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trisemester 3 TCC > liver and biliary > Flashcards

liver and biliary Flashcards

1
Q

what does the liver process?

A

amino acids, carbs, lipids and vitamins

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2
Q

causes of jaundice?

A

hemolytic anemia, hepatitis, obstructive flow

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3
Q

pt. comes to clinic looking yellow and white of eyes are yellow what should be on your differential

A

jaundice

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4
Q

pt comes in with unexplained anorexia and says they have hereditary hemochromatosis what organ is being affected and what is wrong with it?

A

the liver is cirrhotic

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5
Q

you suspect a pt. has cirrhosis of the liver what are the top non rare causes of it?

A

alcohol abuse, chronic viral hepatitis, biliary disease, hereditary hemochomatosis, cryptogenic

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6
Q

what are some rare causes of cirrhosis of the liver?

A

wilsons, alpha antitrypsin deficiency, cardiac cirrhosis

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7
Q

pathologically what kind of nodules would you find on a liver with cirrhosis?

A

mixed

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8
Q

what is infiltrating the liver when it is cirrhotic?

A

cytokines, fibrin

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9
Q

cirrhosis of the liver is mostly a silent progress? T/F

A

true

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10
Q

if somebody dies of liver cirrhosis what is mostly of?

A

portal hypertension, liver failure, hepatocellular carcinoma

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11
Q

example of a prehepatic portal hypertension?

A

portal V thrombosis

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12
Q

example of a post hepatic portal hypertension

A

bud chiari syndrome due to thrombosis of the hepatic v.

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13
Q

what condition of the heart should be considered if they have bud chiari?

A

right sided heart failure

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14
Q

what are most of the cases of cirrhosis of the liver?

A

intraheptic

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15
Q

why would somebody with portal hypertension present with hepatic encephalopathy?

A

increased ammonia

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16
Q

what are the clinical findings of a pt. who has portal hypertension

A

ascites, splenomegaly, hepatic encephalopathy, venous shunts,

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17
Q

what are some examples of venous shunts when somebody has portal hypertension?

A

internal hemorrhoids, esophageal varices, caput medusa

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18
Q

***triad of bud chiari?

A

abdominal pain, ascites, hepatomegaly

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19
Q

some other symptoms of budd chiari?

A

acute rapid abdominal pain, jaundice, hepatomegaly, increased LFTs and encephalopathy

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20
Q

HAV/ hep A is spread how

A

enterically: fecal matter and poor hygiene

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21
Q

when HAV is carried through from the intestines to the liver does in enter the blood stream?

A

no

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22
Q

is HAV asmyptomatic?

A

yes

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23
Q

does HAV cause chronic hep, carrier state or predispose the pt. to cirrhosis or hepatocellular carcinoma?

A

no

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24
Q

HBV spread how?

A
  • blood products
  • sex
  • IV drugs
  • perinatal
  • healthcare workers
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25
Q

are pt. with HBV asymptomatic most of the time or symptomatic?

A

asymptomatic

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26
Q

if a pt. has symptomatic HBV that is mild what is the likely hood of recovery?

A

good

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27
Q

fulimant hepatitis is when what happens?

A

massive liver necrosis

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28
Q

what can chronic hepatitis lead to?

A

hepatic carcinoma which is an important role in hepatocellular carcinoma
or
cirrhosis of the liver

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29
Q

the majority of pt. that have symptomatic HBV _______

A

recover

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30
Q

when inspecting an acute HBV liver under a microscope you notice ?

A
  • cellular infiltrate throughout the lobule
  • ballooning of the cytoplasm of degenerative cells
  • councilman bodies
  • mononuclear cell infiltrate in portal areas
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31
Q

Hep c is the leading cause for what?

A

chronic liver disease

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32
Q

HCV is spread by

A
  • mainly blood products
  • sometimes sex
  • mother to child
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33
Q

what can pt.’s with HCV develop?

A

DM

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34
Q

When considering how a pt. will present to clinic with HCV will they present as asymptomatic or will they show signs of progression to chronic disease of the liver?

A

most pt. will progress to chronic disease of the liver

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35
Q

Hep D replicates on where under what circumstances?

A

in the liver when HBV is present

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36
Q

who is most likely to get HDV?

A

drug addicts and multiple transfusion individuals

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37
Q

hep E is contracted how?

A

water borne infection

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38
Q

is HEV associated iwth chronic liver disease?

A

no

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39
Q

HEV has a high mortality rate among which pt.?

A

pregnant women and HIV

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40
Q

which hepatitis virus has a dual infectin that protects against the HIV replication?

A

HGV

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41
Q

how is HGV spread?

A
  • blood to blood products
  • maybe sex
  • hemodialysis pt.
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42
Q

grossly how will the liver look with viral hepatitis?

A

enlarged

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43
Q

micro. how would the liver look with viral hep?

A
  • multifocal areas of necrosis with lymphocytic infiltrates
  • ballooning degeneration of the hepatocytes
  • councilman bodies
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44
Q

how would pt. present if they had symptoms of viral hepatitis?

A

fever, HA and nasea, vomiting, myalgia, enlarged and tender liver, jaundice with dark urine,

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45
Q

what would you find elevated in the serum of a pt. with viral hep?

A

AST/SGOT is elevated the most

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46
Q

leading cause of liver disease in USA is?

A

alcohol abuse

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47
Q

3 forms of liver disease due to alcohol intake?

A

hepatic steatosis
alcoholic hepatitis
cirrhosis

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48
Q

what are the mild reversible changes of the live in somebody who is an alcoholic?

A

macrovesicular steatosis

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49
Q

what would you find microscopically in alcoholic hepatitis

A

eosinophilic inclusions known as mallory bodies

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50
Q

alcoholic cirrhosis is it irreversible or reversible?

A

it is irreversible

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51
Q

alcoholic cirrhosis, is it seen more in men or women?

A

women

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52
Q

is alcoholic cirrhoiss micro or macro?

A

micro

53
Q

Macorvesicular steatosis is seen with what stain?

A

oil red O stain

54
Q

key findings of chronic alcoholic liver disease?

A

Macrovescular steatotis

  • mallory bodies
  • ballooning degeneration of hepatocytes
  • micronudular cirrhosis
55
Q

stage one of alcoholic liver disease?

A

steatosis - macrovescular

56
Q

2nd stage of alcoholic liver disease

A
  • mallory bodies/neutrophils

- ballooning hepatocytes

57
Q

stage 3 of alcoholic liver disease?

A

micronodular cirrhosis of liver

58
Q

what are some inborn errors of metabolism and pediatric liver disease?

A

wilsons, hemochromatosis, a1-antitrypsin

59
Q

what is hemochromatosis?

A

excessive accumulation of body iron which is that deposited into the parenchymatous organs/liver and pancrease

60
Q

what is a primary cause of hemochromatosis?

A

genetic defect/autosomal recessive

61
Q

secondary cause of hemochromatosis?

A
  • iron overload
  • parentral iron
  • hemolytic anemias
  • aplastic anemia = suppressed BM
62
Q

how would the cells appear in a hemochromatosis pt. microscopically?

A

yellow and golden color

kupffer cells full of granular brown deposits

63
Q

what are some symptomatic findings in a pt. that has hemochromatosis?

A 
liver- micronodular cirrhosis
pancreas - diabetes
Heart- restrictive cardiomegaly
skin- bronze
joints - arthritis
gonads - hypogonadism = amenorrhea and impotence
64
Q

what type of stain are the hepatocytes positive for?

A

prussian blue

65
Q

wilsons disease also known as?

A

hepatolenticular degeneration

66
Q

in wilsons disease fails to enter circulation in the form of what?

A

ceruloplasmin

67
Q

what causes the build up of cu in the body in wilsons disease?

A

absorbed cu fails to enter the circulation in the from of ceruloplasmin and decreased biliary excretion of cu causing liver injury which causes the spill over of cu

68
Q

where does the spilled over cu accumulate?

A
  • putamen of the basal ganglia

- kayser fleicher rings

69
Q

how would you Dx. the pt. with wilsons?

A
  • a decrease in ceruloplasmin level
  • increased hepatic cu
  • increased urinary excretion of cu (body fails to absorb so it excretes and spills over into the body)
70
Q

how does the liver look grossly in a pt. with wilsons?

A

golden, and has mixed nodules

71
Q

a1- antitrypsin deficiency/ AAD causes?

A

over release of neutrophil elastase at the site of inflammation causing desctruction

72
Q

what does a AAD lead to?

A

emphysema
hepatitis
liver cirrhosis

73
Q

what stain is used for liver in AAD pt.?

A

PAS

74
Q

in the lungs of a pt. that has AAD what do you see?

A

panlobular emphysema

75
Q

causes of secondary biliary cirrhosis

A

cholelithiasis
strictures from previous surgery
malignancies of biliary tree and head of pancreas

76
Q

prolonged obstruction and secondary inflammation will lead to?

A

periportal fibrosis > scarring and nodule formation = biliary cirrhosis

77
Q

primary billiary cirrhosis is commonly caused by what?

A

autoimmune disease: ulcerative colitis, chrons disease

78
Q

which enzyme is affected by antibodies in a pt. with an autoimmune disease that results in biliary cirrhosis?

A

pyruvate dehydrogenase

AKA antimitochondrail AB

79
Q

specifically which malignancies will result in billiary cirrhosis?

A

adenocarcinoma of the head of the pancreas, and cancers of the biliary tree

80
Q

microscopically what would you see in billiary cirrhosis?

A
  • demolished biliary duct
  • chronic inflammation in portal areas
  • bile duct destruction
81
Q

Kasai procedure is for pt. that have wat?

A

biliary atresia

82
Q

what is formed in a kasai procedure?

A

rou-en-Y connection

83
Q

what is reyes syndrome and who does it occur in?

A

use of salicylates (ASA) in past especially in children.

84
Q

how would a pt. present to clinic with reyes syndrome?

A
  • febrile with URI –> recovery

- -> projectile vomiting –> delirium and stupor

85
Q

what happens to the body when a pt. has reyes syndrome?

A

mitochondrial injury to the liver, brain and muscle

86
Q

what type of steatosis to the liver does reyes cause?

A

microvesicular

87
Q

what stain is used to see panlobular arrangment of lipid

A

oil red O stains

88
Q

is there hepatocyte necrosis or inflammation with reyes?

A

no

89
Q

the two type of tumors that are caused by contraceptives in women in there childbearing years that and benign?

A

focal nodular hyperplasia & liver cell hepatocellular or hepatic adenoma

90
Q

what is a cavernous hemangioma?

A

congential vascular channel defect

91
Q

what is the most common bengign lesion of the liver?

A

cavernous hemangioma

92
Q

how does the tumors appear on the liver with cavernous hemangioma

A

red blue nodules less than 2cm

93
Q

what is different about the growth of the liver cell adenoma?

A

they are hormone dependent

94
Q

the liver cell adenoma is benign what kind of characteristic does it have?

A

well demarcated

95
Q

where would you commonly see the liver cell adenoma?

A

beneath the capsule

96
Q

complication of a liver cell adenoma?

A

rupture leading to severe hemorrhage

and very rarely may develop into malignancy

97
Q

what is the likelyhood of a pt. having primary carcinoma of the liver?

A

relatively uncommon

98
Q

what do the primary carcinoma of the liver arise from?

A

hepatocytes

99
Q

is hepatocellular carcinoma/HCC more common in men or women?

A

men

100
Q

what may cause HCC?

A
  • cirrhosis of the liver due to HBV and HCV
  • dietary aflatoxins from aspergillus
  • chemicals such as thoratrast
101
Q

what is a more common form of HCC? 1ry or 2ry?

A

2ry by METS

102
Q

what are the most common 1ry sites of cancer that spread to form 2ry HCC?

A

lung
breast
colon
pancreas

103
Q

what is focal nodular hyperplasia?

A

benign tumor like lesion due to a vascular disturbance

104
Q

what may you see microscopically in a liver that has focal nodular hyperplasia of the liver

A
  • hepatocellular nodules
  • central stellate scar
  • radiating fibrous septa
  • lymphocytic infiltrate
  • has large feeder artery in capsule
105
Q

for a FNH liver what stain is used?

A

actin immunohistochemistry

106
Q

mesenchymal hamartoma of liver is what?

A

-uncommon benign tumor of childhood
- multiple cycsts grossly
-

107
Q

what is the etiology of mesenchymal hamartoma of liver?

A
  • primary bile dust plate malformation
    vs
  • abnormal mesodermal development
108
Q

what does the mesenchymal hamartoma consists of?

A

mesenchyme, bile ducts, hepatocyte cords and cysts

109
Q

which brain tumor that occurs in children spread to the liver

A

neuroblastoma

110
Q

forty year old woman pt. comes to clinic and says they had abdominal surgery what was it?

A

cholelithiasis

111
Q

what are the 2 types of stone you can find in a pt. that had gallstones?

A

cholesterol(yellow) and pigment (dark green)

112
Q

which stones found in gallbladder are associated with chronic hemolysis?

A

pigment stones

113
Q

what is the only pathway for cholesterol elimination

A

bile

114
Q

when would gallstones be acquired?

A

the [cholesterol] exceeds solubilizing capacity of bile causing solid cholesterol monohydrate crystals

115
Q

fat fertile and forty is a saying used for what

A

to describe who is more likely to get choleslithiasis

116
Q

what is almost always associated with gallstones?

A

cholecystitis

117
Q

acute calculuous cholecystitis is what?

A

acute inflammation of the gallbladder that has stones

118
Q

obstruction of what in the gallbladder will lead to acute calculuous cholecystitis?

A

neck or the cystic duct

119
Q

what is the most common complication of gallstones?

A

acute calculuous cholecystitis

120
Q

pathologically how would the gall bladder appear with acute calculuous cholecystitis

A
  • enlarged with red adematous wall
  • serous coat covered with fibrinous or suppurative exudate
  • mucosal ulcerations
  • stones are present
121
Q

clinically how would a pt. with acute calculuous cholecystitis present?

A
  • upper abdominal pn. that radiates –> shoulder
  • colicky with stones
  • fever
  • nausea
  • vomiting
  • right subcostal region is tender
  • distended gallbladder
122
Q

what bacteria may cause chronic cholecystitis

A

e coli

123
Q

what are some causes of cholecystitis

A
  • repeated bouts of acute cholecystitis
  • stones
  • ## supersaturation of bile
124
Q

how would the gallblader appear grossly?

A
  • contracted
  • thick grey wall
  • stones
125
Q

tumors of the gallbladder are common or uncommon more in women?

A

common

126
Q

if somebody has a tumor of the gallbladder where is located?

A

the biliary tract?

127
Q

pt. comes in and says that have gallbladder cancer and they caught late what is the outlook?

A

death

128
Q

pathologically what kind of tumor would be located in the gallbladder?

A

adenocarcinoma

129
Q

if a pt. comes in with symptoms of cholelithiasis what must the Dr. test for because they present with the same clinical signs?

A

adenocarcinoma of the gallbladder

trisemester 3 TCC (25 decks)

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