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Lecom pathology year 2 > Liver And Gallbladder- Chapter 18 > Flashcards

Liver And Gallbladder- Chapter 18 Flashcards

1
Q

Where is AST located

A

Mitochondria

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2
Q

Where is ALT located

A

Cytoplasm

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3
Q

What liver test can tell you if alk phos increase is due to bone or not

A

Gamma-glutamic transpeptidase (not elevated in bone)

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4
Q

What happens to cells with hepatic necrosis

A

Cells swell due to defective osmotic regulation at the cell membrane

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5
Q

What type of liver necrosis is described as widespread parenchymal loss’ severe, zonal loss of hepatocytes

A

Confluent necrosis

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6
Q

What type of liver necrosis is described as zone of necrosis that may link central veins to portal tracts or bridge adjacent portal tracts

A

Bridging necrosis

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7
Q

What is the principle cell type involved in scar formation of the liver

A

Hepatic stellate cell

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8
Q

What does hepatic stellate cells store in quiescent form

A

Vitamin A (lipid storing)

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9
Q

How does acute hepatic failure first manifest

A

Nausea, vomiting, jaundice followed by life-threatening encephalopathy and coagulation defects

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10
Q

What results from the hypoalbuminemia seen in hepatic failure

A

Peripheral edema; may cause low oncotic pressure

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11
Q

What are 2 ways to treat hyperammonemia seen with hepatic failure

A

Eat low protein diet and treatment with lactulose

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12
Q

What are the non-specific signs seen with cirrhosis

A

Anorexia, weight loss, weakness

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13
Q

What are some prehepatic causes of portal hypertension

A

Obstructive thrombosis; narrowing of portal vein

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14
Q

What are some intrahepatic causes of portal hypertension

A

Cirrhosis

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15
Q

What accounts for most causes of portal hypertension

A

Cirrhosis

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16
Q

What are some posthepatic causes of portal hypertension

A

Severe R-sided heart failure, constrictive pericarditis, hepatic vein outflow obstruction

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17
Q

What are some major clinical consequences of portal hypertension

A

Ascites, formation of portosystemic venous shunts, congestive splenomegaly, hepatic encephalopathy

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18
Q

Describe the type of virus HAV is

A

Positive sense SS RNA, naked

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19
Q

How does HAV spread

A

Ingestion of contaminated water and foods and is shed in stool for 2-3 weeks before and 1 week after onset of jaundice

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20
Q

What specific cell plays important key role in hepatocellular injury seen with HAV infection

A

CD8+ T cells

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21
Q

Describe the type of virus HBV is

A

DS circular DNA

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22
Q

What is the life cycle for HBV

A

DNA to RNA to DNA

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23
Q

When does HBsAg appear

A

Before onset of symptoms, peaks during overt disease, and often declines to undetectable levels in 12 weeks

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24
Q

What is the major virion of HBV

A

Dane particle

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25
Q

What is the most common chronic blood-borne infection cause

A

HCV

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26
Q

What type of virus is HCV

A

SS RNA Enveloped; flaviviridae family

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27
Q

What is the mean incubation time for HCV

A

9 was

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28
Q

What is the most common reason for liver transplant

A

HCV infection

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29
Q

What type of hepatitis is a quasi species

A

Hepatitis C

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30
Q

What hepatitis infection is associated with metabolic syndrome

A

HCV

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31
Q

What type of virus is HDV

A

Circular defective ssRNA

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32
Q

What type of virus is HEV

A

Positive sense ssRNA, non-enveloped

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33
Q

What viral hepatitis infection is zoonotic

A

Hep E

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34
Q

What population of people are most effected against HepE

A

Pregnant women

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35
Q

What is the form of transmission for HepD

A

Parenteral

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36
Q

Who does chronic liver disease occur in when infected with HepE

A

Immunocompromised host only

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37
Q

How do you diagnose HepA

A

Detection of serum IgM antibodies

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38
Q

What is the defining histo feature of chronic viral hepatitis

A

Mononuclear portal infiltration

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39
Q

What should you think of with ground glass hepatocytes

A

HBV

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40
Q

What is the term for cells with ER swollen by HBsAg

A

Ground glass hepatocytes

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41
Q

What bacteria causes toxic shock infection of the liver

A

S. Aureus

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42
Q

What are hydatid cysts of the liver usually caused by

A

Echinococcal infecitons

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43
Q

What is the most common cause of liver abscesses in developing countries

A

Echinococcal and amebic infections

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44
Q

What type of infections is the most likely cause of liver abscesses in developed countries

A

Pyogenic

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45
Q

What should you think of with hepatocyte rosettes

A

Autoimmune hepatitis

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46
Q

What lab findings are associated with type 1 autoimmune hepatitis

A

ANA, SMA/ AAA anti-SLA/LP

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47
Q

What lab findings are associated with type 2 autoimmune hepatitis

A

Anti-LKM-1, ACL-1

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48
Q

Who is type 1 autoimmune hepatitis most common in

A

Middle-aged to older individuals

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49
Q

What age group is type 2 autoimmune hepatitis most commonly seen in

A

Children and teenagers

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50
Q

Who does chlorpromazine cause cholestasis in

A

Patients who are slow to metabolize it to an innocuous byproduct

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51
Q

Who can halothane cause fatal immune-mediated hepatitis in

A

Some patients exposed to this anesthetic on multiple occasions

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52
Q

What is the most common cause of acute liver failure necessitating transplantation in USA

A

Acetaminophen

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53
Q

What zone of the liver does acetaminophen damage first

A

Zone 3

54
Q

What are the key morphological findings with hepatocellular necrosis

A

Spotty hepatocyte necrosis, massive necrosis, chronic hepatitis

55
Q

What is the major associated agent with buds-chiari syndrome

A

Oral contraceptives

56
Q

What are the major associated agents with hepatocellular adenoma

A

Oral contraceptives, anabolic steroids

57
Q

What are the major associated agents with liver angiosarcoma

A

Thorothrast, vinyl chloride

58
Q

What is hepatitis steatosis usually due to

A

Alcohol consumption

59
Q

What should you think of with Mallory denk bodies

A

Alcoholic hepatitis

60
Q

What should you think of with chicken wire pattern

A

Laennec cirrhosis occuring with alcoholic hepatitis

61
Q

What zone does budd chiari syndrome most commonly affect most

A

Zone 3 (congestion, necrosis, hemorrhage)

62
Q

What is elevated in most patients with NASH

A

ALT and AST

63
Q

What is the most common cause of chronic liver disease in the USA

A

NAFLD

64
Q

What gene is involved in Wilson disease

A

ATP7B

65
Q

What is impaired with Wilson disease

A

Copper excretion

66
Q

Where does the toxic levels of copper seen in Wilson’s disease go

A

Brain, liver, eye

67
Q

What should you think of with kayser-FLeisher rings

A

Wilson disease

68
Q

What is the term for green to brown deposits of copper in descemet membrane in limbus of the cornea

A

Kayser-Fleisher rings

69
Q

What age group does Wilson disease typically occur in

A

Young (6-40)

70
Q

What is decrease in Wilson disease

A

Serum ceruloplasmin

71
Q

What are the special stains used for Wilson disease

A

Rhodamine stain for copper; orcein stain for copper-associated protein

72
Q

What is the main treatment for Wilson disease

A

Penicillamine

73
Q

What is the issue in hemachromatosis

A

Excessive accumulation of iron

74
Q

What clinical things could indicate severe iron overload in teh body

A

Micronodular cirrhosis in all patients; DM; skin pigmentation

75
Q

Does hemachromatosis effect men or women more? Why?

A

Men because women are excreting some of the iron during menstruation

76
Q

What type of cancer are people with hemochromatosis more likely to develop

A

Hepatocellular carcinoma

77
Q

How is neonatal hemochromatosis manifested

A

Severe liver disease and extrahepatic hemosiderin deposition

78
Q

What is the major function of alpha 1-antitrypsin

A

Inhibition of proteases released from neutrophils

79
Q

What happens within alpha 1-antitrypsin

A

Pulmonary emphysema and liver disease develop

80
Q

What is seen morphological with alpha 1-antitrypsin deficiency

A

Round-to-oval cytoplasmic globular inclusions in hepatocytes (acidophilic but strongly PAS+ and diastase-resistant)

81
Q

What converts heme to biliverdin

A

Heme oxygenase

82
Q

What is the uptake of bilirubin by hepatocytes and conjugation done by

A

UDP-glucuronic transferase

83
Q

At what level of bilirubin does jaundice become evident

A

When levels rise above 2-2.5 mg/dL

84
Q

What do mutations in UGT1A1 cause

A

Criggler-Najjar syndromes 1 and 2 and Gilbert syndrome

85
Q

What hereditary hyperbilirubinemias are due to conjugated bilirubin

A

Dubin-Johnson syndrome and rotor syndrome

86
Q

What is the liver pathology seen with Dubin-Johnson Syndrome

A

Pigmented cytoplasmic globules

87
Q

What is the clinical presentation of cholestasis

A

Jaundice, pruritis, skin xanthomas, malabsorption, fat-soluble vitamin Deficiency

88
Q

What should you think of with feathery degeneration

A

Cholestasis

89
Q

What type of biliary atresia is disease that is limited to common duct

A

Type 1

90
Q

What type of biliary atresia is where the disease goes into right and/or left hepatic bile ducts

A

Type 2

91
Q

What type of biliary atresia is when there is also obstruction of bile ducts at or above the porta hepatis

A

Type 3

92
Q

What does the biopsy of neonatal hepatitis show

A

Multinucleated giant hepatocytes

93
Q

What cholangiopathy should you think of with anti-mitochondrial antibodies

A

Primary biliary cirrhosis

94
Q

How does primary biliary cirrhosis commonly first present

A

Itching

95
Q

What are some common clinical features seen in primary biliary cirrhosis

A

Fatigue, pruritis, hepatomegaly, hyperpigmentation, eyelid xanthelasmas, arthropathy

96
Q

How do you treat primary biliary cirrhosis

A

Ursodeoxycholic acid

97
Q

What autoimmune cholangiopathy is highly associated with IBD, particularly ulcerative colitis

A

Primary sclerosing cholangitis

98
Q

What autoimmune cholangiopathy is associated with onion skinnning fibrosis

A

Primary sclerosing cholangitis

99
Q

What autoimmune cholangiopathy is associated with increased IgM and positive p-ANCA

A

Primary sclerosing cholangitis

100
Q

What autoimmune cholangiopathy is highly associated with Sjogrens

A

Primary biliary cirrhosis

101
Q

What is the term for congenital dilations of common bile duct

A

Choledochal cysts

102
Q

What disorder does fibrocystic disease often occur along with

A

Autosomal recessive polycystic renal disease

103
Q

What is the most common cause of impaired intrahepatic blood flow

A

Cirrhosis

104
Q

How does right sided cardiac decompensation effect the liver

A

Leads to passive congestion of liver

105
Q

Describe the liver with right sided cardiac decompensation

A

Liver is slightly enlarged, tense and cyanosis, with rounded edges

106
Q

How does left sided cardiac failure or shock effect the liver

A

Leads to hepatic hypoperfusion and hypoxia, causing ischemic coagulative necrosis of hepatocytes in the central region of the lobule

107
Q

What are the key features of preeclampsia

A

Maternal HTN, proteinuria, peripheral edema, coagulation abnormalities

108
Q

What is the HELLP syndrome associated with preeclampsia

A

Hemolysis, elevated liver enzymes, low platelets

109
Q

What is dysfunctioning with acute fatty liver of pregnancy

A

Mitochondria

110
Q

What can modular regenerative hyperplasia lead to the development of

A

Portal HTN

111
Q

What is the most common benign liver tumor

A

Cavernous hemangiomas

112
Q

Who are most likely to develop hepatocellular adenomas

A

Young women on oral contraceptives and those using anabolic steroids

113
Q

What is the most common liver tumor in early childhood

A

Hepatoblastoma

114
Q

What is frequently activated with hepatoblastoma

A

WNT signaling pathway

115
Q

What infection do most causes of HCC occur with

A

HBV infection

116
Q

What are the most common early mutational events with HCC

A

Activation of beta-catenin and inactivation of p53

117
Q

What is typically elevated in HCC

A

Alpha fetoprotein levels

118
Q

Describe large cell changes of HCC

A

Shows scattered hepatocytes, usually near portal tracts or septa

119
Q

Describe small cell changes in HCC

A

Hepatocytes have high nuclear cytoplasmic ratio and mild nuclear hyperchomasia and/or pleomorphism

120
Q

What is the most common hematogenous metastasis of HCC

A

Lung (late in disease)

121
Q

What is fibrolamellar carcinoma a distinctive variant of

A

HCC

122
Q

At what age do most fibrolamellar carcinomas occur

A

Under the age of 35

123
Q

How does fibrolamellar carcinoma present

A

Single large, hard scirrhous tumor with fibrous bands coursing through it

124
Q

What two exposures are most likely to lead to hepatic angiosarcoma

A

Vinyl chloride and arsenic

125
Q

What type of tumor should be considered if a liver fluke is involved

A

Cholangiocarcinoma

126
Q

What are the most common metastatic tumors of the liver

A

Colon, breast, lung, pancreas

127
Q

What are the key findings with biliary atresia

A

Jaundice, dark urine, pale stools

128
Q

What type of gallstones are radiolucent compared to radiopaque

A

Cholesterol stones are lucent; pigment stones are opaque

129
Q

What demographic are cholesterol stones more common in

A

Northern Europeans, North and South Americans, and native Americans

130
Q

What is the inflammation seen with acute calculus precipitate by usually

A

Obstruction of the neck or cystic duct

131
Q

What is the cause of acute acalculous

A

Ischemia and stasis

132
Q

What should you think of with porcelain gallbladder

A

Chronic cholecystitis

Lecom pathology year 2 (18 decks)

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