Liver Flashcards
describe macrovesicular steatosis and causes of it
- large droplet: single fat vacuole displaces the nucleus to periphery
- small droplet: multiple fat vacuoles (not as fine as microvesicular)
- causes:
- alcohol
- NASH/NAFLD (metabolic)
- malnutrition
describe microvesicular steatosis and causes of it
- multiple fine vacuoles, nucleus is central
- acute fatty liver of pregnancy
- Reye syndrome
- drugs
- NSAIDs, acetaminophen
list the 3 characteristics of cirrhosis
- bridging fibrous septa
- parenchymal nodules created by regeneration
- diffuse involvement of liver
cirrhosis leads to an increased risk of ___
cirrhosis leads to an increased risk of hepatocellular cancer (HCC)
describe the consequences of portal HTN
describe autoimmune hepatitis
- common in females
- elevated serum IgG
- anti-nuclear and anti-smooth muscle antibodies
- anti-LKM (liver kidney microsomal type) antibodies
- type 2, children/teens
- prominent interface and lobular activity, plasma cell infiltrate common
- respond to immunosuppressive therapy
describe primary biliary cholangitis
- formerly called primary biliary cirrhosis
- disease of middle-aged women
- antimitochondrial antibodies
- non-suppurative, granulomatous destruction of small and medium-sized bile ducts
- ductopenia and cirrhosis
- secondary biliary cirrhosis
- due to partial or total bile duct obstruction
- tumors, strictures, gallstones implicated
____ antibodies are found in PBC
antimitochondrial antibodies are found in PBC
describe the histology in primary biliary cholangitis (PBC)
- histology:
- non-suppurative
- granulomatous destruction of small and medium-sized bile ducts
what condition is seen in the image?
primary biliary cholangitis (primary biliary cirrhosis)
describe primary sclerosing cholangitis
- extrahepatic and large intrahepatic ducts
- periductal inflammation and fibrosis → “onion skin” lesions
- ERCP or MRCP: dilatation and beading of the biliary tree
- p-ANCA often positive
- associated with UC
PSC affects the ___ and ____
PSC affects the extrahepatic and large intrahepatic ducts
PSC leads to ____ inflammation and fibrosis with lesions that look like ____
PSC leads to periductal inflammation and fibrosis with lesions that look like onion skins
what is seen on ERCP/MRCP in PSC?
dilatation and beading of the biliary tree
PSC is often ____ positive and is associated with ____
PSC is often p-ANCA positive and is associated with UC
describe what is seen in the image
the HFE gene is located on chr. ____
the HFE gene is located on chr . 6
list causes of secondary iron overload
- parenteral iron overload
- repeated blood transfusions
- iron dextran injections
- ineffective erythropoiesis
- B-thalassemia
- other chronic hemolytic anemias
- increased oral intake
- Bantu disease
- chronic liver disease
- alcohol, hepatitis C
describe how hemochromatosis affects the pancreas
- pancreas
- intensely pigmented
- diffuse interstitial fibrosis
- hemosiderin in both acinar and islet cells
- diabetes mellitus
describe how hemochromatosis affects the heart
- heart:
- hemosiderin in myocardial fibers (cardiomyopathy)
- delicate interstitial fibrosis
describe how hemochromatosis affects the skin
- skin
- slate gray coloration
- iron in dermal melanophages
- increased melanin production
describe Wilson disease
- AR disorder located on chr. 13
- toxic levels of Cu in liver, brain and eyes
- brain = deposited in basal ganglia
- eyes = deposits of copper in descemet membrane of corneal limbus = KF rings
- sunflower cataracts
- blood = hemolysis
describe investigations in Wilson disease
- investigations:
- low serum ceruloplasmin
- increased urinary Cu excretion
- increased hepatic Cu
describe the images
describe hemangioma of the liver
vast majority require no treatment
- remainder:
- pain
- bleeding
- platelet consumption
describe the image
hepatic hemangioma
hepatic adenoma is associated with ___ and ___
hepatic adenoma is associated with oral contraceptives and anabolic steroids
describe a hepatic adenoma
- associated with oral contraceptives, anabolic steroids
- spontaneously hemorrhage, malignant transformation
- may be fatal during pregnancy
- clinical pres.:
- acute:
- pain in abdomen
- shock and hemorrhage
- hemorrhage into tumor or peritoneal cavity
- episodic pain or discomfort
- incidental
- acute:
- normal serum AFP
describe the 3 mutations associated with hepatic adenomas
describe focal nodular hyperplasia (FNH)
- associated with OCs
- most often small, may be large
- central scar on CT, MRI
- resect if symptomatic or uncertain diagnosis
describe the image
describe hepatoblastoma
- most common liver tumor in neonates and young children
- clinical presentation:
- hepatomegaly or abdominal mass, jaundice care
- associated with Beckwith-Wiedermann syndrome, Down syndrome, familial polyposis coli, hemihypertrophy, renal malformation and various cytogenic abnormalities
- AFP elevated
- rapid growth, poor prognosis, spreads to lungs, LN and peritoneum
hepatoblastoma is the most common liver tumor in ____ and is associated with…. (6 conditions)
hepatoblastoma is the most common liver tumor in neonates and young children and is associated with:
- Beckwith-Wiedermann syndrome
- Down syndrome
- familial polyposis coli
- hemihypertrophy
- renal malformation
- various cytogenic abnormalities
the fetal epithelial morphology in hepatoblastoma resembles ____
the fetal epithelial morphology in hepatoblastoma resembles fetal liver
describe the embryonal epithelial morphology in hepatoblastoma
smaller, round, fusiform cells arranged in rosettes, cords and ribbons
describe a hepatoblastoma with combined epithelial-mesenchymal components
- epithelial with mesenchymal elements
- fibrous tissue
- osteoid or cartilaginous differentiation
describe the histology of hepatocellular carcinoma
- histology:
- well differentiated to poorly differentiated
- trabecular, sinusoidal, or pseudoacinar pattern
- bile production by tumor cells, cytoplasmic inclusions
- usually cirrhosis in adjacent liver parenchyma
describe the image
describe clinical features of HCC
- not uniform
- usually masked by underly0-ing liver disease
- ill-defined upper abdominal pain, fatigue, cachexia
- raised AFP levels in 60-75%
- diagnosis = FNA, biopsy
describe fibrolamellar variant of HCC
- younger age
- no association with HBV or cirrhosis
- AFP normal
- outcome similar to HCC in non-cirrhotic liver
- usually single hard tumor with fibrous bands traversing through it
- well-differentiated polygonal cells in cords or nests, separated by fibrous septa
in the fibrolamellar variant of HCC, there is no association with ___ or ___, and ____ is normal
in the fibrolamellar variant of HCC, there is no association with HBV or cirrhosis, and AFP is normal
in the fibrolamellar variant of HCC, there are well-differentiated ____ in cords or nests, separated by ____
in the fibrolamellar variant of HCC, there are well-differentiated polygonal cells in cords or nests, separated by fibrous septa
describe the image
cholangiocarcinoma
multifocal cholangiocarcinoma in a liver from a patient with infestation by the liver fluke Clonorchis sinensis
describe the image
cholangiocarcinoma
invasive malignant glands in a reactive, sclerotic stroma
describe the Charcot triad and what it is associated with
Charcot triad is associated with cholangiocarcinoma
- Charcot triad = jaundice, fever, chills
describe the Raynaud pentad and what it is associated with
Raynaud pentad is associated with cholangiocarcinoma
- Raynaud pentad = Charcot triad + hypotension and mental status changes
- poor prognostic sign
describe metastasis to the liver
