - proliferation and activation of hepatic stellate cells - proinflammatory cytokines, cytokines, disruption of ECM, direct toxin stimulation Sx: anorexia, weight loss, weakness, debilitation - progressive liver failure, portal HTN, hepatocellular CA

Answer 6

Strong evidence for autoimmune pathogenesis Assoc: ulcerative colitis, systemic sclerosis, RA Path: antibodies of anti-mito antibodies, anti-nuclear antibodies (ANA), anti-smooth muscle antibodies (SMA) Morph: dense portal tract inflammation with focal noncaseating granulomas with bile duct destruction and generalized cholestasis - obstruction leads to progressive secondary upstream damage, with ductular proliferation - at end stage, PBC is indistinguishable from other forms of cirrhosis Sx: pruritus, hepatomegaly, jaundice, xanthomas --> progression to cirrhosis, variceal bleeding and ecephalopathy

Answer 7

Chronic cholestatic disease distinguished by inflammation and obliterative fibrosis of extrahepatic and intrahepatic biliary tree - beading of contrast material - autoimmune Assoc: ulcerative colitis Morph: periductular inflammation and onion skin fibrosis with progressive atrophy Sx: weight loss, ascites, variceal bleeding, encephalopathy - increased incidence of chronic pancreatitis and hepatocellular carcinoma

Answer 8

Bile duct obstruction by stone, stricture, carcinoma - congenital biliary atresia - acute and chronic pancreatitis Morph: centrilobular cholestasis, cytoplasmic and canalicular - edema and inflammation in portal triads - minimal hepatocellular alteration except for feathery degeneration adjacent to severe cholestasis - dilation and proliferation of bile ducts - bile thrombi in dilated ducts - extravasation of bile, bile lakes, bile infarcts - bridging portal fibrosis and cirrhosis - suppurative cholangitis and cholangiolitis

Answer 9

Splenomegaly with or without hypersplenism - development of porto-systemic venous anastamoses - ascites typically aggravated by hypoalbuminemia

Answer 10

Inheritance: auto rec mutations in ATP7B gene coding canalicular copper transporting ATPase; copper absorption and delivery to liver is normal, copper excretion into bile reduced - copper accumulates in liver which results in hepatic injury through ROS generation Morph: liver damage mild to severe, fatty change, acute and chronic hepatitis with mallory bodies, cirrhosis, and massive necrosis - eye lesions called kayser fleischer rings involved (green-brown copper at corneal limbus) Sx: acute and chronic liver disease before age 40 - parkinsonism Dx: increased hepatic copper content and increased urinary excretion

Answer 11

Inheritance: auto rec with low levels of protease inhibitor, emphysema and hepatic disease Path: synthesized by hepatocytes, most common genotype is PiMM, most common disease is PiZZ - glutamate to lysine - triggers autophagy, mito dysfunction and proinflammatory NF-kB causing damage Morph: PAS positive cytoplasmic globules in periportal hepatocytes - cholestasis to hepatitis to cirrhosis Sx: jaundice, acute hepatitis or cirrhosis - hepatocellular CA develops in PiZZ adults - smoking worsens lung damage

Answer 12

- one or more nodules - central stellate fibrous scar - scattered bile ducts - normal hepatocytes - bleeding unusual Age: middle aged adults

Answer 13

- nodular transformation of liver without fibrosis - consequence of intrahepatic blood flow - occurs in transplants or vasculitis

Answer 14

Most common benign liver tumors | - blood vessel tumor

Answer 15

Benign hepatocyte neoplasms - common in young women associatedw tih oral contraceptives - beta-catenin and HNFIalpha associated - sheets of hepatocytes containing arteries and veins - portal tracts with bile ducts are absent - remove because could hemorrhage or be carcinomatous - tendency to bleed

Answer 16

Most common primary liver cancer - associated with HBV infection Path: background of chronic liver disease - viral, chronic alcholism, NASH and food - less common: hemochromatosis, tyrosinemia, alpha1 antitrypsin deficiency Morph: solitary mass, multifocal nodules, diffusely infiltrative cancer with liver enlargement in cirrhosis - fibrolamellar CA single cirrhous hard tumor in 20-40 year olds without chronic liver disease Sx: RUQ pain, weight loss, elevated alpha-fetoprotein

Answer 17

Most common liver tumor of early childhood Morph: activation of Wnt/beta catenin pathway - associated with familial polyposis - epithelial type immitates liver - mixed has foci of mesenchymal differentiation including osteoid, cartilage, striated muscle

Answer 18

intra and extrahepatic biliary tree - majority perihilar Path: most without risk antecedent - associated with PSC, fibropoycystic lesions, HCV infection - opisthorchis sinensis Morph: single large mass or multifocal nodules - pale

Answer 19

Substance: majority cholesterol stones, some calcium bilirubinate, some calcium carbonate Risk: increased hepatic cholesterol uptake or synthesis - native americans, industrialized countries, female, age, estrogen, obesity, hypercholesterolemia, rapid weight loss, GB stasis Path: cholesterol - bile supersaturated with cholesterol pigment - unconjugated bilirubin from hemolysis conditions --> also with opisthorchis sinensis, E coli, ascaris lumbricoides Morph: chole stones from GB --> hard pale and yellow bilistones --> black color or brown Sx: asymptomatic - spasmodic colicky pain from passing stones in bile ducts - infl leads to cholecystitis or cholangitis or gallstone ileus

Answer 20

fat, fertile, forty, female, flatulent

Answer 21

Path: chemical irritation by bile and calculi, bacterial infection, pancreatic reflux - could be from ischemia from sepsis with hypotension Morph: enlarged tense bright red green-black gallbladder Age: 5th - 6th decade, female Sx: RUQ pain, fever, anorexia, taycardia, diaphoresis, N/V

Answer 22

repeated bouts of low grade cholecystitis - gallstones can be present morph: fibrosis or enlarged Sx: repated colicky epigastric or RUQ pain Complications: bacterial superinfection, GB perforation, abscess formation or peritonitis

Answer 23

Gender: women Age: older than 70 Assoc: gallstones, chronic GB inflammation is a risk Morph: infiltrating with GB thickening and induration or exophytic growing into lumen as irregular cauliflower like mass - adenocarcinoma most common Sx: same as cholelithiasis