Liver and Gallbladder Pathology Flashcards
what are the characteristics for hepatic inflammation
inflammatory infiltration
kupffer cell hyperplasia
binucleate cells
deglycogenation
classic acute hepatitis
lobular disarray and collapse
chronic hepatitis
interface
what is cirrhosis
a late stage of hepatic fibrosis
What is cirrhosis characterized by ?
distortion of the hepatic architecture/bridging fibrosis, alteration of portal blood flow, formation of regenerative nodules
micronodular cirrhosis is ususally caused by ______-
chemical agent (alcohol)
What are the stages of cirrhosis
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
inactive cirrhosis
no inflammation and intact limiting plates around septa which are fibrotic
slight cirrhosis
mild inflammation, segmental erosion of limiting plates
moderate cirrhosis
moderate inflammation and damage of limiting plates
severe cirrhosis
marked inflammation, extensive damage of limiting plates, piecemeal necrosis and parenchymal damage
HAV characteristics
single stranded RNA virus, with a protein capsin
HBV characteristics
partially double stranded and single stranded DNA genome
Dane particles
HBV infectious components
core antigen of HBV
seen in the liver but NOT in the blood
surface antigen of HBV
produced by the virus in large quantities and shed in the blood stream as spherules and rods
acute cholecystitis
syndrome of right upper quadrant pain, fever, and leukocytosis with gallbladder inflammation, usually related to gallstone disease
acute acalculous cholecystitis
identical to acute CCT but WITHOUT gallstones and usually occurs in critically ill pts
chronic cholecystitis
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
acute cholecystitis is more common in
women
risk factors for gallstones
pregnancy, obesity, hemolytic anemia, medications, native americans, chileans, pima indians, ileal resection, diabetes, TPN, vagotomy, spinal cord injury
what is cholesterolosis
excess cholesterol in the bile; cholesterol deposits macrophages
yellow speckled mucosa surface
cholesterolosis
strawberry gallbladder
cholesterolosis
primary adenocarcinoma of extrahepatic ducts
epithelial malignancies showing glandular or ductal differentiation of the extrahepatic ducts down to ampulla of vater
Klatskin tumor
tumor arising from the common bile duct between right and left hepatic duct
porclain gallbladder
gallbladder with dystrophic calcification from adenocarcinoma
what is the characteristic feature of hepatocellular carcinoma
bile in neoplastic cells
what is elevated in Hepatocellular carcinoma
alpha fetoprotein, increased ALP and GGT, production of ectopic hormones
what should the workup be for HCC
alpha fetoprotein (AFP) and ultrasound, CT, and MRI
gilberts syndrome
mild deficiency in glucuronyl transferase, more common in males
crigler najjar syndrome type 1
severe deficiency of glucuronyl transferase, death in first year or two with kernicterus
crigler najjar syndrome type II
moderate deficiency of glucuronyl transferase, responds to enzyme treatment, can sufer from billirubin encephalopathy
physiologic jaundice of the newborn
transient insufficiency of glucuronly transferase first few days of life
examples of things that cause reduced hepatic uptake (interference with bilirubin albumin bindiing sites)
sulphonamides, breast milk jaundice, salicylates and contrast media
black liver
dubin johnson syndrome
No pruritus or elevation of serum alkaline phosphatase or evidence of cholestasis
dubin johnson syndrome
where does the pigment predominante in Dubin Johnson syndrome
centrolobular zone
brownish coarse pigments stored in hepatocytes
dubin johnson syndrome
rotor syndrome is similar except
no pigment in the liver itssue
occurs in the third trimester of pregnancy when estrogen levels are the highest and disappears postpartum
familial recurrent intrahepatic cholestasis of pregnancy
canicular cholestasis
most common, mostly pericentral without hepatocellular damage
ductal cholestasis
big bile in bile ductules and canals of herng at the periphery of portal fields
cysts of the gallbladder
cuboidal or columnar epithelium resembling bile duct epithelium
bile ducts embedded in fibrous stroma
von meyenburg complex
most common choledochal cyst
type 1–cystic dialtion of the common bile duct
least common choledochal cyst
type 2–true diverticulum of the extrahepatic bile duct located proximal to the duodenum
what is caroli’s disease
congenital disorder characterized by multifocal, segmental dilatation of large intrahepatic bile ducts without aggressive fibrosis leading to biliary sludge and intraductal lithiasis
beyler’s syndrome
paucity of intrahepatic ducts since birth with progressive jaundice and death in 1-2 years
aagenase syndrome
cholestatsis with lymphedema
alagille syndrome
hepatic ductular hypoplasia, retarded physical, mental and sexual development
what is the vulnerable area in autoimmune hepatitis
periportal region with marked chronic inflammation with lymphocyte and macrophages spilling through the limiting plates encricling the hepatocytes…rosetting …piecemeal necrosis
genes associated with hereditary hemochromatosis
HFE gene (C282Y, H63D)
excessive iron deposition in the tissues
hereditary hemochromatosis
what is AAT
inhibitor of proteolytic enzyme elastase
liver manifestation of alpha 1 antitrypsin def.
caused by intrahepatocyte accumulation of AAT molecules rather than proteolytic mechanism
inclusions within hepatocytes that stain positively with periodic acid-Schiff (PAS) reagent but resist digestion by diastase
alpha 1 antitrypsin deficiency
treatment of wilson’s disease
D penicilamine or trientine
vascular amyloidosis
sulfated alcian blue stain- greenish material accumulated in the wall of portal arteriole
nutmeg liver, centrolobular veins congestion
acute right heart failure
Sinusoidal dilatations forming large blood cysts scattered throughout the liver, grossly visible, measuring up to more than 1 cm in diameter
peliosis hepatica
what causes peliosis hepatica
Drugs, anabolic steroids contraceptives, antineoplastic, metals (copper, arsenic), debilitating infections (tuberculosis, endocarditis AIDS), solid tumors, myeloproliferative disorders (myelofibrosis, polycythemia vera), lymphomas, myeloma, renal transplantation
occlusion of MAIN hepatic veins
budd chiari syndrome
