Liver Path 2: Cholestatic and Neoplastic Disease Flashcards
What are 3 complications of cirrhosis?
Decreased synthetic and clearance function.
Portal hypertension.
Hepatocellular carcinoma.
Will blocking just the right or just the left hepatic duct cause cholestasis?
Nope. Blocking both, or blocking the CBD will, though.
Will blocking the cystic duct cause cholestasis?
Nope.
What is a choledochal cyst?
Congenital malformation of bile ducts (or cystic duct) -> true diverticulum (all layers).
What are 3 bad things about choledochal cysts?
Stasis -> stone formation.
Twisting -> duct occlusion.
Can develop dysplasia -> adenocarcinoma.
What’s porcelain gallbladder? Significance?
Diffuse calcification of gallbladder - radiodense on x-ray.
Pathophysiology unclear, but porcelain gallbladders have increased risk of adenocarcinoma.
What’s a Klatskin tumor?
A cholangiocarcinoma that occurs right at the L and R hepatic duct bifurcation, causing cholestasis.
(a cholangiocarcinoma is an adenocarcinoma of the duct epithelium)
Is cholangiocarcinoma associated with cirrhosis? (Associations?)
Nope. Cholangiocarcinomas have no association with underlying liver disease (except for…. PSC?).
(associated with PSC and liver flukes)
Does cholangiocarcinoma cause cholestasis?
Nope - not unless it invades the main ducts.
Aside from inflammation, what problem can bacteria (esp. gut-derived gram negs) in the biliary tree cause?
Bacteria can cause intrahepatic stone formation. Bacteria deconjugate bilirubin -> precipitation.
Review: What’s the treatment for PBC?
Ursodiol.
Not steroids… they don’t work.
Does PBC recur after transplant?
Yes.
Does PSC recur after transplant? What if the patient has had a colectomy for UC?
It can…
It recurs less if a patient has had a colectomy for UC… suggesting some relationship.
Review: What’s the histology buzzword for PSC?
“Onion skin” fibrosis of ducts.
How can PSC cause cholestasis before cirrhosis?
Biliary sludge.
What’s the most common type of malignancy in a non-cirrhotic liver?
Metastatic tumor - most commonly from the GI.
Are primary liver tumors common?
Are most benign or malignant?
They’re quite rare, but over 90% are malignant (most are carcinoma).
A clonal, bleeding mass with “benign appearing hepatocytes” and no mitoses is taken from the liver… what might it be?
Hepatocellular adenoma
Is hepatocellular adenoma a precursor to hepatocellular carcinoma?
Nope. Not at all.
A stellate scar in the middle of a nodules that aren’t bile stained. What could it be?
Focal nodular hyperplasia. It’s benign.
It’s kind of a… focal cirrhosis.
What do bile duct adenomas look like?
They look like mets… small white, firm nodule grossly.
Histologically - bile ducts with lymphocytic infiltrate.
Completely benign.
Big malformed blood vessels in liver…
Hemangioma. Benign.
What’s an eichonicocus?
Cyst(s) from parasites - the “scolex” (scary worm mouth things) can be seen in histology.
Big picture about what causes hepatocellular carcinoma (HCC)?
Anything that causes cirrhosis can cause HCC.
HBV, though, can cause HCC prior to cirrhosis.
2 prognostic factors in HCC?
Vascular invasion
Differentiation
How is diagnosis of angiocarcinoma made?
Cells growing in sinusoids.. but mainly with immunohistochemistry.
