Liver Lecture 3 Flashcards
budd chiari syndrome
hepatic vein obstruction/ thrombosis
- hepatic ascites, abdominal pain and hepatic dysfunction
- centrilobular congestion
sinusoidal obstructive syndrome or veno-occlusive disease
- **`1.bone marrow transplants
- first 3 weeks
- 25% of recipients of allogeneic BMT
2. chemotherapy patients
3. drugs-azathioprine - toxic injury to the sinusoidal endothelium with resulting fibrotic occlusion of small hepatic veins
- Classic triad: Acute RUQ tenderness, hepatomegaly, ascites, weight gain, and jaundice
Histology:
fibrous obliteration of central vein
Acute fatty liver of pregnancy
sudden catastrophic illness occurring exclusively in the 3rd trimester
Microvesicular fatty infiltration
- acute liver failure and encephalopathy
- significant perinatal and maternal mortality
Focal Nodular hyperplasia
- solitary
- central stellate scar
- 20-40
- no malignant potential
- doesnt need to be removed?
Nodular regenerative hyperplasia
widespread transformation of the hepatic parenchyma into small regenerative nodule in the ABSENCE OF FIBROSIS
- partial or diffuse
- non cirrhotic portal hypertension
- associated with solid organ transplant, bone marrow transplant, vasculitis, and HIV
Hepatic adenoma
- young women
- associated with hormones and oral contraceptives
- usually solitary lesion
- cord of normal hepatocytes with absent portal tracts
- prominent solitary arterial vessels
-risk of:
rupture, transform to hepatocellular carcinoma,
-resection indicated if >5cm as risk of malignant
transformation increases
associated with rare metabolic disorder and glycogen diseases
Hemangioma
- most common benign tumor
- discrete red-blue nodules
- microscopically: benign vascular changes and fibrotic tissue
Angiosarcoma
most common primary sarcoma of liver
- malignant vascular tumor
- associated with exposure to vinyl chloride, arsenic
lots of nuclei and deformed vessels
HEpatoblastoma
-most common malignant liver tumor of CHILDHOOD
-male>female
-RUQ mass found on physical exam
-elevated alpha fetoprotein (AFP)
-primary hepatocellular malignancy
epithelial type: fetal and embryonal hepatocytes
mixed epithelial and mesenchymal: fetal and embryonal hepatocytes with foci of mesenchymal differentiation
Hepatocellular carcinoma
third most common cancer death
- incidence rising due to HCV endemic
- vague symptoms
- 95% occur in patients with cirrhosis
- HCC can occur independent of cirrhosis in hepB
- 50% elevated AFP
Treatment: surgery radiofrequency ablation transarterial chemoembolization (TACE) radioembolization liver transplant
What can cause hepatocellular carcinoma?
1.Cirhosis:
NASH
Alcohol
Hep C-repeated cycles on cell death and regeneration
Hemochromatosis
2. chronic hep b-integration of viral dna
3. aflatoxin
4. hereditary tyrosinemia (highest risk-40%)
How does hepatocellular carcinoma look grossly and microscopically?
gross
- single lesion
- multifocal
- diffusely infiltrative
microscopically
- trabecular, acinar/pseudoglandular and undifferentiated
- bile production
- well different (resembling hepatocytes) to poorly differentiated forms
Fibrolamellar variant of HCC
younger person
- not associated with cirrhosis or HBV
- characterized by areas of dense collagenous fibrosis and large polygonal tumor cells
- thought to have better prognosis
Cholangiocarcinoma
malignancy of bile ducts 10% intrahepatic extrahepatic arising from bile ducts outside the liver -perihilar (50-60%) -distal bile duct (20-30%) -periampullary
What are the risk factors for cholangiocarcinoma?
- primary sclerosing cholangitis
- congenital fibropolycystic disease of the biliary system
-caroli’s disease
3 cirrhosis - exposure to thorotrast
- liver fluke: opisthorchis sinensis
