Liver Path 3 - Nelson

Question 1

What characterizes pre-eclampsia?

What is HELLP syndrome?

Answer 1

Maternal hypertension, proteinuria, peripheral edema, and coagulation abnormalities

Preeclampsia can sometimes become severe and then manifest HELLP syndrome.
Hemolysis
Elevated 
Liver-enzymes 
Low 
Platelets

Question 2

Acute Fatty Liver of Pregnancy is characterized by acute onset of liver dysfunction. What do you see on liver biopsy?

Answer 2

Microvesicular steatosis

Same thing you see in liver of Reye Syndrome

Question 3

Most common benign neoplasm of the liver:

Answer 3

Hemangioma

Question 4

What is the name of the congenital dilatation of the common bile duct? What patients does it happen to?

Answer 4

Choledochal cyst

Occurs in kids

Question 5

What is caroli’s disease?

Answer 5

Intrahepatic biliary dilatation, which communicates with biliary tree

(A few different congenital disorders fall under this disease’s umbrella

Question 6

This lesion is composed of a proliferation of all liver parenchymal elements. Imaging studies will show a central stellate scar.
What is it?

Answer 6

Focular Nodular Hyperplasia

Question 7

This lesion is a well-circumscribed benign neoplasm. Lack of portal triads and central veins will help you see it’s not normal liver. It’s more common in young reproductive age females taking oral contraceptives.

Answer 7

Hepatocellular Adenoma

Question 8

Most important factors disposing to HCC (hepatocellular carcinoma) are Chronic Viral Hepatitis and toxin exposure. What is the differences between major risk in the U.S. vs major risk in China/SE Asia?

Answer 8

Chronic hepatitis from HBV and HCV have very big risk.
Aflotoxin (mld toxin growing on nuts) is major toxin

In U.S. -> it usually stems from cirrhosis

Question 9

Cholangiocarcinomas are carcinomas arising from intra- or extra-hepatic bile ducts. Tumor nodules are usually white and hard. It is associated with liver flukes, PSC, Caroli’s Disease, Congenital Hepatic fibrosis, choledochal cysts, viral hepatitis and NAFLD. What neoplastic lesion would have to be excluded to make the dx or cholangiocarcinoma?

Answer 9

Exclude Adenocarcinoma metastasis to the liver.

Question 10

Four F’s of gallstones?

And other risk factors?

Answer 10

Female, Forty, Fat, Fertile

rapid weight loss, pregnancy, oral contraceptives (progesterone decreases gall-bladder smooth muscle tone in pregnancy)

Question 11

When you think about acute cholecystitis, you should think about what kin of inflammation?

Answer 11

Neutrophilic

Neutrophils! Neutrophils!

Question 12

Stones in common bile duct:

Answer 12

Choledocholithiasis!

Question 13

When you think about chronic cholecystitis, you should think about what kind of inflammation?

Answer 13

Chronic lymphocytic inflammation

also fibrosis

Question 14

Why are pigment stones more common in Eastern Asia as opposed to the cholesterol stones more commonly seen in W. Europe and the Americas?

Answer 14

In E Asiathere is an increase in bacterial/parasitic biliary infections which are associated with the pigmented stones.

Question 15

What type of cholangiocarcinoma arises at comfluence of R and L hepatic ducts?

Answer 15

Klatskin tumor
or
Perihilar cholangiocarcinoma

Question 16

A patient presents to your office with painless jaundice. Labs show an increase in alkaline phosphatase and GGT. Endoscopic ultrasound and biopsy reveals intraductal nodule which is consistent with adenocarcinoma.
Diagnosis?

Answer 16

Extra-hepatic cholangiocarcinoma!