Liver Disease Flashcards
1
Q
Clinical indications of cytoplasmic accumulation of material
A
- accumulation ==> cell damage and death
- Fat – Steatosis
- Bile – Cholestasis
- Iron – Hemosiderosis
- Copper – Wilson’s Disease/cholestasis
- Viral particles – Viral hepatitis
2
Q
Pathologic findings in hepatocyte death
A
- balooning degeneration =
- hepatocyte swelling
- clumping of organelles and keratin filaments
- clearing of cytoplasm
- necrosis & apoptosis
- decreaseing cells size
- increased eosinophilia @ cytoplasm
- small dark nucleus
3
Q
Ballooning degeneration indicates…
A
steatohepatitis
4
Q
necrosis/apoptosis @ confluent zone 3 indicates…
A
- wide spread ischemia
5
Q
acidophils @ interface zone indicate…
A
- acidophils = single necrotic/apoptotic cell w/in liver parenchyma
- DDx:
- autoimmune hepatitis
- viral hepatitis
6
Q
Neutrophils indicate…
A
steatohepatitis
7
Q
Eosinophils indicate…
A
drug reaction
8
Q
Plasma cells indicate…
A
autoimmune hepatitis
9
Q
Portal based inflammation indicates…
A
biliary disease
10
Q
Interface inflammation indicates…
A
- autoimmune hepatitis
- viral hepatitis
11
Q
Zone 3 inflammation indicates…
A
- autoimmune hepatitis
- acute cellular rejection (transplant pts)
12
Q
Pathologic findings of cholestasis
A
- cholestasis = bile accumulation @ hepatic parenchyma
- obstructive vs. non-obstructive causes
- ==> ballooning degeneration
13
Q
Pathologic findings of bile ductular reaction
A
- obstructive outflow ==> bile build up @ canilliculi of zone 1 hepatocytes
- hepatocytes ==metaplasia==> ~bile duct cells
- ==> bile duct-like structures @ interface zone + PMNs + edema
14
Q
Progressive fibrosis ==>
A
cirrhosis
15
Q
Clinicopathologic patterns in Acute Hepatitis
A
- Clinical
- new onset sx lasting < 6 mo.
- labs = evelated AST & ALT
- Causes
- acute viral
- autoimmune
- adverse drug rxn
- indiopathic
- Pathology
- marked lobular disarray
- inflammation
- numerous single necrotic hepatocytes
- no significant fibrosis
16
Q
Clinicopathologic patterns in Chronic Hepatitis
A
- Clinical
- hepatic injury/inflammation > 6 mo.
- Causes
- viral, autoimmune, drug rxn, idiopathic
- Pathologic
- less lobular disarray and inflammation
- rare single necrotic hepatocytes
- slow progression of fibrosis
17
Q
Scales used to assess severity of chronic hepatitis
A
- GRADE = assessment of necroinflammatory activity
- = ~current liver damage
- STAGE = degree of fibrosis
- = ~cumulative injury over time
- both scales use 0-4 scale
18
Q
Cirrhosis characteristics
A
- end stage of chronic liver disease
- pathologic findings
- fibrous septa
- distortion of architecture
- regeneration nodules
- clinical/laboratory findings
- portal HTN
- poor synthetic fxn
- ==> increased risk for hepatocellular carcinoma
19
Q
Characteristics of cholestatic liver disease
A
- acute or chronic jaundice
- laboratory findings
- elevated alkaline phosphatase
- elevated GGT (gamma glutamyl transpeptidase)
- elevated bilirubin
- obstructive vs. nonobstructive causes
- pathologic
- interface ductular rxn + edema + PMNs
20
Q
Viral Hepatitis: types of virus
A
- Hep A = ssRNA
- Hep B = dsDNA
- Hep C = ssRNA
- Hep D = ssRNA
- Hep E = ssRNA
21
Q
Viral Hepatitis: Routes of transmission
A
- Hep A = fecal-oral
- Hep B
- parenteral
- sexual contact
- perinatal
- Hep C
- parenteral
- IV drugs, intranasal cocaine = risks
- parenteral
- Hep D = parenteral
- Hep E = fecal-oral
22
Q
Viral Hepatitis: risk for chronicity
A
- Hep A = never
- Hep B = 10%
- Hep C = 80%
- Hep D = rare
- Hep E = never
23
Q
Hep A: Serology/Dx
A
- detected by serum IgM (and sometimes IgG) specific antibodies
24
Q
Hep B: Serology/Dx
A
- HBsAg (antigen)
- antibody (IgM or IgG) HBcAg
- IgM = acute/initial infection
- IgG = ~chronic/indicates past infection
25
Hep C: Serology/Dx
* PCR for HCV RNA
* ELISA for antibody to HCV
26
HCV: presentation/histology
* rarely presents as acute hepatitis
* histo
* interface and lobular necroinflammatory activity
* progressive fibrosis
* nodular lymphocytic aggregates @ portal areas
27
HBV: presentation/histology
* histology
* ground glass hepatocytes = viral particles @ cytplasm
* sanded nuclei = viral particles @ nucleus
*
28
Non-hepatotropic viruses that infect the liver
* HSV
* CMV
* adenovirus
29
Presentation of autoimmune hepatitis
* lab tests
* high AST, ALT
* normal ALP
* positive autoantibody (ANA, ASMA)
* histology
* interface and centrolobular necrainflammation
* hepatocyte necrosis
* prominent plasma cells
30
Clinical Presentation of Primary biliary cirrhosis (PBC) vs. Primary Sclerosing Cholangitis (PSC)
* PBC = autoimmune destruction of intrahepatic bile ducts
* insidious
* pruritis
* jaundice (later)
* females
* liver fxn = high ALP, GGT, & bilirubin
* positive AMA; elevated IgM
* PSC = idiopathic ==\> inflammation and fibrosis of (mostly) extrahepatic bile ducts
* liver fxn = high ALP, GGT, bilirubin
* no other signs/symptoms
* progression ==\> fatigue, pruritis, jaundice
* males
* strong association w/ulcerative colitis
31
Pathologic Presentation of Primary biliary cirrhosis (PBC) vs. Primary Sclerosing Cholangitis (PSC)
* PBC
* plasma cell rich inflammation @ portal areas
* lymphocytic cholangitis
* bile duct destruction
* ==\> duct loss (ductopenia)
* PSC
* beading of extra- (and intra-) hepatic bile ducts
* lymphocytic periductular inflammation
* progressive fibrosis ==\> onion skin fibrosis
32
Characteristics of drug-induced liver injury
* varied presentations
* varied histology
* necrosis, cholestatis, acute hepatitis, etc.
* most common cause = acetominophen
33
Histologic findings of steatohepatitis
* non-alcoholic steatohepatitis (NASH) vs. alcoholic steatohepatitis
* triad =
* steatosis
* lobular inflammation
* ballooning degeneration
* alcoholic SH
* mallory hyaline
* prominent PMNs
* chronic changes
* chicken-wire fibrosis (=sinusoidal pattern)
* secondary micronodular fibrosis
34
Clinical presentation of alcoholic steatohepatitis
* Hx = alcohol
* Labs
* AST: ALT = 2(+) : 1
* normal ALP
* high GGT
35
Presentation of Hemochromatosis
* genetic disorder (Auto Rec.)
* males \> females
* pathophsyiology = abnormal regulation of iron absorption ==\> excess/deposition of iron
* clinical
* liver disease
* diabetes
* heart failure
* histology
* iron deposition @ hepatocytes
* initially @ periportal region
* ==\> hepatic injury & fibrosis
36
Presentation of Wilson's disease
* genetic (auto rec) dz of copper overload
* clinical
* neuro sx
* Kayser-Fleischer rings on opthalm exam
* histology
* copper accumulation @ hepatocytes
* steatosis or acute/chronic hepatits-like changes possible
37
Presentation of Alpha-1-Antitrypsin
* genetic (auto rec) of decreased production of protease inhibitor (that limits tissue damage)
* clinical
* mostly ==\> emphysema
* liver disease (10%)
* histology
* intracytoplasmic acculumulation of PAS positive hyaline globules
* progressive fibrosis
38
Presentation/characteristics of hepatocellular carcinoma
* most common primary malignant tumor of liver
* exclusively in pts w/ chronic liver disease and cirrhotic liver
* prognosis
* size
* macroscopic & microscopic vascular invasion
* focality
* invasion
39
Common benign liver tumors + characteristics
* hemangioma
* most common
* vascular spaces
* ==\> vague GI sx
* well-circumscribed
* focal nodular hyperplasia (FH)
* hyperplastic parenchyma due to vascular anomaly
* histo = central stellate scar, ductular rxn
* hepatocellular adenoma
* proliferation of benign hepatocytes
* assoc. w/OCPs
* risk of rupture
* well-circumscribed
40
Characteristics of hepatocellular carcinoma
* Hepatocellular carcinoma (HCC)
* patients have cirrhotic/chronic liver dz.
* Distinct mass in a cirrhotic liver
* May have green-yellow color (bile)
* Thickened hepatic plates
* Endothelialization of sinusoids
* No true portal areas
41
Characteristics of cholangiocarcinoma
* May be intra- or extrahepatic
* PSC is a major risk factor
* Usually presents at an advance stage
* Densely fibrotic mass in the hilar region with infiltrative edges
* Tan-white in color
* Invasive gland forming tumor with abundant desmoplastic response
