Liver and Gallbladder Flashcards by Clyde Silverio

reversible liver injury

steatosis and cholestasis

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irreversible liver injury

necrosis and apoptosis

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vitamin A storage cells in the liver

hepatic stellate cells

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markers of hepatocyte integrity

AST, ALT, LDH

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markers of hepatocyte synthetic function

albumin, PT, aPTT, ammonia

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[diagnosis]

jaundice, cholestasis, hepatic encephalopathy, asterixis, occurring within 26 weeks post initial insult

acute liver injury

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most common drug that cause acute liver failure

acetaminophen

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Acute liver failure causes

ABCDEF

A hepatitis, acetaminophen
B hepatitis
C hepatitis, cryptogenic
D hepatitis, drugs/toxins
E hepatitis
F atty liver

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hepatitis virus that can cause chronic hep infection

HBV, HCV

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[diagnosis]
jaundice with pruritus,
palmar erythema, spider angiomas, hypogonadism, gynecomastia, HPO axis abnormalities, portal HPN

chronic lover disease

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[veins involved]

Portocaval anastomoses causing esophageal varices

esophageal branch of the left gastric vein and azygous vein

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[veins involved]

Portocaval anastomoses causing hemorrhoids

superior, middle, and inferior rectal veins

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[veins involved]

Portocaval anastomoses causing caput medusae

periumbilical veins and abdominal wall collaterals

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hallmark of chronic viral hepatitis

portal inflammation

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[diagnosis: hepatitis]

ground glass appearance of hepatocytes.

hepatitis b

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[diagnosis: hepatitis]

lymphoid follicles, bile duct injury and steatosis (fatty change)

hepatitis c

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[diagnosis: acute vs chronic]

ballooning degerenration, apoptosis, macrophages aggregates, scan mononuclear infiltrate

acute hepatitis

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[diagnosis: acute vs chronic]
dense mononuclear necrosis, ground glass cells (Hep B) or fatty change (hep C), interface hepatitis, ductular reaction, bridging fibrosis

chronic hepatits

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this refers to stem cell activation of hepatocyte during regeneration

ductular reaction

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[diagnosis: autoimmune hepatitis]

female, middle aged, ANA, AntiSMA, anti-SLA/LP, AMA

more favorable prognosis

Type 1 Autoimmune Hepatitis

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[diagnosis: autoimmune hepatitis

female, children to teenagers, anti LKM, CYP2D6 antibodies, anti ACL1

less favorable prognosis

Type 2 autoimmune hepatitis

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anesthetic drug that causes dose-dependent hepatitis

halothane

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this drug causes cholestasis leading to hepatitis

chlorpromazine

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___ amount of alcohol that is associated with development of ALD

80g/day

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[form of alcoholic liver disease] lipid droplets in hepatocytes, fatty changes, perivenular fibrosis

hepatocellular steatosis

[form of alcoholic liver disease] hepatocyte swelling, mallory denk bodies, neutrophilic infiltration

alcoholic steatosis

[form of alcoholic liver disease] fibrosis at central vein, perisinusoidal, chicken-wire fence pattern

steatofibrosis

[alcoholic SH vs non-alcoholic SH] PMN predominant, fibrosis prominent around central vein, mallory denk bodies are more

Alcoholic steatohepatitis

alcoholic SH vs non-alcoholic SH] mononuclear infiltrates, fibrosis prominent around portal vein, less mallory denk bodies

Non-alcoholic SH

[diagnosis] 1. micronodular cirrhosis 2. Diabetes mellitus 3. abnormal skin pigmentation

hemochromatosis

[diagnosis] ATPB mutation (Ch13)

wilson disease

deposition of copper in the corneal limbus

keyser-fleisher ring

most commonly diagnosed inherited hepatic disorder in infants and children

alpha 1 antitrypsin deficiency

[diagnosis] accumulation of misfolded proteins in hepatocytes, PAS positive, diastase-resistant hyaline globules

alpha 1 anti trypsin deficiency

Inherited disorder that cause indirect hyperbilirubinemia

crigler-najjr I and II | Gilbert syndrome

Inherited disorder that cause conjugated hyperbilirubinemia

Dubin-johnson | Rotor syndrome

most common cause if large bile duct obstruction

gallstones in adult, biliary atresia in children

[diagnosis] 1. fever 2. jaunduce 3. RUQ pain

ascending cholangitis

treatment of choice of extrahepatic biliary atresia

kasai procedure

[diagnosis: autoimmune cholangitis] female, 30-70 years old, progressive, AMA(+) lymphoplasmacytic infiltration with or without granulomas (Florid duct lesion)

primary biliary cirrhosis

[diagnosis: autoimmune cholangiopathies] 30 years old, usually males, associated with IBD, pancreatitis, retroperitoneal fibrosis stricture and beading of large bile ducts onion skin fibrosis, beading of contrast medium

primary sclerosing cholangitis

[diagnosis] 1. pain 2. jaundice 3. abdominal mask

choledocal cyst

___ disease where there is dilatation of intrahepatic bile duct

caroli disease

___ disease where there is dilatation of intrahepatic bile duct

caroli disease

[diagnosis] obstruction >/ 2 hepatic veins liver enlargement, pain, ascites hypercoaguable state hemorrhagic centrilobular necrosis

budd chiari syndrome

nutmeg liver is associated with what type of HF

left-sided HF

most common benign tumor in the liver

cavernous hemangioma

most common liver tumor of early childhood

hepatoblastoma

most common tumor involving liver

metastasis

most common primary malignant tumor of the liver

hepatocellular CA

second most common primary malignant tumor of the liver

cholangiocarcinoma

[diagnosis] well-demarcated, poorly encapsulated with central scar that contains blood vessels, usually arterial hypervascular with dense capillary blush on angiography

focal nodular hyperplasia

[diagnosis: liver] incidental mass, hypovascular on angiography, no uptake on liver scan, assciated with OCP use

hepatocellular adenoma

tumor marker for hepatocellular CA

alpha fetoprotein

most common metastatic site of HCCA

lung

most common location of cholangiocarcinoma

perihilar (klatskin)

most common congenital anomaly of gallbladder

folded fundus or phrygian cap

most common biliary tract disease

cholelithiases

[diagnosis: GB stone] pale yellow, round to ovoid, finely granular, hard radiolucent but can be radiopaque if with sufficient CaCO3

cholesterol stone

[diagnosis: GB stone] spiculated, molded surface sterile, radiopaque

black pigment

[diagnosis: GB stone] spiculated, molded surface, with Ca salts of fatty acids infected, radiolucent

brown pigment

[diagnosis: chronic cholecystitis] foamy macrophages

xanthogranulomatous cholecystitis

[diagnosis: chronic cholecystitis] extensive dystrophic calcification, increased risk for CA

porcelain GB

[diagnosis: chronic cholecystitis] atrophic, dilated with clear secretions

hydrops

most important risk factor for GB CA

gallstone

[diagnosis] RUQ pain, anorexia, elevated ALP

GB CA