Liver 3 Flashcards
What is a dense portal inflammatory infiltrate with abundant histiocytes forming a granuloma around damaged ducts? what disease is it associated with?
- florid duct lesion
2. PBC
Primary biliary cirrhosis is associated with auto-immune antibody?
anti-mitochondrial antibody
Is PBC or PSC intrahepatic and extrahepatic?
PSC— PBC is intrahepatic only
What liver enzymes are elevated in PBC and PSC?
alk phos and GGT
T-F – in PBC and PSC there is equal involvement of obstruction in all triads?
False- patchy involvement of triads
obstruction in all triads would be found outside liver
Is PBC more common in males or females? PSC?
- female
2. Male
What antibody is often found in PSC?
UC-ANCA
What do we see on a cholangiogram in PBC? PSC?
- pruned biliary tree
2. beaded bile ducts
What is the distinctive lesion in PBC? PSC?
- florid duct
2. fibro-obliterative
Is PBC or PSC at risk to cholangiocarcinoma?
PSC
What does a fibro-obliterative lesion look like? what disease is it associated with?
- onion skin inflammation- periductal concentric
2. PSC
If there is mixed hepatitic cholangitic, what should we be thinking/
overlap syndromes, but mainly adverse drug reaction
When serum albumin drops, what is the consequence?
edema
What does ammonia cause in the brain?
hepatic encephalopathy/coma
What is the antidote to acetaminophen overdose?
N-acetylcysteine
Where (zone wise) dose necrosis in acetaminophen toxicity begin?
centrilobular (least oxygen)
and extends through the others
Fulminant hepatic necrosis can be caused by what viruses?
Hep A and B
What is the main drug that causes fulminant hepatic necrosis?
acetaminophen- most common cause in our population
What vascular problem causes fulminant hepatic necrosis?
Budd-Chiari
acute venous outflow obstruction
What conditions can increase susceptibility in acetaminophen toxicity?
- alcohol users
- malnutrition
- chronic liver disease
T-F– cirrhosis can be caused by many things even if they don’t cause chronic liver disease?
false- only ones that cause chronic liver disease
What are three genetic causes of cirrhosis?
hemochromatosis
alpha-1-antitrypsin
Wilson’s disease
What 3 biliary disease causes cirrhosis?
PBC
PSC
Bile Duct Obstruction
What is a very prominent sign of cirrhosis from the gross image standpoint?
regenerative nodules
Cirrhosis leads to excess of what hormone? what does it lead to?
- estrogen-
- gynecomastia, spider hemaniomas, testicular atrophy, palmar erythema
What does portal hypertension lead to?
- esophageal varices
- enlarged spleen
- ascites
- collateral vessels
Patients with cirrhosis are at particular high risk of elevated ammonia because of what 3 things?
- bleeding into esophageal varicose–>gut break down of blood to ammonia
- reduced hepatocyte number to metabolize ammonia
- ammonia bypasses liver in collateral vessels that arise in portal hypertensions
What are the 4 main causes of death in cirrhosis?
- bleeding- esophageal varices
- hepatic coma
- Infection
- hepatocellular carcinoma
Benign hepatic tumors are uncommon, but what is the most common type?
hepatic adenomas
Are primary or secondary malignant tumors more common in the liver-
secondary by far
90% of primary malignant hepatic tumors are of what type?
hepatocellular carcinoma
others are cholangiocarcinoma, angiosarcoma, hepatoblastoma
What histological sign is common in hepatic adenoma?
free-floating arteriole
What is the most common cause of hepatic adenoma that they want us to know about?
oral contraceptives
What is a main clinical problem seen in hepatic adenoma?
subcapsular adenoma can rupture when large, particularly during pregnancy
T-F- hepatocellular carcinoma is the most common cause of cancer deaths world-wide?
False- 3rd (majority of chronic HBV infection from 3rd world countries)
What food contaminant causes hepatocellular carcinoma?
aflatoxin
What tumor marker do your see in hepatocellular carcinoma?
alpha-fetoprotein
In HCC, why is the tumor green?
malignant cells make bile
The majority of cholangiocarcinoma are sporadic, but what are they also associated with?
- primary sclerosing cholangitis
- liver flukes
[POOR PROGNOSIS]
Is the gallbladder essential for biliary function?
No
what percentage of gallstones are silent?
80%
10-20% of people have stones
How does a gallstone lead to intestinal obstruction?
large stone erodes directly into adjacent loop of small bowel
What is the most common type of gallstone?
cholesterol stones
What are the risk factors for cholesterol stones?
Female, Fat, Forty, Fertile
Rapid weight loss
stasis
disorders of bile metabolism
hyperlipidemia
what are pigment stones?
excess unconjugated bilirubin-
what is acalculous cholecystitis?
No stones- occurs in severely ill and thought to be from ischemia
FATAL IF NOT TREATED
chronic cholecystitis leads to what?
wall fibrosis
what is choledocholithiasis?
stones within the bile ducts
- asymptomatic
- pancreatitis
- obstructions
- cholangitis
- hepatic abscess
- secondary biliary cirrhosis
- acute calculous cholecystitis
What is cholangitis?
bacterial infection of the bile ducts (usually gram-negative aerobes)
What is a risk factor for cholangitis?
obstructed bile flow
What are the signs and symptoms of pancreatitis?
abdominal and back pain
elevated serum amylase and lipase
What are the complications of acute pancreatitis?
shock
pseudocyst
What are the complications of chronic pancreatitis?
intractable pain
maldigestion
pseudocyst
What is the 4th leading cause of cancer deaths in the US?
pancreatic adenocarcinoma
Where do pancreatic adenocarcinomas arise from?
the duct
T-F–pancreatic adenocarcinomas are usually subclinical until lethal?
True- extremely poor prognosis
