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liver/GB/pancreas pathology Flashcards

1
Q

among top 10 most common causes of death in the US and the primary route for liver-related deaths

A

cirrhosis

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2
Q

etiologies of cirrhosis

A

alcohol abuse, viral hepatitis, non-alcohol steatohepatitis, biliary disease, iron overload

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3
Q

iron overload can lead to _____ and _____; complications include:

A

hepatocyte death and inflammation

reduced liver function, portal hypertension, and increased risk for hepatocellular cancer

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4
Q

morphologic changes in cirrhosis include:

A
  1. bridging fibrous septae
  2. parenchymal nodules
  3. changes in architecture that lead to parenchymal injury and scarring
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5
Q

a fibrotic liver has markedly compromised ____ and decreased ___

A

blood supply; function

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6
Q

portal hypertension leads to:

A
  1. ascites
  2. esophageal varices
  3. splenomegaly
  4. hepatic encephalopathy
  5. hypogonadism
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7
Q

portal hypertension can occur ____, ____, and _____

A

prehepatic (obstructive thrombi), intrahepatic (cirrhosis), and post hepatic (right sided heart failure)

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8
Q

causes of jaundice

A

hemolytic anemias (#1 cause), bilirubin overproduction, hepatitis, reduced hepatocyte uptake, obstruction of bile flow

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9
Q

hepatocyte injury that is associated with inflammation

A

hepatitis

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10
Q

benign, self-limiting disease; viremia is transient- rarely screen donor blood for this

A

hepatitis A virus (HAV

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11
Q

route of transmission for HAV

A

fecal-oral route of transmission- seen with overcrowded/unsanitary condition; ingestion of contaminated food and water

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12
Q

hepatitis B induced liver disease is an important precursor for _____

A

hepatocellular carcinoma

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13
Q

hepatitis B is a ___ virus spread by _____; incubation period: _____

A

DNA; parenteral contact/sexual spread; 4-26 weeks

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14
Q

_____ determines the ultimate outcome of Hep B

A

host immune response

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15
Q

hallmark features of hepatitis C (85%)

A

persistent infection + chronic hepatitis

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16
Q

hepatitis C is the most frequent viral infection associated with the need for _____

A

liver transplantation

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17
Q

hep C previously treated with ____; now, treatment with _____ considered curative

A

interferon and ribavirin; protease and nucleoside inhibitors

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18
Q

hep D requires presence of _____ for infection (co-infection usually presents as ____ and _____

A

Hep B; transient; self-limited

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19
Q

Hep E (which is similar to _____) is an enterically transmitted, water-borne infection with high mortality rate in _____; not associated with chronic liver disease

A

similar to hep A; pregnant women

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20
Q

hep G has some similarity to ____ but is not hepatotropic; does not increase ____ such as _____

A

hep C; liver enzymes; serum aminotransferases

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21
Q

Hep G replicates in ____ and ____

A

bone marrow; spleen

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22
Q

a chronic, progressive hepatitis variant with an unknown etiology; pathology is associated with T-cell mediated autoimmunity

A

autoimmune hepatitis

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23
Q

3 overlapping forms of alcoholic liver disease

A
  1. hepatic steatosis (fatty liver)
  2. alcoholic hepatitis
  3. cirrhosis (only develops in a minority of patients
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24
Q

____ of chronic liver disease is associated with overuse of alcohol

A

60%

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25
Q

____ of deaths in alcoholic liver disease due to cirrhosis

A

40-50%

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26
Q

clumps of cytokeratins, eosinophilic cytoplasmic inclusions in fatty liver from alcohol

A

mallory or mallory-denk bodies

27
Q

most common metabolic liver disease

A

non-alcoholic fatty liver disease

28
Q

primary cause of liver disease in the US; can arise with or without nonspecific inflammation

A

non-alcoholic fatty liver disease

29
Q

patients develop hepatocyte injury and 10-20% progress to cirrhosis (seen primarily in obese patients)

A

nonalcoholic steatohepatitis (NASH)

30
Q

approx ____ of obese persons have some form of fatty liver disease

A

70%

31
Q

excessive accumulation of body iron; most is deposited in the liver, pancreas, and heart

A

hemochromatosis

32
Q

classic triad associated with hemochromatosis

A

cirrhosis with hepatomegaly, diabetes mellitus, and skin pigmentation

33
Q

results from a failure to incorporate copper (Cu) into ceruloplasmin; consequently get accumulation of toxic Cu levels in the liver, brain, and eye

A

wilson’s disease

34
Q

liver features of hemochromatosis include ____ cirrhosis with ____

A

micronodular cirrhosis; hemosiderin

35
Q

develop pulmonary emphysema from protein degrading enzymes; also develop liver disease, formation of mallory bodies, and PAS positive granules within hepatocytes

A

alpha1-antitrypsin deficiency

36
Q

results from obstruction of extrahepatic duct

A

secondary biliary cirrhosis

37
Q

primary cause is cholelithiasis (gall stones), then malignancies of biliary tree or head of pancreas

A

biliary tree obstruction

38
Q

inflammatory autoimmune disease; affects intrahepatic bile ducts

A

primary biliary cirrhosis (PBS)

39
Q

fibrosing cholangitis of bile ducts- develop luminal obliteration; liver eventually develops biliary cirrhosis

A

primary sclerosing cholangitis (PSC)

40
Q

there is an increase in ____ and _____ in PSC patients

A

chronic pancreatitis; hepatocellular carcinoma (HCC)

41
Q

nodular hyperplasia can lead to focal or diffuse alteration in _____, resulting in _____ and a _____

A

hepatic blood supply; obliteration of the portal veins; compensatory increase in arterial supply

42
Q

cancer of biliary tree; most are adenocarcinomas; very desmoplastic tumor- tumors firm and gritty; generally fatal within 6 months

A

cholangiocarcinoma (CCA)- bile duct carcinoma

43
Q

most common liver tumor in young pediatric patients; epithelioid type; rapidly fatal (within months) if not treated

A

hepatoblastoma

44
Q

benign; associated with oral contraceptives (if discontinued, may regress); histology: bland hepatocytes and no bile ducts

A

hepatocellular adenoma

45
Q

worldwide the 3rd leading cause of cancer deaths in western countries (5th in the US); male predominance 3:1

A

hepatocellular carcinoma

46
Q

etiologic factors for HCC

A

cirrhosis (90%), due to chronic viral infection (HBV, HCV) or chronic alcoholism, NASH (nonalcoholic steatohepatitis), food contaminants (primarily aflatoxins)

47
Q

all HCC variants have strong propensity for _____

A

vascular invasion

48
Q

found in young males and females (20s-40s), distinct from HCC, no known risk factors, “scirrhous tumor,” better prognosis

A

fibrolamellar variant of HCC

49
Q

primary soft tissue sites for metastasis to occur (metastatic tumors more common than primary tumors); most common primary cancers are:

A

liver and lungs

colon, breast, lung, and pancreas

50
Q

often the only sign of metastatic spread to liver is _____ bc liver has tremendous functional reserve

A

hepatomegaly

51
Q

pathogenesis of gall stone formation (cholelithiasis)

A

supersaturation, initiation, growth

52
Q

two types of stones

A

cholesterol cholelithiasis (mostly radiolucent) and bilirubin cholelithiasis (mostly radiopaque)

53
Q

risk factors for pigment stones

A

hemolysis, GI disorders, biliary infections

54
Q

risk factors for cholesterol stones

A

increased in caucasians, increasing age and obesity; more women than men (2:1), estrogens (pregnancy and oral contraceptives), gall bladder stasis, hereditary contribution

55
Q

increased frequency in women in their 7th decade of life; associated with gallstones (95%) or infectious agents within the gallbladder (chronic inflammatory states)

A

adenocarcinoma of the gallbladder (malignant cancer)

56
Q

reversible parenchymal injury of the pancreas associated with inflammation

A

acute pancreatitis

57
Q

80% of cases of acute pancreatitis related to ____ or ____

A

biliary tract disease; alcoholism

58
Q

symptoms of acute pancreatitis are _____ (cardinal manifestation)

A

abdominal pain ; “acute abdomen” ; “upper back intense pain”

59
Q

develop irreversible destruction of the exocrine pancreas, with ensuing fibrosis and eventual destruction of the endocrine parenchyma

A

chronic pancreatitis

60
Q

pancreatic cancers (mostly adenocarcinomas) are the ____ leading cause of cancer deaths in the US

A

4th

61
Q

increased risk for pancreatic cancers with ____, ____, and ____

A

smoking; diabetes mellitus; chronic pancreatitis

62
Q

___ is usually the first sign of pancreatic cancers, but typically too late; _____ is associated with tumors at the pancreatic head

A

pain; obstructive jaundice

63
Q

migratory thrombophlebitis formation of platelet aggregation factors and procoagulents from pancreatic tumor or its necrotic products

A

Trousseau sign

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