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Pathology II Exam II > Liver 3 > Flashcards

Liver 3 Flashcards

1
Q

What is a dense portal inflammatory infiltrate with abundant histiocytes forming a granuloma around damaged ducts? what disease is it associated with?

A
  1. florid duct lesion

2. PBC

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2
Q

Primary biliary cirrhosis is associated with auto-immune antibody?

A

anti-mitochondrial antibody

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3
Q

Is PBC or PSC intrahepatic and extrahepatic?

A

PSC— PBC is intrahepatic only

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4
Q

What liver enzymes are elevated in PBC and PSC?

A

alk phos and GGT

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5
Q

T-F – in PBC and PSC there is equal involvement of obstruction in all triads?

A

False- patchy involvement of triads

obstruction in all triads would be found outside liver

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6
Q

Is PBC more common in males or females? PSC?

A
  1. female

2. Male

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7
Q

What antibody is often found in PSC?

A

UC-ANCA

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8
Q

What do we see on a cholangiogram in PBC? PSC?

A
  1. pruned biliary tree

2. beaded bile ducts

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9
Q

What is the distinctive lesion in PBC? PSC?

A
  1. florid duct

2. fibro-obliterative

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10
Q

Is PBC or PSC at risk to cholangiocarcinoma?

A

PSC

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11
Q

What does a fibro-obliterative lesion look like? what disease is it associated with?

A
  1. onion skin inflammation- periductal concentric

2. PSC

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12
Q

If there is mixed hepatitic cholangitic, what should we be thinking/

A

overlap syndromes, but mainly adverse drug reaction

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13
Q

When serum albumin drops, what is the consequence?

A

edema

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14
Q

What does ammonia cause in the brain?

A

hepatic encephalopathy/coma

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15
Q

What is the antidote to acetaminophen overdose?

A

N-acetylcysteine

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16
Q

Where (zone wise) dose necrosis in acetaminophen toxicity begin?

A

centrilobular (least oxygen)

and extends through the others

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17
Q

Fulminant hepatic necrosis can be caused by what viruses?

A

Hep A and B

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18
Q

What is the main drug that causes fulminant hepatic necrosis?

A

acetaminophen- most common cause in our population

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19
Q

What vascular problem causes fulminant hepatic necrosis?

A

Budd-Chiari

acute venous outflow obstruction

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20
Q

What conditions can increase susceptibility in acetaminophen toxicity?

A
  1. alcohol users
  2. malnutrition
  3. chronic liver disease
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21
Q

T-F– cirrhosis can be caused by many things even if they don’t cause chronic liver disease?

A

false- only ones that cause chronic liver disease

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22
Q

What are three genetic causes of cirrhosis?

A

hemochromatosis
alpha-1-antitrypsin
Wilson’s disease

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23
Q

What 3 biliary disease causes cirrhosis?

A

PBC
PSC
Bile Duct Obstruction

24
Q

What is a very prominent sign of cirrhosis from the gross image standpoint?

A

regenerative nodules

25
Q

Cirrhosis leads to excess of what hormone? what does it lead to?

A
  • estrogen-

- gynecomastia, spider hemaniomas, testicular atrophy, palmar erythema

26
Q

What does portal hypertension lead to?

A
  1. esophageal varices
  2. enlarged spleen
  3. ascites
  4. collateral vessels
27
Q

Patients with cirrhosis are at particular high risk of elevated ammonia because of what 3 things?

A
  1. bleeding into esophageal varicose–>gut break down of blood to ammonia
  2. reduced hepatocyte number to metabolize ammonia
  3. ammonia bypasses liver in collateral vessels that arise in portal hypertensions
28
Q

What are the 4 main causes of death in cirrhosis?

A
  1. bleeding- esophageal varices
  2. hepatic coma
  3. Infection
  4. hepatocellular carcinoma
29
Q

Benign hepatic tumors are uncommon, but what is the most common type?

A

hepatic adenomas

30
Q

Are primary or secondary malignant tumors more common in the liver-

A

secondary by far

31
Q

90% of primary malignant hepatic tumors are of what type?

A

hepatocellular carcinoma

others are cholangiocarcinoma, angiosarcoma, hepatoblastoma

32
Q

What histological sign is common in hepatic adenoma?

A

free-floating arteriole

33
Q

What is the most common cause of hepatic adenoma that they want us to know about?

A

oral contraceptives

34
Q

What is a main clinical problem seen in hepatic adenoma?

A

subcapsular adenoma can rupture when large, particularly during pregnancy

35
Q

T-F- hepatocellular carcinoma is the most common cause of cancer deaths world-wide?

A

False- 3rd (majority of chronic HBV infection from 3rd world countries)

36
Q

What food contaminant causes hepatocellular carcinoma?

A

aflatoxin

37
Q

What tumor marker do your see in hepatocellular carcinoma?

A

alpha-fetoprotein

38
Q

In HCC, why is the tumor green?

A

malignant cells make bile

39
Q

The majority of cholangiocarcinoma are sporadic, but what are they also associated with?

A
  • primary sclerosing cholangitis
  • liver flukes

[POOR PROGNOSIS]

40
Q

Is the gallbladder essential for biliary function?

A

No

41
Q

what percentage of gallstones are silent?

A

80%

10-20% of people have stones

42
Q

How does a gallstone lead to intestinal obstruction?

A

large stone erodes directly into adjacent loop of small bowel

43
Q

What is the most common type of gallstone?

A

cholesterol stones

44
Q

What are the risk factors for cholesterol stones?

A

Female, Fat, Forty, Fertile

Rapid weight loss
stasis
disorders of bile metabolism
hyperlipidemia

45
Q

what are pigment stones?

A

excess unconjugated bilirubin-

46
Q

what is acalculous cholecystitis?

A

No stones- occurs in severely ill and thought to be from ischemia

FATAL IF NOT TREATED

47
Q

chronic cholecystitis leads to what?

A

wall fibrosis

48
Q

what is choledocholithiasis?

A

stones within the bile ducts

  • asymptomatic
  • pancreatitis
  • obstructions
  • cholangitis
  • hepatic abscess
  • secondary biliary cirrhosis
  • acute calculous cholecystitis
49
Q

What is cholangitis?

A

bacterial infection of the bile ducts (usually gram-negative aerobes)

50
Q

What is a risk factor for cholangitis?

A

obstructed bile flow

51
Q

What are the signs and symptoms of pancreatitis?

A

abdominal and back pain

elevated serum amylase and lipase

52
Q

What are the complications of acute pancreatitis?

A

shock

pseudocyst

53
Q

What are the complications of chronic pancreatitis?

A

intractable pain
maldigestion
pseudocyst

54
Q

What is the 4th leading cause of cancer deaths in the US?

A

pancreatic adenocarcinoma

55
Q

Where do pancreatic adenocarcinomas arise from?

A

the duct

56
Q

T-F–pancreatic adenocarcinomas are usually subclinical until lethal?

A

True- extremely poor prognosis

Pathology II Exam II (16 decks)

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