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GI Week 4 > Lecture 40: Liver Pathology II > Flashcards

Lecture 40: Liver Pathology II Flashcards

1
Q

What are characteristics of acute injury?

A

Ischemia, self-limited

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2
Q

What are characteristics of chronic injury?

A

Propensity for going onto cirrhosis

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3
Q

What is the gold standard for diagnosis of cirrhosis?

A

Tissue section

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4
Q

What are metabolic causes of cirrhosis?

A
  1. Wilsons
  2. Hematochromatosis
  3. Alpha-1 antitrypsin deficiency
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5
Q

What goes along zone 3 of liver?

A

Fibrosis due to an outflow block like Budd-Chiari

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6
Q

What is cirrhosis?

A

The disruption of hepatocellular architecture by:

  1. regenerative nodules
  2. Fibrosis
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7
Q

What do nodules represent?

A

Regenerative areas of hepatocytes surrounded by fibrosis

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8
Q

What are the complications of cirrhosis?

A
  1. Portal HTN
  2. Hypersplenism
  3. Decreased platelets
  4. Decreased synthetic function
  5. Varices
  6. Bleeding
  7. Encephalopathy
  8. altered drug metabolism
  9. Hepatocellular carcinoma risk
  10. Spontaneous bacterial peritonitis
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9
Q

Where is bilirubin derived from?

A

From HEME

Macrophages that take up dead RBCs

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10
Q

What are the histological features of cholestasis?

A
  1. Bile plugs

2. Feathery degeneration

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11
Q

What are the characteristics of the ampulla of Vater?

A
  1. structural sphincter which opens to duodenum

2. common channel for bile duct and main pancreatic duct

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12
Q

What might patients with painless jaundice have?

A

Pancreatic adenocarcinoma from head region

This is because obstruction of bile duct is slow

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13
Q

What is a choledochal cyst?

A

A cystic SWELLING of the bile ducts!
Can lead to stone formation and cholestasis, can have all layers of gall bladder
Have propensity to develop ADENOCARCINOMA

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14
Q

What is the significance of porcelain gallbladder?

A

It results when there is calcification in the wall of the gall bladder
Porcelain gallbladder = increased risk of adenocarcinoma

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15
Q

What is a Klatskin tumor?

A

A type of an adenocarcinoma that is a
Cholangiocarcinoma (derived from biliary
Epithelial cells) which arises at the bifurcation
Of the right and left bile ducts

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16
Q

What is the only way to cause jaundice by obstruction?

A

BOTH the right and left hepatic ducts

OR just the common duct must be blocked

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17
Q

Would cholecystitis lead to jaundice?

A

Hypothetically possible but you need many stones to obstruct
The common duct or both hepatic ducts

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18
Q

What are the characteristics of acute cholangitis?

A

An ascending bacterial infection in the biliary tree

Results in systemic manifestations like fever and sepsis

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19
Q

What are the key characteristics of Cholangiocarcionma?

A
  1. Non-cirrhotic liver…cirrhosis does NOT correlate with cholangiocarcinoma
  2. associated with UC and PSC!
    Can be extra/intrahepatic
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20
Q

What are the extrahepatic causes of bile duct obstruction?

A
  1. biliary atresia
  2. PSC
  3. strictures/stones
21
Q

What are the intrahepatic causes of bile duct obstruction?

A
  1. PBC
  2. GvHost disease
  3. Chronic rejection
  4. Idiopathic adulthood ductopenia
  5. Sarcoid/drugs/others
22
Q

What are the two most common disease affecting the bile ducts?

A
  1. Primary biliary cirrhosis

2. Primary sclerosing cholangitis

23
Q

What are the characteristics of Primary Biliary Cirrhosis (PBC)?

A

A progressive inflammatory attack and subsequent destruction in intrahepatic bile ducts
Leads to LOSS OF HEPATIC BILE DUCTS, fibrosis and cirrhosis
95% of individuals have a positive antimitochondrial antibody (AMA)!!
Mostly women
Can present with Pruritus

24
Q

What is the significance of a positive AMA test?

A

Antimitochondrial antibody

It is suggestive of Primary Biliary Cirrhosis

25
Q

What are the histological features of PBC?

A
  1. destruction of bile ducts by lymphocytes and GRANULOMAS
  2. florid duct lesion
  3. cirrhosis and jaundice are LATE manifestations
26
Q

What is the pathogenesis of PBC?

A
  1. normal biliary epithelial cell
  2. Abnormal expression and/or antigenic mimickery of E2 component of pyruvate dehydrogenase
  3. Cellular immunologic attack
  4. Biliary epithelial cell death
    Autoimmunity?
27
Q

What are the associated diseases

Of PBC?

A 
Sicca Syndrome
Thyroid
Arthralgia
Raynauds
Vitiligo
Yeah a bunch of autoimmune shit
28
Q

What are the characteristics of Primary Sclerosing Cholangitis?

A

A progressive disease which has stricture formation of extrahepatic biliary system resulting in diagnostic and pathognomonic BEADING of the duct seen on ERCP
70% of PSC patients have ulcerative colitis
Associated with HLA-DRw52a

29
Q

Which bile duct disease is associated with Ulcerative colitis?

A

Primary Sclerosing Cholangitis

30
Q

What do PSC and PBC have in common?

A

Both are insidious onset

31
Q

What are the histologic features of PSC?

A

Shows mild inflammation
Fibrosis around the duct that leads to ONION SKINNING
Eventual loss of duct and cirrhosis

32
Q

What imaging test result is PATHOGNOMONIC for PSC?

A

Beading

33
Q

Where do you get biliary sludge?

A

In PSC

34
Q

What are the types of cells that cancer

Can arise from in the liver?

A
  1. Hepatocyte
  2. bile duct
  3. blood vessels
35
Q

What are types of benign liver tumors?

A
  1. hepatic adenoma
  2. focal nodular hyperplasia
  3. bile duct adenoma
  4. hemangioma
    Benign PRIMARY liver tumors are rare
    Are NOT precursors to anything malignant
36
Q

What are the types of malignant liver tumors?

A
  1. HCC (hepatocyte)
  2. Cholangiocarcinoma
  3. Angiosarcoma
    MALIGNANT primary liver tumors are 91% common
37
Q

What is the most common tumor in a NON-CIRRHOTIC liver?

A

Metastatic disease!

38
Q

What are the characteristics of hepatic adenoma?

A

Benign
Solitary lesions comprised solely of hepatocytes
May be associated with OCP use
NOT A PRECURSOR

39
Q

What is the only place where the dysplasia  adenocarcinoma does not lead to carcinoma?

A

IN THE LIVER

Hepatic Adenoma does NOT lead to HCC!!

40
Q

What is significance about focal nodula hyperplasia, bile duct adenoma, hemangioma?

A

They are not the precursors to malignancy!!!

41
Q

What are types of infections that form mass lesions?

A
  1. Abscess
    • bacterial
    • fungal
    • amoebic
  2. Parasites
    • eichonicocus
42
Q

What are the histological features of an eichonicocus cyst?

A

You can see hooklets of the scolex stain with acid fast

43
Q

What are the characteristics of Hepatocellular carcinoma?

A

Represents 90% of primary liver malignancies
Tumor composed of malignant hepatocytes
Strong relationship to HBV and HCV
An indicator of HCC is Serum Alpha Fetoprotein
Can be caused by toxins like aflatoxin

44
Q

What does an elevated AFP (alpha fetal protein) mean?

A

It could be suggestive of HCC

45
Q

What portends a bad prognosis for HCC?

A
  1. High nuclear grade

2. High vascular invasion

46
Q

What should be considered for a patient
That presents with decompensated
Cirrhosis?

A

HCC

47
Q

What are angiosarcomas?

A

Sarcomas of the blood vessels

Associated with chemical injury

48
Q

What does cirrhosis predispose you for?

A

Hepatocellular carcinoma

49
Q

Malignant hepatic tumors derived from the bile ducts are termed?

A

Cholangiocarcinoma

GI Week 4 (12 decks)

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