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Pathology > Liver and Gallbladder > Flashcards

Liver and Gallbladder Flashcards

1
Q

Reversible responses to liver injury

A

steatosis (fatty change)
cholestasis
ballooning
Mallory hyaline

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2
Q

Irreversible responses to liver injury

A

necrosis - ischemic injury
apoptosis - viral hepatitides
*Councilman bodies

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3
Q

Measure hepatocyte INTEGRITY

A

AST
AST
LDH

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4
Q

Measure hepatocyte EXCRETORY function

A

Bilirubin (B1, B2, TB)
Alkaline phosphatase
GGT

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5
Q

Measure hepatocyte SYNTHETIC function

A

albumin
PT
aPTT
ammonia

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6
Q

Lab finding in Acute Liver Failure

A

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

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7
Q

Major outcomes of Portal HPN

A

APES

Ascites
Portosystemic shunts
hepatic Encephalopathy
congestive Splenomegaly

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8
Q

Common causes of death in cirrhosis

A

Hepatic encephalopathy
Bleeding from esophageal varices
Bacterial infection
HCC

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9
Q

Hepatorenal syndrome

A

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

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10
Q

Hepatitis viruses that can cause ACUTE liver failure

A

BEA

Hepa B
Hepa E
Hepa A

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11
Q

Hepatitis viruses transmitted via fecal-oral route

A

Hepa A
Hepa E

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12
Q

Hallmark of chronic viral hepatitis

A

PORTAL INFLAMMATION WITH FIBROSIS

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13
Q

Findings in Hepatitis B

A

BaGaGa

GROUND GLASS HEPATOCYTES

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14
Q

Findings in Hepatitis C

A

CaLaBaSa

LYMPHOID FOLLICLES
BILE DUCT INJURY
STEATOSIS

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15
Q

Morphologic forms of alcohol induced liver injury

A

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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16
Q

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

Prussian blue (+) hemosiderin granules

A

HEMOCHROMATOSIS

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

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17
Q

AR
Impaired Cu excretion into bile and incorporation to ceruloplasmin

ATP7B mutation Ch 13

INCREASED copper and urinary copper excretion
DECREASED serum ceruloplasmin

A

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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18
Q

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

a-1 antitrypsin deficiency

19
Q

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

portal fibrosis
ductular reaction
ductular bile ducts

A

EXTRAHEPATIC BILIARY ATRESIA

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

20
Q

Autoimmune Cholangiopathies

FEMALE

(+) AMA

ASSOCIATED CONDITIONS:
Sjogren
Hashimoto
Scleroderma

A

PRIMARY BILIARY CHOLANGITIS (PBC)

small to medium sized intrahepatic

HISTOLOGY
florid duct lesions
cirrhosis
nodular regenerative hyperplasia

21
Q

Autoimmune Cholangiopathies

MALE

(+) ANCA

ASSOCIATED CONDITIONS:
IBD
pancreatitis
idiopathic fibrosing diseases

A

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

22
Q

Sequelae of Primary Biliary Cholangitis

A

HCC - increased risk

23
Q

Sequelae of Primary Sclerosing Cholangitis

A

cholangiocarcinoma- increased risk

24
Q

MC benign tumor of the liver

A

CAVERNOUS HEMANGIOMA

25
Q

MC liver tumor of EARLY CHILDHOOD

A

HEPATOBLASTOMA

26
Q

MC tumor involving the liver

A

METASTASES

27
Q

MC primary malignant tumor

A

HCC

28
Q

2nd MC primary malignant tumor

A

Cholangiocarcinoma

29
Q

Focal Nodular Hyperplasia

benign
ADULT WOMEN

non-neoplastic

angiography:
HYPERVASCULAR w/ dense capillary blush

liver scan:
NORMAL to INCREASED UPTAKE

A

MORPHOLOGY

central stellate scar
nodular architecture
ductular reaction

30
Q

HEPATOCELLULAR ADENOMA

benign
ADULT WOMEN

OCP and anabolic steroids

angiography:
HYPOVASCULAR w/ dense capillary blush

liver scan:
NO UPTAKE

A
30
Q

HEPATOCELLULAR ADENOMA

benign
ADULT WOMEN

OCP and anabolic steroids

(+) malignant potential

angiography:
HYPOVASCULAR w/ dense capillary blush

liver scan:
NO UPTAKE

A

MORPHOLOGY

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

31
Q

MC setting and emergence of HCC

abdominal pain, malaise, fatigue
weight loss
hepatomegaly

LUNGS - MC site of metastasis

A

Chronic liver disease w/ cirrhosis

32
Q

Tumor marker for HCC

A

alpha feto protein

33
Q

Imaging result of HCC (Contrast CT scan)

A

early enhancement in arterial phase –> rapid venous washout

34
Q

Risk Factors of HCC

A

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

35
Q

MC liver tumor of EARLY CHILDHOOD

activation of WNT signaling pathway

A

HEPATOBLASTOMA

ASSOCIATIONS:
FAP
Beckwith Wiedemann Syndrome

36
Q

Metastatic sites of malignant biliary tumors

A

colon
breast
lung
pancreas

37
Q

MC congenital anomaly of the gallbladder

A

PHRYGIAN CAP - folded fundus

38
Q

MC biliary tract disease

A

Cholelithiasis (Gallstones)

asymptomatic
epigastric or RUQ pain after a fatty meal

39
Q

Complications of Gallstones Disease

A

Cholecystitis
Obstructive Cholestasis
Pancreatitis
Gallstone Ileus - BOUVERET SYNDROME

40
Q

CHOLESTEROL STONES

RADIOLUCENT

A

Supersaturation of bile with cholesterol
HYPOmotility
Accelerated nucleation
Mucus hypersecretion

41
Q

PIGMENT STONES

BLACK - sterile; radiopaque
BROWN - infected; radiolucent

A

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

42
Q

Morphology of Acute Cholecystitis

A

NEUTROPHILS in GB wall

43
Q

Morphology of Chronic Cholecystitis

A

MONONUCLEAR cells in GB wall
ROKITANSKY ASCHOFF SINUSES - mucosal outpouchings

Pathology (24 decks)

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