liver/GB/pancreas pathology Flashcards
among top 10 most common causes of death in the US and the primary route for liver-related deaths
cirrhosis
etiologies of cirrhosis
alcohol abuse, viral hepatitis, non-alcohol steatohepatitis, biliary disease, iron overload
iron overload can lead to _____ and _____; complications include:
hepatocyte death and inflammation
reduced liver function, portal hypertension, and increased risk for hepatocellular cancer
morphologic changes in cirrhosis include:
- bridging fibrous septae
- parenchymal nodules
- changes in architecture that lead to parenchymal injury and scarring
a fibrotic liver has markedly compromised ____ and decreased ___
blood supply; function
portal hypertension leads to:
- ascites
- esophageal varices
- splenomegaly
- hepatic encephalopathy
- hypogonadism
portal hypertension can occur ____, ____, and _____
prehepatic (obstructive thrombi), intrahepatic (cirrhosis), and post hepatic (right sided heart failure)
causes of jaundice
hemolytic anemias (#1 cause), bilirubin overproduction, hepatitis, reduced hepatocyte uptake, obstruction of bile flow
hepatocyte injury that is associated with inflammation
hepatitis
benign, self-limiting disease; viremia is transient- rarely screen donor blood for this
hepatitis A virus (HAV
route of transmission for HAV
fecal-oral route of transmission- seen with overcrowded/unsanitary condition; ingestion of contaminated food and water
hepatitis B induced liver disease is an important precursor for _____
hepatocellular carcinoma
hepatitis B is a ___ virus spread by _____; incubation period: _____
DNA; parenteral contact/sexual spread; 4-26 weeks
_____ determines the ultimate outcome of Hep B
host immune response
hallmark features of hepatitis C (85%)
persistent infection + chronic hepatitis
hepatitis C is the most frequent viral infection associated with the need for _____
liver transplantation
hep C previously treated with ____; now, treatment with _____ considered curative
interferon and ribavirin; protease and nucleoside inhibitors
hep D requires presence of _____ for infection (co-infection usually presents as ____ and _____
Hep B; transient; self-limited
Hep E (which is similar to _____) is an enterically transmitted, water-borne infection with high mortality rate in _____; not associated with chronic liver disease
similar to hep A; pregnant women
hep G has some similarity to ____ but is not hepatotropic; does not increase ____ such as _____
hep C; liver enzymes; serum aminotransferases
Hep G replicates in ____ and ____
bone marrow; spleen
a chronic, progressive hepatitis variant with an unknown etiology; pathology is associated with T-cell mediated autoimmunity
autoimmune hepatitis
3 overlapping forms of alcoholic liver disease
- hepatic steatosis (fatty liver)
- alcoholic hepatitis
- cirrhosis (only develops in a minority of patients
____ of chronic liver disease is associated with overuse of alcohol
60%
____ of deaths in alcoholic liver disease due to cirrhosis
40-50%
clumps of cytokeratins, eosinophilic cytoplasmic inclusions in fatty liver from alcohol
mallory or mallory-denk bodies
most common metabolic liver disease
non-alcoholic fatty liver disease
primary cause of liver disease in the US; can arise with or without nonspecific inflammation
non-alcoholic fatty liver disease
patients develop hepatocyte injury and 10-20% progress to cirrhosis (seen primarily in obese patients)
nonalcoholic steatohepatitis (NASH)
approx ____ of obese persons have some form of fatty liver disease
70%
excessive accumulation of body iron; most is deposited in the liver, pancreas, and heart
hemochromatosis
classic triad associated with hemochromatosis
cirrhosis with hepatomegaly, diabetes mellitus, and skin pigmentation
results from a failure to incorporate copper (Cu) into ceruloplasmin; consequently get accumulation of toxic Cu levels in the liver, brain, and eye
wilson’s disease
liver features of hemochromatosis include ____ cirrhosis with ____
micronodular cirrhosis; hemosiderin
develop pulmonary emphysema from protein degrading enzymes; also develop liver disease, formation of mallory bodies, and PAS positive granules within hepatocytes
alpha1-antitrypsin deficiency
results from obstruction of extrahepatic duct
secondary biliary cirrhosis
primary cause is cholelithiasis (gall stones), then malignancies of biliary tree or head of pancreas
biliary tree obstruction
inflammatory autoimmune disease; affects intrahepatic bile ducts
primary biliary cirrhosis (PBS)
fibrosing cholangitis of bile ducts- develop luminal obliteration; liver eventually develops biliary cirrhosis
primary sclerosing cholangitis (PSC)
there is an increase in ____ and _____ in PSC patients
chronic pancreatitis; hepatocellular carcinoma (HCC)
nodular hyperplasia can lead to focal or diffuse alteration in _____, resulting in _____ and a _____
hepatic blood supply; obliteration of the portal veins; compensatory increase in arterial supply
cancer of biliary tree; most are adenocarcinomas; very desmoplastic tumor- tumors firm and gritty; generally fatal within 6 months
cholangiocarcinoma (CCA)- bile duct carcinoma
most common liver tumor in young pediatric patients; epithelioid type; rapidly fatal (within months) if not treated
hepatoblastoma
benign; associated with oral contraceptives (if discontinued, may regress); histology: bland hepatocytes and no bile ducts
hepatocellular adenoma
worldwide the 3rd leading cause of cancer deaths in western countries (5th in the US); male predominance 3:1
hepatocellular carcinoma
etiologic factors for HCC
cirrhosis (90%), due to chronic viral infection (HBV, HCV) or chronic alcoholism, NASH (nonalcoholic steatohepatitis), food contaminants (primarily aflatoxins)
all HCC variants have strong propensity for _____
vascular invasion
found in young males and females (20s-40s), distinct from HCC, no known risk factors, “scirrhous tumor,” better prognosis
fibrolamellar variant of HCC
primary soft tissue sites for metastasis to occur (metastatic tumors more common than primary tumors); most common primary cancers are:
liver and lungs
colon, breast, lung, and pancreas
often the only sign of metastatic spread to liver is _____ bc liver has tremendous functional reserve
hepatomegaly
pathogenesis of gall stone formation (cholelithiasis)
supersaturation, initiation, growth
two types of stones
cholesterol cholelithiasis (mostly radiolucent) and bilirubin cholelithiasis (mostly radiopaque)
risk factors for pigment stones
hemolysis, GI disorders, biliary infections
risk factors for cholesterol stones
increased in caucasians, increasing age and obesity; more women than men (2:1), estrogens (pregnancy and oral contraceptives), gall bladder stasis, hereditary contribution
increased frequency in women in their 7th decade of life; associated with gallstones (95%) or infectious agents within the gallbladder (chronic inflammatory states)
adenocarcinoma of the gallbladder (malignant cancer)
reversible parenchymal injury of the pancreas associated with inflammation
acute pancreatitis
80% of cases of acute pancreatitis related to ____ or ____
biliary tract disease; alcoholism
symptoms of acute pancreatitis are _____ (cardinal manifestation)
abdominal pain ; “acute abdomen” ; “upper back intense pain”
develop irreversible destruction of the exocrine pancreas, with ensuing fibrosis and eventual destruction of the endocrine parenchyma
chronic pancreatitis
pancreatic cancers (mostly adenocarcinomas) are the ____ leading cause of cancer deaths in the US
4th
increased risk for pancreatic cancers with ____, ____, and ____
smoking; diabetes mellitus; chronic pancreatitis
___ is usually the first sign of pancreatic cancers, but typically too late; _____ is associated with tumors at the pancreatic head
pain; obstructive jaundice
migratory thrombophlebitis formation of platelet aggregation factors and procoagulents from pancreatic tumor or its necrotic products
Trousseau sign
