Liver and Gallbladder Pathology

Question 1

what are the characteristics for hepatic inflammation

Answer 1

inflammatory infiltration
kupffer cell hyperplasia
binucleate cells
deglycogenation

Question 2

classic acute hepatitis

Answer 2

lobular disarray and collapse

Question 3

chronic hepatitis

Answer 3

interface

Question 4

what is cirrhosis

Answer 4

a late stage of hepatic fibrosis

Question 5

What is cirrhosis characterized by ?

Answer 5

distortion of the hepatic architecture/bridging fibrosis, alteration of portal blood flow, formation of regenerative nodules

Question 6

micronodular cirrhosis is ususally caused by ______-

Answer 6

chemical agent (alcohol)

Question 7

What are the stages of cirrhosis

Answer 7

1) incomplete septal- no noduels, some incomplete briding
2) ealry-thin bridging fibrosis with dissecting nodules
3) moderately advanced–thick bridging fibrosis with dissecting nodules
4) advanced–wide septa with regenerative hyperplastic nodules

Question 8

inactive cirrhosis

Answer 8

no inflammation and intact limiting plates around septa which are fibrotic

Question 9

slight cirrhosis

Answer 9

mild inflammation, segmental erosion of limiting plates

Question 10

moderate cirrhosis

Answer 10

moderate inflammation and damage of limiting plates

Question 11

severe cirrhosis

Answer 11

marked inflammation, extensive damage of limiting plates, piecemeal necrosis and parenchymal damage

Question 12

HAV characteristics

Answer 12

single stranded RNA virus, with a protein capsin

Question 13

HBV characteristics

Answer 13

partially double stranded and single stranded DNA genome

Question 14

Dane particles

Answer 14

HBV infectious components

Question 15

core antigen of HBV

Answer 15

seen in the liver but NOT in the blood

Question 16

surface antigen of HBV

Answer 16

produced by the virus in large quantities and shed in the blood stream as spherules and rods

Question 17

acute cholecystitis

Answer 17

syndrome of right upper quadrant pain, fever, and leukocytosis with gallbladder inflammation, usually related to gallstone disease

Question 18

acute acalculous cholecystitis

Answer 18

identical to acute CCT but WITHOUT gallstones and usually occurs in critically ill pts

Question 19

chronic cholecystitis

Answer 19

used by the pathologist to describe chronic inflammatory cell infiltration of the gallbladder; the result of acue attaacks of CCT leading to fibrosis and thickening of the gallbladder

Question 20

acute cholecystitis is more common in

Answer 20

women

Question 21

risk factors for gallstones

Answer 21

pregnancy, obesity, hemolytic anemia, medications, native americans, chileans, pima indians, ileal resection, diabetes, TPN, vagotomy, spinal cord injury

Question 22

what is cholesterolosis

Answer 22

excess cholesterol in the bile; cholesterol deposits macrophages

Question 23

yellow speckled mucosa surface

Answer 23

cholesterolosis

Question 24

strawberry gallbladder

Answer 24

cholesterolosis

Question 25

primary adenocarcinoma of extrahepatic ducts

Answer 25

epithelial malignancies showing glandular or ductal differentiation of the extrahepatic ducts down to ampulla of vater

Question 26

Klatskin tumor

Answer 26

tumor arising from the common bile duct between right and left hepatic duct

Question 27

porclain gallbladder

Answer 27

gallbladder with dystrophic calcification from adenocarcinoma

Question 28

what is the characteristic feature of hepatocellular carcinoma

Answer 28

bile in neoplastic cells

Question 29

what is elevated in Hepatocellular carcinoma

Answer 29

alpha fetoprotein, increased ALP and GGT, production of ectopic hormones

Question 30

what should the workup be for HCC

Answer 30

alpha fetoprotein (AFP) and ultrasound, CT, and MRI

Question 31

gilberts syndrome

Answer 31

mild deficiency in glucuronyl transferase, more common in males

Question 32

crigler najjar syndrome type 1

Answer 32

severe deficiency of glucuronyl transferase, death in first year or two with kernicterus

Question 33

crigler najjar syndrome type II

Answer 33

moderate deficiency of glucuronyl transferase, responds to enzyme treatment, can sufer from billirubin encephalopathy

Question 34

physiologic jaundice of the newborn

Answer 34

transient insufficiency of glucuronly transferase first few days of life

Question 35

examples of things that cause reduced hepatic uptake (interference with bilirubin albumin bindiing sites)

Answer 35

sulphonamides, breast milk jaundice, salicylates and contrast media

Question 36

black liver

Answer 36

dubin johnson syndrome

Question 37

No pruritus or elevation of serum alkaline phosphatase or evidence of cholestasis

Answer 37

dubin johnson syndrome

Question 38

where does the pigment predominante in Dubin Johnson syndrome

Answer 38

centrolobular zone

Question 39

brownish coarse pigments stored in hepatocytes

Answer 39

dubin johnson syndrome

Question 40

rotor syndrome is similar except

Answer 40

no pigment in the liver itssue

Question 41

occurs in the third trimester of pregnancy when estrogen levels are the highest and disappears postpartum

Answer 41

familial recurrent intrahepatic cholestasis of pregnancy

Question 42

canicular cholestasis

Answer 42

most common, mostly pericentral without hepatocellular damage

Question 43

ductal cholestasis

Answer 43

big bile in bile ductules and canals of herng at the periphery of portal fields

Question 44

cysts of the gallbladder

Answer 44

cuboidal or columnar epithelium resembling bile duct epithelium

Question 45

bile ducts embedded in fibrous stroma

Answer 45

von meyenburg complex

Question 46

most common choledochal cyst

Answer 46

type 1--cystic dialtion of the common bile duct

Question 47

least common choledochal cyst

Answer 47

type 2--true diverticulum of the extrahepatic bile duct located proximal to the duodenum

Question 48

what is caroli's disease

Answer 48

congenital disorder characterized by multifocal, segmental dilatation of large intrahepatic bile ducts without aggressive fibrosis leading to biliary sludge and intraductal lithiasis

Question 49

beyler's syndrome

Answer 49

paucity of intrahepatic ducts since birth with progressive jaundice and death in 1-2 years

Question 50

aagenase syndrome

Answer 50

cholestatsis with lymphedema

Question 51

alagille syndrome

Answer 51

hepatic ductular hypoplasia, retarded physical, mental and sexual development

Question 52

what is the vulnerable area in autoimmune hepatitis

Answer 52

periportal region with marked chronic inflammation with lymphocyte and macrophages spilling through the limiting plates encricling the hepatocytes...rosetting ...piecemeal necrosis

Question 53

genes associated with hereditary hemochromatosis

Answer 53

HFE gene (C282Y, H63D)

Question 54

excessive iron deposition in the tissues

Answer 54

hereditary hemochromatosis

Question 55

what is AAT

Answer 55

inhibitor of proteolytic enzyme elastase

Question 56

liver manifestation of alpha 1 antitrypsin def.

Answer 56

caused by intrahepatocyte accumulation of AAT molecules rather than proteolytic mechanism

Question 57

inclusions within hepatocytes that stain positively with periodic acid-Schiff (PAS) reagent but resist digestion by diastase

Answer 57

alpha 1 antitrypsin deficiency

Question 58

treatment of wilson's disease

Answer 58

D penicilamine or trientine

Question 59

vascular amyloidosis

Answer 59

sulfated alcian blue stain- greenish material accumulated in the wall of portal arteriole

Question 60

nutmeg liver, centrolobular veins congestion

Answer 60

acute right heart failure

Question 61

Sinusoidal dilatations forming large blood cysts scattered throughout the liver, grossly visible, measuring up to more than 1 cm in diameter

Answer 61

peliosis hepatica

Question 62

what causes peliosis hepatica

Answer 62

Drugs, anabolic steroids contraceptives, antineoplastic, metals (copper, arsenic), debilitating infections (tuberculosis, endocarditis AIDS), solid tumors, myeloproliferative disorders (myelofibrosis, polycythemia vera), lymphomas, myeloma, renal transplantation

Question 63

occlusion of MAIN hepatic veins

Answer 63

budd chiari syndrome