Liver & Gallbladder Flashcards
1
Q
components of porta hepatis (5)
A
portal vein
hepatic artery
common hepatic duct
nerves
lymphatics
2
Q
the portal vein supplies how much of the blood supply to the liver
A
60-70%
3
Q
the hepatic artery supplies how much of the blood supply to the liver
A
30-40%
4
Q
anatomic organization of the liver, these are organized around the the terminal hepatic vein tributaries (central vein)
A
lobules
5
Q
these surround the central vein and is the farthest from the blood supply
A
centrilobular hepatocytes
6
Q
these are at the periphery or near the portal tract and is the closest to the blood supply
A
periportal hepatocytes
7
Q
zone where there is the least oxygenation in the acini
A
zone 3
8
Q
zone where there is the most oxygenation
A
zone 1
9
Q
sinusoids epithelium
A
fenestrated epithelium
10
Q
3 components of sinusoids
A
space of Disse
Kupffer cells
canals of Herring
11
Q
portal triad
A
portal venule
hepatic arteriole
bile duct
12
Q
4 primary diseases of the liver
A
viral hepatitis
alcoholic liver disease
NAFLD
hepatocellular carcinoma
13
Q
3 secondary causes of liver damage
A
cardiac disease
metastatic cancer
extrahepatic infections
14
Q
three main mechanisms of liver injury
A
cholestasis
necrosis
apoptotic cell death
15
Q
most common site of metastasis of hepatocellular carcinoma
A
lungs
16
Q
hepatic blood flow (4)
A
-superior and inferior mesenteric veins drain into hepatic portal vein
-hepatic portal vein enters liver at porta hepatis with hepatic artery
-hepatic portal vein and artery branch into smaller branches until they become two parts of portal triad
-hepatic portal vein and artery drain into sinusoids and form central vein
17
Q
accumulation of fat and bilirubin
A
cholestasis
18
Q
apoptotic cell death in liver can produce these eosinophilic apoptotic bodies histologically
A
Councilman bodies
19
Q
rejection characterized by a mixed inflammatory infiltrate with lymphocytes, eosinophils, and sometimes neutrophils
A
Acute cell mediated/cellular rejection
20
Q
characterized by an inflammatory infiltrate and apoptotic hepatocytes.
A
chronic hepatitis
21
Q
hepatocytes are 3-4x the size of neighboring hepatocytes and have cleared out cytoplasm and is associated with oxidative stress (apoptosis)
A
ballooning/degeneration
22
Q
hepatocyte death following injury caused by hypoxia and ischemia
A
necrosis
23
Q
two characteristics of necrotic hepatocytes
A
lack nuclei and have clumps of eosinophilic cytoplasm
24
Q
continuous and widespread parenchymal injury
A
confluent necrosis
25
hepatic steatosis can be stained with what two stains
H&E, oil red O
26
thick ropy or dense eosinophilic clumps within ballooned hepatocytes
Mallory-Denk bodies
27
combination of steatosis, lobular inflammation, and ballooned hepatocytes
steatohepatitis
28
stain copper rich granules seen in Wilson disease
rhodanin
29
PAS positive cytoplasmic granules accumulate in this genetic disease
alpha 1-antitrypsin deficiency
30
pooling of blood in the central hepatic venules and sinusoids persists, causing hypoxia and compression atrophy of centrilobular hepatocytes
Nutmeg liver/ chronic passive congestion
31
fibrosis which is bridging from one structure to another (central vein or portal tract)
bridging fibrosis
32
fibrous strands surround nodules of hepatocytes
cirrhosis
33
portal tract is expanded by fibrous tissue that forms strands extending into the lobule
portal fibrosis
34
concentric fibrosis with primary sclerosing cholangitis (onion skinning)
periductal fibrosis
35
parenchymal nodules surrounded by dense bands of fibrosis, creating a bumpy surface with depressed areas of scarring and bulging of regenerative nodules
cirrhosis
36
form of cirrhosis commonly caused by a virus
macronodular
37
form of cirrhosis commonly caused by alcohol abuse
micronodular
38
clinically, you can determine hepatocyte integrity by looking at this value
liver enzymes
39
clinically, you can determine biliary excretory function by looking at this value
bilirubin
40
clinically, you can determine hepatocyte function by looking at this value
serum protein (albumin)
41
persistent or relapsing hepatic disease for a period of more than 6 months
chronic hepatitis
42
delta agent, unique RNA virus whose life cycle is dependent on HBV
HDV / hepatitis D
43
major cause of liver disease worldwide
HCV / hepatitis C
44
usually a benign self-limited infection that does not cause chronic hepatitis and rarely produces fulminant hepatitis
HAV / hepatitis A
45
this form of hepatitis does not cause chronic hepatitis
HEV / hepatitis E
46
enterically transmitted, waterborne infection that usually produces a self limiting disease
HEV / hepatitis E
47
increased risk for developing hepatocellular carcinoma (2)
HBV and HCV
48
perinatal transmission is high during childbirth for this form of hepatitis
HBV / hepatitis B
49
10% of HIV infected individuals are coinfected with
HBV
50
25% of HIV infected individuals are coinfected with
HCV
51
form of AI hepatitis that is more common in middle age and older individuals
type 1
52
form of AI hepatitis that has smooth muscle antibodies
type 1
53
form of AI hepatitis that is seen in children and teenager
type 2
54
form of AI hepatitis that has liver kidney antibodies
type 2
55
predominant cell in inflammatory infiltrates of AI hepatitis
plasma cell
56
these openings are in areas of marked activity in autoimmune hepatitis
rosettes
57
3 presentations of fatty liver disease
steatosis, steatohepatitis, cirrhosis
58
this presentation of fatty liver disease is more prominent in alcoholic disease
steatohepatitis
59
3 forms of alcohol-induced liver injury
-hepatic steatosis
-alcoholic hepatitis
-fibrosis and cirrhosis
60
90-100% of heavy drinkers develop this
fatty liver
61
10-35% of heavy drinkers develop this
alcoholic hepatitis
62
8-20% of heavy drinkers develop this
cirrhosis
63
30% of chronic alcoholics have this form of viral hepatitis
HCV
64
10-20% of pts with alcoholic cirrhosis develop this
hepatocelllular carcinoma
65
risk of cirrhosis increases proportionally with consumption of this amount of alcohol
more than 30g of alcohol per day
66
80g of ethanol per day that generally produces mild reversible hepatic changes in fatty liver disease
short term intake
67
40-80g of alcohol per day increases risk for severe injury in fatty liver disease
long term intake
68
4 pathologic effects of alcohol
-change in lipid metabolism
-decreased export of lipoproteins
-cell injury caused by reactive oxygen species
-damaging alcohol metabolites
69
most common cause of chronic liver disease
nonalcoholic fatty liver disease
70
5 conditions associated with NAFLD
-metabolic syndrome
-Type 2 diabetes
-Obesity
-Hypertension
-dyslipidemia
71
20% of people with NAFLD display this condition
nonalcoholic steatohepatitis
72
infection of the liver via the gut and biliary tract
ascending infection
73
infection of the liver through the portal system via GI tract
vascular seeding
74
infection of the liver from an adjacent source
direct invasion
75
4 ways infectious organisms can reach the liver
-ascending
-vascular seeding
-direct invasion
-penetrating injury
76
excessive absorption of iron commonly caused by a mutation in the HFE gene
hemochromatosis
77
fully developed hemochromatosis can develop into what
micronodular cirrhosis
78
80% of fully developed hemochromatosis can develop into what two conditions
DM, abnormal skin pigmentation
79
autosomal recessive disorder caused by a mutation of the ATP7B gene resulting in impaired copper excretion
Wilson disease
80
accumulation of toxic levels of copper in these three organs due to Wilson disease
liver, brain, eye
81
protects lung tissue against attack by the enzyme neutrophil elastase
alpha 1-antitrypsin
82
autosomal recessive disorder marked by very low levels of circulating protein that is caused by mutations leading to the misfolding of the protein
alpha 1-antitrypsin deficiency
83
liver disease that produces hepatic encephalopathy within 6 months of the initial diagnosis
acute liver failure
84
when the encephalopathy develops within 2 weeks of the onset of jaundice
fulminant liver failure
85
when the encephalopathy develops within 3 months
sub-fulminant liver failure
86
retention of bilirubin resulting in jaundice or icterus
cholestasis
87
elevated ammonia levels correlate with impaired neuronal function and cerebral edema
hepatic encephalopathy
88
hepatocytes responsible for clotting factors and activating coagulation factors
coagulopathy
89
obstruction at the prehepatic, intrahepatic or post hepatitis level can cause this in acute liver failure
portal hypertension
90
portal hypertension is commonly seen with this condition
chronic liver failure (as a cause of esophageal varices)
91
renal failure in association with liver failure with no intrinsic morphologic or functional causes for kidney dysfunction
hepatorenal syndrome
92
hepatorenal syndrome onset
decreased urine output, rising BUN and creatinine levels
93
clinical features of acute liver failure (2)
portal hypertension and hepatorenal syndrome
94
diffuse remodeling of liver into parenchymal nodules surrounded by fibrous bands and vascular shunting
chronic liver failure and cirrhosis
95
4 leading causes of cirrhosis worldwide
chronic HBV, chronic HCV, NAFLD, ALD
96
this stain demonstrates type III collagen in the space of Disse indicating hepatocyte loss in chronic liver failure
Retic/reticulin
97
this stain demonstrates advanced fibrosis in chronic liver failure
trichome
98
this stain demonstrates iron deposition in chronic liver failure as it causes a decrease in iron metabolism
iron
99
40% of patients with chronic liver failure or cirrhosis are asymptomatic until
the advanced stages
100
chronic severe jaundice can lead to this
pruritus
101
this is a clinical feature in chronic liver failure or cirrhosis due to impaired estrogen metabolism
hyperestrogenemia
102
resistance of portal flow at the level of sinusoids and increase in portal flow caused by hyperdynamic circulation in chronic liver failure
portal hypertension
103
can lead to portosystemic shunts, varices, ascites, splenomegaly, hemorrhoids, periumbilical caput medusae
portal hypertension
104
two functions of bile
-dietary fat emulsification
-eliminates bilirubin, excess cholesterol, and other waste products that cannot be excreted into urine (insufficiently water soluble)
105
jaundice may occur in these three settings of increased bilirubin production
-extravascular hemolysis
-hepatocyte dysfunction (hepatitis)
-obstruction of bile flow
106
heme is broken down by heme oxygenase into these two products
iron and biliverdin
107
biliverdin reductase converts biliverdin into this (unconjugated)
bilirubin
108
this protein transports bilirubin to the liver
albumin
109
bilirubin is converted to this in the liver (conjugated)
bilirubin glucuronide
110
bilirubin glucoronide is further broken down to urobilinogen and stercobilinogen in this organ
the colon
111
four major steps of bilirubin metabolism
-uptake from circulation
-intracellular storage
-conjugation with glucuronic acid
-biliary excretion
112
insoluble and tightly bound to albumin
unconjugated bilirubin
113
water soluble and nontoxic, loosely bound to albumin
conjugated bilirubin
114
physiologic jaundice of the newborn
neonatal jaundice
115
common inherited condition that manifests as fluctuating unconjugated hyperbilirubinemia of variable severity due to a mutation in encoding a gene (not associated with morbidity)
Gilbert syndrome
116
results from an autosomal recessive defect in the transport protein responsible for hepatocellular excretion of bilirubin glucuronides which results in conjugated hyperbilirubinemia
Dubin-Johnson syndrome
117
gross appearance of liver in Dubin-Johnson syndrome
darkly pigmented liver and hepatomegaly
118
demographics of Dubin-Johnson syndrome
Ashkenazi jewish and Japanese
119
does normal liver tissue contain visible bile
NO
120
foamy bile pigment in hepatocytes in cholestasis
feathery degeneration
121
5 possible presentations of cholestasis
-jaundice
-pruritus
-skin xanthomas
-intestinal malabsorption symptoms
-elevated serum alkaline phosphatase and GGT
122
cellular appearance of cholestasis (4)
-enlargement of hepatocytes
-dilated canaliculi
-apoptotic hepatocytes
-bile pigment in hepatocytes
123
feathery degeneration is present in
cholestasis
124
ballooning degeneration is present in
steatohepatitis
125
most common cause of bile duct obstruction in adults
extrahepatic cholelithiasis
126
second most common cause of bile duct obstructions in adults
malignant obstructions
127
third most common cause of bile duct obstruction in adults
post surgical strictures
128
prolonged bile duct obstruction can lead to
biliary cirrhosis
129
cystic anomaly of the extrahepatic biliary tree
choledochal cysts
130
causes of bile duct obstruction in children (4)
-biliary atresia
-cystic fibrosis
-choledochal cysts
-syndromes with insufficienty intrahepatic bile ducts
131
prolonged conjugated hyperbilirubinemia in neonates
neonatal cholestasis
132
major causes of neonatal cholestasis (2)
primary biliary atresia, neonatal hepatitis
133
disorders causing conjugated hyperbilirubinemia in neonates
neonatal hepatitis
134
4 symptoms of primary biliary atresia
-jaundice
-dark urine
-light or acholic stools
-hepatomegaly
135
complete or partial obstruction of the extrahepatic biliary tree that occurs within the first 3 months of life
biliary atresia
136
single most frequent cause of death from liver disease in early childhood
biliary atresia
137
secondary bacterial infection of the biliary tree that may complicate duct obstruction
ascending cholangitis
138
common enteric organisms that may cause ascending cholangitis
coliforms and enterococci
139
cholestasis due to diseases of the intrahepatic biliary tree or hepatocellular secretory failure
intrahepatic cholestasis
140
in severe cases of ascending cholangitis, this can occur
suppurative cholangitis
141
progressive, inflammatory, often granulomatous, destruction of small- and medium sized intrahepatic bile ducts which can cause fibrosis
primary biliary cholangitis
142
progressive, inflammation and obliterative fibrosis of intra- and extrahepatic bile ducts of all sizes, leading to dilation of preserved segments
primary sclerosing cholangitis
143
autoantibodies associated with primary biliary cholangitis
AMA (antimitochondrial antibodies)
144
granulomatous reaction to the bile duct undergoing destruction in primary biliary cholangitis
florid duct lesion
145
liver infarcts are
rare
146
most common cause of a small portal vein branch obstruction
schistosomiasis
147
sharply demarcated area of red-blue discoloration due to an acute thrombosis in the small portal vein branches
infarct of Zahn
148
is there necrosis in intrahepatic portal vein obstruction
no
149
mortality is high for this hepatic venous outflow obstruction
hepatic vein thrombosis
150
occlusion of the smallest intrahepatic branches
sinusoidal obstruction syndrome
151
obstruction of two or more major hepatic veins that produces liver enlargement, pain, and ascites
Budd-Chiari syndrome
152
nutmeg liver is caused by what sided heart failure
right
153
risk factors of hepatic venous outflow obstruction (2)
-pregnancy
-oral contraceptive use with underlying thrombotic disorders
154
solitary or multiple hyperplastic hepatocellular nodules that may develop in the noncirrhotic liver due to lesions arising from local alterations in hepatic parenchymal blood supply
focal nodular hyperplasia of hepatocytes
155
these have a central stellate scar and appear well demarcated with poorly encapsulated nodules
focal nodular hyperplasia
156
most common benign liver tumors made of blood vessels
cavernous hemangiomas
157
malignant transformation of HC adenomas are strongly associated with what (2)
-oral contraceptives
-anabolic steroids
158
benign hepatocyte neoplasm that tends to be very large
hepatocellular adenoma
159
benign lesions composed of aggregates of bile ducts with irregularly shaped open lumens, often with intraluminal bile plugs and embedded in fibrosis
bile duct hamartoma
160
another term for bile duct hamartomas
von Meyenburg complexes
161
most common liver malignancy
metastasis
162
most common primary liver tumor
hepatocellular carcinoma
163
second most common primary liver tumor that arises from bile ducts
cholangiocarcinomas
164
tumor composed of tissue resembling fetal liver cells, mature liver cells, or bile duct cells, usually in infants and children
hepatoblastoma
165
rare hepatic tumor that originated from endothelial and fibroblastic tissue with abundant vasculature
angiosarcoma
166
the most common cause of hepatocellular carcinoma
chronic liver disease
167
HBV infection and exposure to aflatoxin increases the risk for this cancer
HCC
168
common place of metastasis of HCC
lungs
169
occur in noncirrhotic livers and may track along the intrahepatic portal tract system or produce a single massive tumor
intrahepatic cholangiocarcinoma
170
generally small lesions at the time of diagnosis, causing obstruction of the biliary tract
extrahepatic cholangiocarcinoma
171
two syndromes associated with hepatoblastoma
Familial adenomatous polyposis and Beckwith-Wiedemann syndrome
172
pathologic hallmarks of acute cellular rejection / t cell mediated rejection of a liver transplant (3)
-portal inflammation
-bile duct inflammation/damage
-venous endothelitis
173
does a gallbladder have a submucosa
no
174
most common congenital anomaly of the gallbladder with a folded fundus
Phyrgian cap
175
95% of biliary tract disease is attributable to
gallstones
176
stones that contain crystalline cholesterol monohydrate
cholesterol stones
177
stones made of bilirubin calcium salts
pigment stones
178
gallstones/choleliths are most common in this demographic
females over 40
179
gallstone risk factors (4)
fat, forty, female, fertile
180
a large stone erodes directly into an adjacent loop of small bowel causing intestinal obstruction
gallstone ileus
181
this always occurs with gallstones
cholecystitis (inflammation of the gallbladder)
182
4 complications of cholecystitis
sepsis, abscess, fistula, ileus
183
adenomyomatosis causes hyperplastic changes causing a reactive proliferation of mucosa filled with bile, forming these
Rokitansky-Aschoff sinuses
184
strawberry gallbladder
cholesterolosis
185
deposition of foamy, cholesterol-laden histiocytes in the subepithelium of the gallbladder
cholesterolosis
186
dense, hyaline fibrosis transforming the gallbladder wall often with calcification
porcelain gallbladder
187
20% of porcelain gallbladder is associated with
gallbladder carcinoma
188
most common malignancy of the extrahepatic biliary tract
gallbladder carcinoma
189
most important risk factor associated with gallbladder carcinoma
cholelithiasis
190
this form of cholangitis is also a risk factor for gallbladder carcinoma
primary sclerosing cholangitis
191
only ____ of people with gallbladder carcinoma are diagnosed at a stage that is early enough for curative surgery
10%
192
most gallbladder carcinomas are not diagnosed __________
preoperatively
