Liver and Biliary Tract

Question 1

What characterizes Cirrhosis?

Answer 1

Fibrosis and Formation of regenerative nodules

Question 2

What are the complications of Cirrhosis?

Answer 2

Portal HTN
Ascites
Splenomegaly
Bleeding Esophageal Varices (opens form portal-systemic venous collaterals- 40% mortality rate)

Question 3

What is another cause of ascites due to cirrhosis , other than increased portal hydrostatic pressure?

Answer 3

Decreased intravascular oncotic pressure due to hypoalbuminemia

Question 4

In cirrhotic patients, what happens to aldosterone secretion?

Answer 4

it increases

Question 5

Which bilirubin concentration increases with intravascular hemolysis?

Answer 5

Unconjugated/ Indirect

Question 6

Why is physiologic jaundice more pronaunced in premature infancts?

Answer 6

Because of inadequate hepatic clearance of biirubin and increased ertyhrocyte turnover

Question 7

Why does fetal bilirubin levels in utero remain low?

Answer 7

Because bilirubin crosses the placenta, where it is conjugated an exreted by the mother’s liver

Question 8

What are patholigc changes seen in acute viral hepatitis?

Answer 8

disrray of liver cell plates, ballooning degeneration of hepatocy tes, intracellular and extracellular bile stasis, apoptoc Councilman bodis, and mononuclear inflammatory cell infiltrates

Question 9

HBV carriers with circulating immune complexes are at risk fo developing what diseases?

Answer 9

Polyarteritis odusa ( necrotizing arteritis that can lead to psuedoaneurysm, renal thrombosis, inflammation, and hemorrhage)
Serum sickness-like syndrome
Glomerulonephritis
Cryoglobulinemia

Question 10

C. sinensis liver fluke is most commonly associated with what pathology?

Answer 10

Cholangiocarcinoma (associated with substantial fibrosis and can be confused with metastatic carcinoma and reactive fibrosis)

The fluke takes residence in the biliary tree

Question 11

Whaqt charactrizes Hepatorenal syndrome?

Answer 11

Feautures of Renal hypoperfusion (including oliguria, azotemia and increased serum creatinine levels)
Microscopically the kidney appears normal

Question 12

In Hepatorenal syndrome. what causes renal failure?

Answer 12

Renal failure is caused by hypoperfusion and vasoconstriction, a combination mediated by various hormones and vasoactive substances, some of whichmay not be cleared by the cirrhotic liver.

The kidney can actually be used for transplantation with normal functioning.

Question 13

Which patients are susceptible to pigment stone formation?

Answer 13

Patients with SCD or other chronic hemolytic anemias that generate excess bilirubin

Question 14

What can be found microscopically in Primary Biliary Cirrhosis?

Answer 14

bile ducts are surrounded primarily by CD8 T cells, plasma cells and macrophages are also seen. In some portal tracts, lymphoid follicles are conspicuous,. Discrete eptihelioid granulomas often occur in the portal tracts and may impinge on the bile ducts.
Collagenosu septae extend from the portal tracts into the lobular parenchyma and encircle some lobules.

Cholestasis may be present when sever and is located at the periphery of the portal tracts. The endstage of Pbc IS CIRRHOSIS AND IS CHARACTERIZED BY A DARK GREEEN BILE-STAINED LIVER WITH FINE NODULARITY

Question 15

Intrahepatic venous thrombosis may be associated by what patholgoical states?

Answer 15

Increasesd blood viscosity (Polycythemia vera or othre myeloproliferative disorders)
Hypercoaguable states asscoicated with hematolgic cancers
Certain Solid Tumors
Pregancy
Paroxysmal Nocturnal hemoglobinuria

Question 16

What are risk factors for cholesterol stones?

Answer 16

female sex
diabetes
pregnancy
estrogen therapy

Question 17

What are the complicatoins of legement of stones in the common bile duct?

Answer 17

Obstructive Jaundice
Cholangitis
Acute Pancreatitis

Patient swith cholelithiasis have a 25 fold increased risk of acut epancreatitis acomopared to the general population

Rarely gallbladder empyema, perforation , fistula formation, bile peritonitis, gallstone ileus

Question 18

What’s the best method to assess the extent of liver disease in a patient with viral hepatitis?

Answer 18

Liver Biopsy
(liver cell injury and inflammation;
ballooning degeneration of liver cells, intracellular and extracellular bile stasis, acidophilic bodies, and a mononuclear cell infiltrate should be seen)

Question 19

What characterizes primary sclerosing cholangitis? What diseases is it associated with?

Answer 19

Inflammation
Obliterative Fibrosis of Intrahepatic and extrahepatic bile ducts with dilation of preserved segments

70% of patients have Ulcerative Colitis
Cholangiocarcinoma is a late complication

Question 20

What is the most common genetic cause of liver damage in infants and children? What are ists characteristics?

Answer 20

apha 1 antitrypsin deficincy
round-to-oval cytopllasmic globular inclusions of misfolded alpha1 antritypsin proteins in hepatocytes.

the globules stain red with PAS after removing gllycogen with diastase

Question 21

What’s the pathogenesis of pyogenic liver abscesses?

Answer 21

Staphylococci, streptococci, and gm NEG enterobacteria (anaerobic innhabitants of the GI tract for example)
- gain access to the liver via direct extension from contiguous organs or through the protal vein or hepatic artery.

Extrahepatic biliary obstruction which leads to ascending cholangitis is the most common causes and isusually associated with choledochlithasis. Other causes are Diverticulitis and IBD.

The organism can also originate within the abdomen and reach the liver by embolization

Question 22

How does an acute hepatitis appear grossly? micro?

Answer 22

Macro:the liver loses 1/3 of its normal weight
Glisson capsule is wrinkled and mottled

Micro: massive death of hepatocytes with a collapsed collagenous framework

Question 23

What is toxic dose of acetmaminophen afteer a single acute ingestion?

Answer 23

150mg/kg in children, 7 g in adults