Liver and Gallbladder II Flashcards
What are the key features of autoimmune hepatitis?
- young to middle aged white female
- negative viral serologic markers
- high sertum titers of autoantibodies
- treatment: immunosuppressive therapy
- with treatment, no significant fibrosis
- but w/o treatment, develop cirrhosis very quickly
- for in sample
- plasma cells
what are the 3 overlapping forms of alcoholic liver disease?
- leading cause of chronic liver disease in the western world
- 3 overlapping forms
- fatty liver disease
- alcoholic hepatitis
- cirrhosis
What form of alcohlic liver diesease is shown in the provided image?
major causes to develop fatty liver disease:
- obesity
- diabetes
- alcohol abuse
- more pale and lighter than normal liver parenchyma, yellowish tint
- mostly macrovesicular, but can have some microvesicular
What form of alcohlic liver diesease is shown in the provided image?
Alcohlic Statohepatitis
- significant injury/swelling to hepatocytes along with fat accumulation (ballooning)
- may see some necrosis – won’t see necrotic cells, but will see marks of inflammation
- mallory bodies (amorphous, dense, eosinophilic bodies)
What form of alcohlic liver diesease is shown in the provided image?
- Cirrhosis
- result of long term alcohol abuse & inflammation
- in most people with will be asymptomatic unti later stages
- if people have symptoms, they are pretty nonspecific
- fatigue
- weight loss
- loss of appetite
- sleep more
- later symptoms
- coaguopathy (lack of coagulation factors)
- encephalopathy (not taking toxins out of GI)
- jaundice (no able to get ride of bilirubin)
- if people have symptoms, they are pretty nonspecific
How would you diagnose a patient with the following liver sample if they drank less than 20g of alcohol a week
Non-alcoholic steatohepatitis
- not as much acute inflammation
- not as many mallory bodies
What is the inherited disorder that leads to abnormal absorption of iron?
Symptoms & causes?
hemochromatosis
- store fare more iron
- free iron is toxin, so you have iron deposition into diff organs (liver, pancreas, heart, etc), so can end up with cirrhosis, pancreattis, cardiac arrythmias
- hyper-pigmentation, form increased melanin production & increased iron deposition in the skin
- with calcium pyrophosphate crystals in their joints
- liver will be dark brown
Based on the stain information provided, what are the intracellular granule composed of?
What disease does this person likely have?
Iron – hemochromatosis
- golden brown cytoplasmic granules
- bile pigment has a slightly greener tint & you woudl expect to see bile plugs
- can do an iron stain– will stain blue
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The sign shown in the provided eye indicates what problem could be happening with the liver?
Wilson Disease: Kayser-Fleischer Rings
- increased copper in the eye, the brain, and the liver
- serum plasma levels will be low
- can present with acute liver failure or psychiatric manifestations
- likely will have cirrhotic liver
The red globules present in the stain on the right is indicative of what disease?
Alpha1-Antitrypsin deficiency
- typically affects lungs more than liver
- alpha1-antitrypsin will protect the body from the products released by neutrophils during acute inflammatory process
- can end up with emphyzema & cirrhosis very
- normal livers have lots and lost of glycogen
- PAS with diastase, digests the glycogen so you can see the PAS positive, diastase resistant cytoplasmic granules of alpha1 antitrypsin
- presenc of these globules in the heptocytes indicates they are not getting released into the serum, leading ot a deficiency
Wnat is cholestasis?
anything that causes impairment of the flow of the bile
- obstruction of the intra/extra hepatic ducts
- biliary stasis form sepsis
What are the most common causes of bile duct obstruction in adults and children respectively?
Potential sequelae?
- Adults
- gallstones
- Children
- biliary atresia
- CF
- choledochal cysts
- potential sequelae
- ascending cholangitis
- secondary bacterial infectino f biliary tree
- secondary biliary cholangitis/cirrhosis
- due to prolonged obstruction (fibrotic response)
- classic symptoms: pruitis, jaundice, malaise, hepatosplenomegaly
- ascending cholangitis
Characteristics of primary biliary cholangitis?
- inflammtory destruction of medium sized intrahepatic bile ducts (autoimmune disease)
- middle-agd women
- insidious onset
- later on have symptoms of cirrhosis
- 90% have circulating anti-mitochondrial antibodies
Characteristics of primary sclerosing cholangitis?
- immune-mediated damage to bile ducts
- young to middle-aged male predominance
- nonspecific antibody profile
- 70% associated with chronic inflammatory bowel disease
- concentric fibrosis
- ban see beaded appearance on ERCP b/c diffuse segmental stricture alternating w/ normal or dialated duct segments
- usually biopsy is not needed
What features do you see in nodular hyperplasia?
How can you differentiate it from cirrhosis?
- solitary or multiple hyperplastic nodules in non-cirrhotic liver due to focal alterations in hepatic blood flow
- don’t know what causes it, no malignant potential but can be mistaken for a neoplasm
- nodule is well circumscribed & will have a central stellate scar
- remember, cirrhosis is a diffuse process so you will see fibrous material throughout, whereas this fibrous material will only be seen affected areal
- vasculature in the rest of the liver will be normal
Characteristics of hepatocellular adenoma?
Description?
Risk Factors?
Which of the 4 subtypes of hepatocellular adenoma is most at risk for development into a carcinoma?
- benign neoplasm, usually solitary
- may be incidental finding or may cause pain
- can rupture, & lead to intraabdominal bleeding (can be life threatening)
- Well-circumscribed, typically nonincapsulated
- small arteries w/o portal tract
- varying degrees of inflammation, but no significant mitotic factors
- Risk factors
- women > men
- oral contraceptives
- obesity, metabolic syndrome, maturity-onset diabetes of the young
- alcohl & tobacco
- anabolic steroid
- no central scar, not associated with cirrhosis
- beta-catenin activated adnomas are most at risk for development into carcinoma
What are the malignat tumors of the liver?
Risk Factors?
- Tumors
- hepatocyte origin
- hepatocellular carcinoma
- classic
- fibrolamellar
- hepatocellular carcinoma
- of bile duct origin
- cholangiocarcinoma
- metastatic
- hepatocyte origin
- Risk factors
- cirrhosis
- hep B/C
- some hepatocellular adenomas
- aflatoxin exposure
- anabolic steroids
- inherited metabolic diseases
- hemochromatosis, alpha-AT deficiency, Wilson disease
- acquired metabolic syndrome
- diabetes mellitus, non-alcoholic fatty liver disease, obesity
What are the two types of hepatocelular carcinoma shown in the provided image?
- the uninodular one can look deceptively well circumscribed b/c it has a capsule
- Grade 1 is closer to normal apearance & grade 4 is much more anaplastic
How do we differentiate hepatocellular carcnoma from metastatic carcinoma?
- within hepatocarcinoma, there is not much desmoplasia & not much of a reaction from the surroundign liver to the tumor
- expect an elevated serum AFP
- in a metastatic tumor you will have a lot a desmoplasia & fibrotic reaction to the tumor
Characteristics of Fibrolamellar subtype of hepatocellular carcinoma (HCC)?
most affected demographic?
- yunger age (20-40)
- Features
- no cirrhosis
- normal serum AFP
- slow grwing
- well-defined, slitary
- lobular arrangement of interconnecting fibrous septae
- micro
- cells will be vey pink
- large cells with prominent nucleoli
- bants of fibrosis that are sort of parallel to each other
Features of cholangiocarcinoma?
most affected demographic?
risk factors?
- malignancy of the biel ducts
- middle aged to older individuals
- extrahepatic or intrahepatic
- features
- well-to-moderately tubular adenocarcinoma in abundant fibrous desmoplastic stroma
- may have areas of calcification
- no elevation AFP, but yes elevation of CEA
- risk factor
- chronic ibd
- liver flukes
What is the most common liver tumor?
Why do you not biopsy it?
hemangioma
- usually an invidental finding– benign
- risk of bleeding (why you don’t poke it with a needle)
- may undergo thrombosis and sclerosis
Where are the most common origin of metastases to the liver?
- colorectal (by far)
- breast
- lung
- gyndcologic
- genitourinary
- melanomas
What are the two types of gallstones shown in the provided imgage?
- cholesterol
- bright yellow
- pigmented
- from chornic hemolytic anemia
Symptoms of acute cholecystitis?
- bleeding
- mucosal erosions
- edema
Freatures of chronic cholecystitis
- +/- serosal fibrosis
- variably thickened wall
- stones usually present
- +/- mucosal erosion
- stones typiccaly present but not required
- tiny diverticular-like herniatiosn called “rokitansky-Aschoff Sinus”
What is porcelain gallbladder?
why is it a particular concern?
result of cholecystitis
dystrophic calcification of gallbladder
increased risk of adenocarcinoma
The follwing images are examples of what condition?
Cholesterolosis
