Liver and Gallbladder Flashcards by Jamaira Belmes

Reversible responses to liver injury

steatosis (fatty change)
cholestasis
ballooning
Mallory hyaline

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Irreversible responses to liver injury

necrosis - ischemic injury
apoptosis - viral hepatitides
*Councilman bodies

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Measure hepatocyte INTEGRITY

AST
AST
LDH

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Measure hepatocyte EXCRETORY function

Bilirubin (B1, B2, TB)
Alkaline phosphatase
GGT

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Measure hepatocyte SYNTHETIC function

albumin
PT
aPTT
ammonia

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Lab finding in Acute Liver Failure

INITIAL - increase in ALT and AST
LATER - decrease in AST and ALT

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Major outcomes of Portal HPN

APES

Ascites
Portosystemic shunts
hepatic Encephalopathy
congestive Splenomegaly

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Common causes of death in cirrhosis

Hepatic encephalopathy
Bleeding from esophageal varices
Bacterial infection
HCC

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Hepatorenal syndrome

systemic vasodilation –> renal hypoperfusion –> RAAS activation –> Na retention and renal afferent arteriolar vasoconstriction–> decreased GFR

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Hepatitis viruses that can cause ACUTE liver failure

BEA

Hepa B
Hepa E
Hepa A

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Hepatitis viruses transmitted via fecal-oral route

Hepa A
Hepa E

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Hallmark of chronic viral hepatitis

PORTAL INFLAMMATION WITH FIBROSIS

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Findings in Hepatitis B

BaGaGa

GROUND GLASS HEPATOCYTES

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Findings in Hepatitis C

CaLaBaSa

LYMPHOID FOLLICLES
BILE DUCT INJURY
STEATOSIS

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Morphologic forms of alcohol induced liver injury

steatosis - MACROVESICULAR - MC

alcoholic hepatitis - ballooned hepatocytes w/ Mallory hyaline
*necro-inflammatory activity

fibrosis - CHICKEN WIRE fibrosis –> micronodular cirrhosis (LAENNEC cirrhosis) - MC

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Excessive iron absorption and deposition into liver and pancreas, heart, joint, and other organs

Prussian blue (+) hemosiderin granules

HEMOCHROMATOSIS

TRIAD
micronodular cirrhosis (200 fold increase risk HCC)
DM (d.t. pancreatic fibrosis)
abnormal skin pigmentation

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AR
Impaired Cu excretion into bile and incorporation to ceruloplasmin

ATP7B mutation Ch 13

INCREASED copper and urinary copper excretion
DECREASED serum ceruloplasmin

WILSON’S DISEASE

liver, brain (basal nuclei) and eyes

steatosis
cirrhosis
putaminal atrophy
KAYSER FLEISCHER RING - green to brown copper deposits in DESCEMET MEMBRANE in corneal LIMBUS

TREATMENT:
penicillamine
zinc based therapy
liver transplantation

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MC diagnosed inherited hepatic disorder in infants and children

AR disorder of protein folding – decreased a1AT
misfolded a1at accumulates in hepatocytes – triggers unfolder protein response – HEPATOCYTE DEATH BY APOPTOSIS

increased risk of HCC (d.t. associated cirrhosis)

a-1 antitrypsin deficiency

Complete or partial obstruction of the extrahepatic biliary tree within the 1st 3 mos of life

portal fibrosis
ductular reaction
ductular bile ducts

EXTRAHEPATIC BILIARY ATRESIA

inflammation and fibrosis of the hepatic or common bile ducts - HALLMARK

Autoimmune Cholangiopathies

FEMALE

(+) AMA

ASSOCIATED CONDITIONS:
Sjogren
Hashimoto
Scleroderma

PRIMARY BILIARY CHOLANGITIS (PBC)

small to medium sized intrahepatic

HISTOLOGY
florid duct lesions
cirrhosis
nodular regenerative hyperplasia

Autoimmune Cholangiopathies

MALE

(+) ANCA

ASSOCIATED CONDITIONS:
IBD
pancreatitis
idiopathic fibrosing diseases

PRIMARY SCLEROSING CHOLANGITIS (PSC)

extrahepatic and large intrahepatic

RADIOLOGY
strictures and beading large bile ducts

HISTOLOGY
acute and chronic inflammation – “ONION SKIN FIBROSIS” and STRICTURES
lithiasis
biliary cirrhosis

Sequelae of Primary Biliary Cholangitis

HCC - increased risk

Sequelae of Primary Sclerosing Cholangitis

cholangiocarcinoma- increased risk

MC benign tumor of the liver

CAVERNOUS HEMANGIOMA

MC liver tumor of EARLY CHILDHOOD

HEPATOBLASTOMA

MC tumor involving the liver

METASTASES

MC primary malignant tumor

HCC

2nd MC primary malignant tumor

Cholangiocarcinoma

Focal Nodular Hyperplasia benign ADULT WOMEN non-neoplastic angiography: HYPERVASCULAR w/ dense capillary blush liver scan: NORMAL to INCREASED UPTAKE

MORPHOLOGY central stellate scar nodular architecture ductular reaction

HEPATOCELLULAR ADENOMA benign ADULT WOMEN OCP and anabolic steroids angiography: HYPOVASCULAR w/ dense capillary blush liver scan: NO UPTAKE

HEPATOCELLULAR ADENOMA benign ADULT WOMEN OCP and anabolic steroids (+) malignant potential angiography: HYPOVASCULAR w/ dense capillary blush liver scan: NO UPTAKE

MORPHOLOGY discrete mass w/ areas of hemorrhage hepatocytes - benign to atypical architecture little fibrous septa

MC setting and emergence of HCC abdominal pain, malaise, fatigue weight loss hepatomegaly LUNGS - MC site of metastasis

Chronic liver disease w/ cirrhosis

Tumor marker for HCC

alpha feto protein

Imaging result of HCC (Contrast CT scan)

early enhancement in arterial phase --> rapid venous washout

Risk Factors of HCC

infections - HBV and HBC toxins - aflatoxins, alcohol hepatocellular adenoma metabolic liver diseases - NAFLD, hemochromatosis, a-1 antitrypsin deficiency

MC liver tumor of EARLY CHILDHOOD activation of WNT signaling pathway

HEPATOBLASTOMA ASSOCIATIONS: FAP Beckwith Wiedemann Syndrome

Metastatic sites of malignant biliary tumors

colon breast lung pancreas

MC congenital anomaly of the gallbladder

PHRYGIAN CAP - folded fundus

MC biliary tract disease

Cholelithiasis (Gallstones) asymptomatic epigastric or RUQ pain after a fatty meal

Complications of Gallstones Disease

Cholecystitis Obstructive Cholestasis Pancreatitis Gallstone Ileus - BOUVERET SYNDROME

CHOLESTEROL STONES RADIOLUCENT

Supersaturation of bile with cholesterol HYPOmotility Accelerated nucleation Mucus hypersecretion

PIGMENT STONES BLACK - sterile; radiopaque BROWN - infected; radiolucent

increased calcium salts of unconjugated bilirubin from increased hemolysis, ileal dysfunction or bypass, biliary tract infection

Morphology of Acute Cholecystitis

NEUTROPHILS in GB wall

Morphology of Chronic Cholecystitis

MONONUCLEAR cells in GB wall ROKITANSKY ASCHOFF SINUSES - mucosal outpouchings