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Basic Human Pathology 2 > Liver and Gallbladder > Flashcards

Liver and Gallbladder Flashcards

1
Q

what is the normal weight of a liver

A

1650 g

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2
Q

what are the 5 components of the portal hepatis

A

portal vein
hepatic artery
common hepatic duct
nerves
lymphatics

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3
Q

what are non-pathologic grooves of the liver called

A

leibermeister grooves

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4
Q

what is the anatomic unit which organizes the liver

A

lobule - made of sheets of hepatocytes

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5
Q

what is an important sinusoid cell of the liver

A

kupffer cells - breaks down red blood cells

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6
Q

why doesn’t the liver normally undergo necrosis

A

it has two blood supplies - portal vein and hepatic artery

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7
Q

what are the three components of a portal triad (tract)

A

portal venule
hepatic arteriole
bile duct

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8
Q

what are the three main mechanisms of liver injury

A

cholestasis
necrosis
apoptotic death

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9
Q

define cholestasis

A

accumulation of fat and bilirubin within the liver, typically due to an obstruction of the bile tract

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10
Q

how does cholestasis present microscopically

A

orange-yellow pigments

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11
Q

what is the most common cause of cholestasis

A

sepsis

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12
Q

what do you see microscopically in acute liver inflammation

A

lots of lymphocytic infiltration

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13
Q

what is hepatocytic ballooning (degeneration)

A

when presented with oxidative stress, hepatocytes undergo morphologic change and become much larger in size
additionally, they have a cleared out cytoplasm

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14
Q

what are councilman bodies

A

these are eosinophilic apoptotic bodies outside of hepatocytes

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15
Q

what are the two most common causes of multi-lobulated necrosis of the liver

A

acetaminophen toxicity and acute viral hepatitis

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16
Q

what is the macroscopic presentation of massive necrosis of the liver

A

small organ with a soft, yellow cut surface

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17
Q

what is the most common form of liver disease

A

hepatic steatosis

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18
Q

what are four common causes of macrovesicular steatosis

A

alcohol abuse
obesity
diabetes mellitus
viral hepatitis C

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19
Q

which special stain can be used to diagnose hepatic steatosis

A

oil red O

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20
Q

what are mallory-denk bodies

A

thick, ropy eosinophilic clumps within a ballooned hepatocyte

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21
Q

what is the main difference between a mallory-denk body and a councilman body

A

a mallory-denk body is only seen within a ballooning hepatocyte
a councilman body are found outside of the hepatocytes

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22
Q

which liver condition has a greasy cut surface due to lipid accumulation

A

steatohepatitis

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23
Q

define hemosiderosis

A

too much iron in the body

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24
Q

how does iron deposition in the liver appear microscopically

A

brown, granular pigments

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25
Q

what is Wilson disease

A

a recessive disorder caused by a mutation of the ATP7B gene which results in impaired copper excretion, thus causing it to build up in the body

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26
Q

what is alpha1-antitrypsin deficiency

A

genetic disease that is characterized by an accumulation of PAS positive cytoplasmic granules

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27
Q

what is nutmeg liver

A

chronic passive congestion of the liver

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28
Q

what is bridging fibrosis

A

fibrosis that spans between two central veins or portal tracts

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29
Q

fibrous strands surrounding liver nodules are suggestive of what

A

cirrhosis

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30
Q

define periductal fibrosis

A

onion skinning (concentric) fibrosis surrounding ducts - can be suggestive of primary sclerosing cholangitis

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31
Q

what is the macroscopic presentation of liver cirrhosis

A

nodules surrounded by dense bands of fibrosis cause a bumpy surface

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32
Q

what is the size of the nodules in macronodular cirrhosis

A

greater than 3 mm

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33
Q

what is the size of the nodules in micronodular cirrhosis

A

less than 3 mm

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34
Q

what is the etiology of macronodular cirrhosis

A

viral

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35
Q

what is the etiology of micronodular cirrhosis

A

alcohol

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36
Q

what do liver enzyme tests do

A

determine hepatocyte integrity

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37
Q

what do bilirubin tests do

A

test biliary excretory function

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38
Q

what do serum protein/albumin tests do

A

test hepatocyte function

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39
Q

what is hepatitis A (HAV)

A

mostly benign and self limiting infection that does not cause chronic hepatitis

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40
Q

what is hepatitis B (HBV)

A

uncommon infection thanks to vaccines
most patients are asymptomatic
increases your risk for developing hepatocellular carcinoma

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41
Q

what is hepatitis C (HCV)

A

infection that most commonly leads to chronic disease
significantly increases your risk for developing hepatocellular carcinoma

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42
Q

what is the most common type of viral hepatitis

A

hepatitis C (HCV)

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43
Q

what is hepatitis D (HDV)

A

infection that only occurs in those who also have hepatitis B (HBV)

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44
Q

what is hepatitis E (HEV)

A

water-borne infection that does not cause chronic hepatitis or hepatocellular carcinoma

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45
Q

what is fulminant hepatic failure

A

liver disease that can be caused by viruses
can only be cured through a liver transplant

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46
Q

what is the criteria for a chronic hepatitis diagnosis

A

persistent or relapsing hepatic disease for a period of time more than 6 months

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47
Q

what are the three triggers for autoimmune hepatitis

A

viral infections, drugs, or toxin exposures

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48
Q

who is most affected by autoimmune hepatitis

A

females - 78%

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49
Q

who is most affected by type 1 autoimmune hepatitis

A

middle-age/older individuals

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50
Q

who is most affected by type 2 autoimmune hepatitis

A

children/teenagers

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51
Q

what are the two distinguishing microscopic features of autoimmune hepatitis

A

hepatocyte rosettes and lots of plasma cells

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52
Q

what are the 5 progressive steps of liver disease

A

isolated steatosis
non-alcoholic steatohepatitis (NASH)
alcoholic liver disease
fibrosis
cirrhosis

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53
Q

what is the most well-known cause of fatty liver disease

A

alcohol

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54
Q

what are the three stages/presentations of fatty liver disease

A

steatosis
steatohepatitis
cirrhosis

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55
Q

what are the three criteria for an alcoholic liver disease diagnosis

A

hepatic steatosis
alcoholic hepatitis
fibrosis and cirrhosis

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56
Q

which special stain is used to differentiate fibrosis

A

Trichrome stain

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57
Q

what percentage of heavy drinkers will develop fatty liver (hepatic steatosis)

A

90-100%

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58
Q

what percentage of heavy drinkers with fatty liver (hepatic steatosis) will develop alcoholic hepatitis

A

10-35%

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59
Q

what percentage of heavy drinkers with fatty liver (hepatic steatosis) and alcoholic hepatitis will develop cirrhosis

A

8-20%

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60
Q

30% of chronic alcoholics have which disease

A

hepatitis C (HCV)

61
Q

your risk of cirrhosis increases with how much alcohol a day

A

30 g of alcohol per day

62
Q

how much alcohol is considered short term intake

A

80 g of alcohol per day

63
Q

how much alcohol is considered long term intake

A

40-80 g of alcohol per day

64
Q

what is the most common cause of chronic liver disease in the US

A

nonalcoholic fatty liver disease (NAFLD) - will develop into chronic liver disease

65
Q

what are the five conditions associated with nonalcoholic fatty liver disease

A

metabolic syndromes
type 2 diabetes
obesity
dyslipidemia
hypertension

66
Q

what is an ascending infection

A

an infection that comes from the gut and biliary tract to reach the liver

67
Q

what is the most common vascular seeding location to the liver

A

through the portal system via the GI tract

68
Q

what is hemochromatosis

A

excessive absorption of iron caused by a mutation in the HFE gene

69
Q

what are three primary sites of iron deposition in the body

A

liver, pancreas, and skin

70
Q

what can fully developed cases of hemochromatosis lead to

A

diabetes mellitus and abnormal skin pigmentation

71
Q

in Wilson disease, copper builds up in which three structures

A

liver
brain
eye

72
Q

what is a Kayser-Fleischer ring

A

ring of copper build up seen in the eye in Wilson disease

73
Q

where is alpha1-antitrypsin synthesized

A

in the liver

74
Q

10-20% of neonates present with hepatitis and cholestatic jaundice if they have which condition

A

alpha1-antitrypsin deficiency

75
Q

what are two common examples of drug and toxin induced liver injury

A

Tylenol (acetaminophen) and cholesterol medication

76
Q

define acute liver failure

A

liver disease that produces hepatic encephalopathy within 6 months of the initial diagnosis

77
Q

what is fulminant liver failure

A

acute liver failure where the encephalopathy develops within 2 weeks of onset of jaundice

78
Q

what is sub-fulminant liver failure

A

liver failure where the encephalopathy develops within three months of the onset of jaundice

79
Q

what is a retic (reticulin) stain used for

A

looks for type 3 collagen

80
Q

what are four consequences of portal hypertension

A

ascites, encephalopathy, splenomegaly, and esophageal varices

81
Q

what are the four major steps of bilirubin metabolism

A

uptake from circulation
intracellular storage
conjugation with glucuronic acid
biliary excretion

82
Q

what are the two types of bilirubin

A

unconjugated and conjugated

83
Q

what is the normal serum bilirubin levels in an adult

A

0.3 to 1.2 mg/dL

84
Q

what serum bilirubin levels would someone with jaundice have

A

greater than 2 mg/dL

85
Q

what is neonatal jaundice

A

jaundice in a newborn due to the fact that they cannot conjugate and excrete bilirubin until they are fully mature at 2 weeks of age

86
Q

what is Gilbert syndrome

A

condition where a person cannot conjugate bilirubin so it accumulates

87
Q

what is Dublin-Johnson syndrome

A

condition where a person cannot excrete bilirubin so it accumulates
most often affects jewish and Japanese people

88
Q

what are two possible clinical presentations of cholestasis

A

xanthomas and intestinal malabsorption

89
Q

what are the four steps of cholestasis

A

enlargement of hepatocytes
dilated canaliculi
apoptotic hepatocytes
bile pigment hepatocytes

90
Q

what is feathery degeneration

A

foamy bile pigment of hepatocytes that is seen in advanced cholestasis

91
Q

what are the three causes of bile duct obstruction in adults

A

extrahepatic cholelithiasis (gallstones)
malignant obstructions
post surgical strictures

92
Q

what is the most common cause of bile duct obstruction in adults

A

extrahepatic cholelithiasis (gallstones)

93
Q

what are the two most common causes of bile duct obstruction in children

A

biliary atresia (stricture) and cystic fibrosis

94
Q

define neonatal cholestasis

A

prolonged conjugated hyperbilirubinemia in the neonate

95
Q

what are the two most common causes of neonatal cholestasis

A

primary biliary atresia (stricture) and neonatal hepatitis

96
Q

what is primary biliary cholangitis

A

inflammation and destruction of intrahepatic bile ducts which leads to fibrosis

97
Q

what is primary sclerosing cholangitis

A

inflammation and fibrosis of intrahepatic and extrahepatic bile ducts which leads to dilation

98
Q

who is most affected by primary biliary cholangitis

99
Q

who is most affected by primary sclerosing cholangitis

100
Q

which condition is associated with primary biliary cholangitis

A

sjogren syndrome

101
Q

which condition is associated with primary sclerosing cholangitis

A

inflammatory bowel disease

102
Q

in which condition would you see strictures and beading of large bile ducts

A

primary sclerosis cholangitis

103
Q

what is the most common cause of extrahepatic portal vein obstruction

A

cause of most cases is unknown

104
Q

what is an infarct of Zahn

A

red-blue discoloration seen in the liver due to intrahepatic portal vein obstruction

105
Q

what are the two most common causes of intrahepatic portal vein obstruction

A

schistosomiasis and obliterative portal venopathy

106
Q

how does schistosomiasis affect the liver

A

the eggs of the parasite lodge themselves into the smallest portal vein branches and cause obstructions

107
Q

mortality is high in which type of hepatic venous outflow condition

A

hepatic vein thrombosis

108
Q

what is sinusoidal obstruction syndrome

A

occlusion of the smallest intrahepatic branches of the liver

109
Q

what are three causes of sinusoidal obstruction syndrome

A

Jamaican bush tea
stem cell transplantation
chemotherapy

110
Q

what is Budd-chiari syndrome

A

obstruction of two or more major hepatic veins which causes an enlarged liver

111
Q

what are the two major risk factors of hepatic venous outflow obstructions

A

pregnancy and oral contraceptives

112
Q

what is the cause of chronic passive congestion of the liver “nutmeg liver”

A

right sided heart failure

113
Q

what is focal nodular hyperplasia

A

a tumor of the hepatocytes
grossly shows a central scar

114
Q

what is the most common cause of focal nodular hyperplasia

A

alterations in hepatic parenchymal blood supply
ex. arteriovenous malformations

115
Q

what is a cavernous hemangioma

A

benign, vascular tumor of the liver
leads to dilated and thin-walled vessels microscopically

116
Q

what is the most common benign liver tumor

A

cavernous hemangioma (made of blood vessels)

117
Q

what is a hepatocellular adenoma

A

benign neoplasm of the hepatocytes that tend to be very large
have malignant transformation potential

118
Q

what is a hamartoma

A

bengin mass of disorganized tissue such as cartilage that is native to a particular anatomic location

119
Q

what is a bile duct hamartoma

A

benign lesions of aggregates of bile ducts with irregularly shaped open lumens (von meyenburg complexes)

120
Q

what are von Meyenburg complexes

A

hamartomas - channels of proliferating cartilage in the liver

121
Q

in which condition would you see von Meyenburg complexes

A

bile duct hamartoma

122
Q

what is the most common primary liver tumor

A

hepatocellular carcinoma - a tumor of the hepatocytes

123
Q

what is the second most common primary liver tumor

A

cholangiocarcinoma - a tumor of the bile ducts

124
Q

what is a hepatoblastoma

A

liver tumor of infants and children that is made tissue resembling fetal liver cells, mature liver cells, or bile duct cells

125
Q

what is an angiosarcoma

A

hepatic tumor that originates from endothelial and fibroblastic tissue
made mostly of vessels

126
Q

what are 4 common causes of hepatocellular carcinoma

A

HBV
HCV
aflatoxin
alcohol

127
Q

what is the most common cause of hepatocellular carcinoma

A

chronic liver disease

128
Q

how does hepatocellular carcinoma spread

A

vascular invasion or direct extension

129
Q

what is cholangiocarcinoma

A

malignant adenocarcinoma arising from intrahepatic and extra hepatic bile ducts
commonly caused by certain foods/parasites

130
Q

what is the most common liver tumor of early childhood

A

hepatoblastoma

131
Q

a hepatoblastoma is associated with which two conditions

A

FAP (familial adenomatous polyposis) and Beckwith-Wiedmann syndrome

132
Q

what is the most common metastasis location of hepatocellular carcinoma

133
Q

how can Clostridium perfringes affect the liver

A

it can cause gangrenous gas necrosis which leads to abscess pockets (should not be confused with cysts)

134
Q

chronic transplant rejection (CTR) presents clinically as what

A

progressive cholestasis

135
Q

what is the most common congenital anomaly of the gallbladder

A

Phrygian cap

136
Q

what is unique about the wall of the gallbladder

A

it has no submucosa

137
Q

define choleliths

138
Q

95% of biliary tract disease is caused by what

A

choleliths (gallstones)

139
Q

what are the two main types of gallstones

A

cholesterol and pigment stones

140
Q

what are pigment stones made out of

A

bilirubin calcium salts

141
Q

what are the four F’s of gallstone risks

A

female
fat
forty
fertile

142
Q

define cholecystitis

A

inflammation of the gallbladder

143
Q

what are rokitansky-aschoff sinuses

A

benign condition characterized by hyperplastic changes in the wall of the gallbladder

144
Q

define cholesterolosis

A

“strawberry gallbladder”
deposition of cholesterol laden histiocytes

145
Q

what is porcelain gallbladder

A

dense, hyaline fibrosis transforming gallbladder wall often with calcifications
most commonly caused by long standing inflammation

146
Q

what is the most common malignancy of the extra hepatic biliary tract

A

gallbladder carcinoma

147
Q

who is most at risk for gallbladder carcinoma

A

females around 70 years old

148
Q

what is the most important risk factor associated with gallbladder carcinoma

A

cholelithiasis

Basic Human Pathology 2 (14 decks)

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