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NYCC Visceral Pathology > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

How long do RBCs live?

A

120 days

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2
Q

Where do RBCs go when they die?

A

Red pulp of the spleen

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3
Q

What two veins form the hepatic portal vein?

A

Superior mesenteric vein and splenic vein

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4
Q

Where does conjugation of bilirubin occur?

A

Liver

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5
Q

What makes up the common hepatic duct?

A

Right and left hepatic duct

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6
Q

What makes up the common bile duct?

A

Cystic duct and common hepatic duct

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7
Q

What duct leads to and from the gall bladder?

A

Cystic duct

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8
Q

What is the breakdown product of hemosiderin/RBCs?

A

Bilirubin

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9
Q

What is stercobilin?

A

fermented byproduct of bile giving stool its normal brown colour

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10
Q

Where does bile ferment to make stercobilin?

A

colon

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11
Q

What is another term for jaundice?

A

Icterus

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12
Q

What is jaundice?

A

Hyperpigmentation of the skin due to hyperbilirubinemia and deposition of bilirubin on body surfaces

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13
Q

What turns yellow if you have jaundice?

A

Everything

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14
Q

What is prehepatic hyperbilirubinemia?

A

Unconjugated hyperbilirubinemia characterized by normal urine & stool with yellowing skin (jaundice)

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15
Q

What effect will pre-hepatic hyperbilirubinemia have on stool, urine, and skin?

A

Stool = Normal (brown colour)
Urine = Normal (Pale amber)
Skin = Yellow

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16
Q

What are potential causes of prehepatic unconjugated hyperbilirubinemia?

A
  • ^RBC destruction from autoimmune hemolytic anemia
  • mismatched blood transfusion
  • hypersplenism (overactive spleen)
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17
Q

What is hepatic hyperbilirubinemia?

A

Unconjugated or conjugated hyperbilirubinemia characterized by pale gray or clay colored stool and normal urine with yellowing skin

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18
Q

What effect will hepatic hyperbilirubinemia have on stool, urine, and skin?

A

stool: clay-coloured
urine: normal
skin: yellow

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19
Q

What can cause hepatic hyperbilirubinemia?

A

Tumor or cirrhosis (liver pathology)

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20
Q

A tumor will cause (Slow/Sudden) onset of hepatic hyperbilirubinemia?

A

Sudden

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21
Q

Cirrhosis or a liver pathology will cause (Slow/Sudden) onset of hepatic hyperbilirubinemia?

A

Slow

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22
Q

What is post-hepatic hyperbilirubinemia?

A

Conjugated hyperbilirubinemia characterized by pale gray or clay coloured stool and dark green or black urine

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23
Q

What causes post-hepatic hyperbilirubinemia?

A

Obstruction/compression (SOL) of common bile duct:
- Gallstones
- pancreatic carcinoma
- abdominal cancer

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24
Q

Prehepatic hyperbilirubinemia causes (Conjugated/Unconjugated/Both) hyperbilirubinemia(s)?

A

Unconjugated

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25
Q

Hepatic hyperbilirubinemia causes (Conjugated/Unconjugated/Both) hyperbilirubinemia(s)?

A

Both
(trends toward unconjugated)

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26
Q

Post-hepatic hyperbilirubinemia causes (Conjugated/Unconjugated/Both) hyperbilirubinemia(s)?

A

Conjugated

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27
Q

What effect will conjugated hyperbilirubinemia have on the stool, urine, and skin?

A

Stool = Pale gray/clay
Urine = Dark
Skin = Yellow

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28
Q

What is kernicterus?

A

severe neonatal jaundice caused by unconjugated hyperbilirubinemia in a newborn due to an enzyme defect that can lead to bile crossing the blood brain barrier and causing irreversible brain damage

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29
Q

Kernicterus results in (Conjugated/Unconjugated/Both) hyperbilirubinemia(s)?

A

Unconjugated

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30
Q

What are general causes of hepatitis?

A

Virus
Autoimmune conditions
Alcoholism

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31
Q

Hepatitis can be both acute or chronic (TRUE/FALSE)?

A

TRUE

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32
Q

What type of cancer can hepatitis lead to?

A

Hepatocellular carcinoma

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33
Q

Which type(s) of hepatitis has a fecal-oral vector and can only be contracted once?

A

Hepatitis A

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34
Q

Which type(s) of hepatitis are spread through bodily fluids, blood transfusions, STDs, and IV drug use and are chronic conditions?

A

Hepatitis B and C

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35
Q

What is the most common cause of hepatitis?

A

Alcohol

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36
Q

What is hepatitis?

A

Inflammation of the liver

37
Q

What deposition illnesses can predispose a person to hepatitis and hepatocellular carcinoma?

A

Wilson’s disease
Hemochromatosis

38
Q

What is cirrhosis?

A
  • Destruction of normal liver architecture by fibrous bands around regenerative nodes of hepatocytes
  • death and regeneration of hepatic architecture with extracellular matrix deposition
39
Q

What are most cases of cirrhosis due to?

A
  • Alcoholism
  • chronic viral hepatitis
  • metabolic diseases (hemochromatosis & Wilson’s disease)
40
Q

An alpha-antitrypsin deficiency in a patient with emphysema can lead to cirrhosis of the liver (TRUE/FALSE)?

A

TRUE
(allows destruction of liver)

41
Q

What are the clinical features of cirrhosis?

A
  • Ascites
  • Caput medusae
  • Hepatic jaundice
  • Hypoalbuminemia (pitting edema)
  • Portal hypertension (risk of esoph. varices)
  • endocrine abnorm. (gynecomastia)
42
Q

What is the histological feature unique to cirrhosis?

A

Bridging fibrous septae (scar tissue between lobules)

43
Q

What is caput medusae and what liver pathology is it consistently seen with in later stages?

A

Dilated periumbilical veins commonly seen in late stage cirrhosis

44
Q

What is the pathogenesis of Wernicke-Korsakoff syndrome?

A

Chronic alcoholics with a B1 deficiency (also gastric stapling and anorexics)

45
Q

What is Wernicke’s encephalopathy?

A

disease of brain, altered consciousness w/
- impaired short-term memory
- ophathlmoplegia
- nystagmus
- due to lesions in hypothalamus, mamillary bodies, and midbrain

46
Q

What is Korsakoff’s psychosis?

A

Acute onset of severe memory impairment characterized by confusion, confabulation, and hallucinations
(i.e., disease of mind)

47
Q

57 year old male patient presents to your office with the smell of alcohol on his breath. Physical exam shows spidery veins around his belly button. The patients eyes are a yellowish hue along with his skin. The patient is noticeably shaky in regards to his balance, almost as if he is intoxicated. A lateral gaze test was positive for nystagmus. He seems to be repeating questions as if he forgot he already asked you. What is the likely diagnosis for this patient?

A

Wernicke’s encephalopathy

48
Q

57 year old male patient presents to your office with the smell of alcohol on his breath. Physical exam shows spidery veins around his belly button. The patients eyes are a yellowish hue along with his skin. When asked about his chief complaint, he begins to tell a story about how aliens stole his favorite handkerchief and caused him to trip and hurt his knee while he was in fast pursuit on his 10 speed mountain bike. He seems to be serious about this explanation. What is the likely diagnosis?

A

Korsakoff’s psychosis

49
Q

What is hemochromatosis?

A

Autosomal dominant disease resulting in excessive absorption of iron in body tissues leading to deposition in parts of the body such as the liver

50
Q

What conditions can cause hemochromatosis besides an autoimmune mechanism?

A

Multiple blood transfusions and excessive medicinal iron intake

51
Q

What is the pathogenesis of hemochromatosis?

A
  • ^iron deposition in tissues promotes free-radical induced damage to the oxidation of iron via the Fenton reaction
  • leads to cirrhosis and eventually hepatocellular carcinoma
52
Q

49 year old male patient presents to your office complaining of odd bowel movements and upper right quadrant pain. The patient claims that their stool is a pale gray color. When asked about urination, the patient states that his urine appears to be normal. His wife even had the audacity to claim that his eyes were yellow yesterday! When asked about any medications or supplements, the patient reports to taking 6 or 7 iron tablets a day and cooking with a cast iron pan after watching a 3 AM infomercial about iron deficiency anemia (Which he doesn’t want). What is the likely diagnosis for this patient, what is the primary cause of his pathology, and what is he at risk for developing?

A

Hemochromatosis; primary cause is increased Fe intake with an increased risk of developing cirrhosis and hepatocellular carcinoma

53
Q

Wilson’s disease is a(n) ____ disease?

A

Hepatolenticular

54
Q

What is Wilson’s disease?

A

Autosomal recessive inherited disorder of copper metabolism

55
Q

What is the pathogenesis of Wilson’s disease?

A

Ceruloplasmin deficiency decreases copper excretion resulting in toxic copper overload on various tissues

56
Q

What carrier protein is deficient in patients with Wilson’s disease?

A

Ceruloplasmin

57
Q

A Kaiser-Fleisher ring is a golden-brown discoloration of both irises seen in what condition?

A

Wilson’s disease

58
Q

What autoimmune disease can present with childhood chronic hepatitis?

A

Wilson’s disease

59
Q

Mallory bodies are present in what liver pathology?

A

Wilson’s disease

60
Q

What are Mallory bodies?

A

degenerating hepatocytes

61
Q

What are the clinical features of Wilson’s disease specific to the brain?

A
  • psychiatric abnormalities
  • parkinsonian-like tremor / hand tremor
  • cogwheel rigidity
  • bradykinesia
  • masked facial expressions
  • slurred speech
  • ataxia
62
Q

16 year old male patient presents to your office complaining of a hand tremor while he is reading at night. The patients mom also reports that the child has been expressionless for about a month now and his speech has become impaired. Upon inspection of CN III, you notice that both of the patients eyes have a golden-brown discoloration in the iris. The patients skin is also a tint of yellow. What is the likely diagnosis?

A

Wilson’s disease

63
Q

What is a hepatic abcess?

A

Rare pyogenic mass due to hematogenous spread of a bacterial,viral, or candida infection

64
Q

What pattern of inflammation is present in a hepatic abcess?

A

Suppurative

65
Q

What pattern of necrosis is present in a hepatic abcess?

A

Liquefactive

66
Q

23 year old female patient presents to your office with upper right quadrant pain. The patient is running a fever of 102.1. Ultrasound is ordered and shows a hypoechoic mass on the liver. A needle aspiration of the tissue shows large amounts of purulent exudate and neutrophils. What is the likely diagnosis?

A

Hepatic abcess

67
Q

What is meant by the term hypoechoic in regards to ultrasound?

A

Less dense, darker, fluid filled mass on an ultrasound

68
Q

What is meant by the term hyperechoic in regards to ultrasound?

A

More dense, whiter, solid mass on an ultrasound

69
Q

What is the most common neoplasia of the liver?

A

Hemangioma

70
Q

What is a hemangioma?

A

increased capillaries in a well-defined area
(like a ‘birthmark’ in the liver)

71
Q

A hemangioma of the liver is (Hyperechoic/Hypoechoic)?

A

Hypoechoic

72
Q

A hepatic abscess is (Hyperechoic/Hypoechoic)?

A

hypoechoic

73
Q

A hemangioma of the liver is often an incidental finding (TRUE/FALSE)?

A

TRUE

74
Q

What populations are most affected by hepatic adenomas?

A
  • MC in females
  • most cases in pregnant women w/ Hx of contraceptive use
75
Q

What are the clinical features of a hepatic adenoma?

A
  • may present as solitary or nodular mass
  • may present w/ right hypochondrial pain
76
Q

A 21 year old male patient is reporting upper right quadrant pain. He reports having a rough night of drinking last night for his 21st birthday and wanted to make sure that he wasn’t dying. An ultrasound is ordered in order to make the patient feel better. To your surprise, the ultrasound reveals a hypoechoic mass on the liver. Patient history reveals that he has never drunken alcohol until last night. He has no smoking history, and the pain just started this morning after a night of drinking. You adjust the patient’s atlas with a hole in one technique and tell the patient to go eat some charcoal to help with the pain. What is the likely diagnosis for the mass present on the patients liver?

A

Hemangioma

77
Q

34 year old female presents to your office with some pain under her ribs on the right side of her abdomen. She is 6 months pregnant. The only notable drug use in her history is of birth control that she obviously went off of in order to have a child. An ultrasound is ordered for the abdomenopelvic region and in the upper right quadrant. The baby is perfectly fine and healthy. The upper right quadrant of the abdomen reveals a mass on the liver. The mass is dense and well circumscribed. The patient reports no other symptoms and is not running a fever. What is the likely diagnosis?

A

Hepatic adenoma

78
Q

What is the most common human cancer?

A

Hepatocellular carcinoma

79
Q

What factors can predispose a person to hepatocellular carcinoma?

A
  • Hepatitis
  • alcoholism
  • Wilson’s disease
  • hemochromatosis
  • alpha1-AT deficiency
  • aflatoxin B1
80
Q

What gives rise to aflatoxin B1?

A

Aspergillosis (black mold)

81
Q

An alpha 1-antitrypsin deficiency is associated with what respiratory pathology?

A

Emphysema

82
Q

What predisposes a patient to a hemangiosarcoma?

A

associated w/ prior chemical exposure:
- Vinyl chloride
- arsenic
- thorium or thorotrast exposure

83
Q

What are the clinical features of a hemangiosarcoma?

A
  • presents as multicentric tumor (poorly-defined, multiple lesions)
  • local & systemic illness due to metastasis
84
Q

55 year old male patient presents to your office. He has been a plastic factory worker for 30 years now. He is going to retire soon due to thoracic and lumbar back pain that has been getting worse the last 6 months. The patient also reports losing 25 pounds in the last month which he attributes to his lengthy work schedule. An ultrasound is performed in the thoracic and lumbar regions. The thoracic ultrasound reveals multicentric masses on the liver. What is the likely diagnosis?

A

Hemangiosarcoma

85
Q

What is the most common malignancy of the liver?

A

Hepatic metastasis

86
Q

Where does hepatic metastasis often originate from?

A
  • GI
  • breast
  • lung
  • malignant melanoma
87
Q

All abdominal cavity tumors prefer to metastasize to ____ in a ____ fashion

A
  • liver
  • “canon ball”
88
Q

62 year old male patient presents to your office complaining of left lower quadrant abdominal pain and right upper quadrant abdominal pain as well as blood in the stool. The patient has a history of diverticulitis at the sigmoid colon but reports that he has been sticking to his high fiber, low seed diet. A prior doctor that he saw for his diverticulitis wrote in his note that he possesses and APC gene mutation in the sigmoid colon and is at increased risk for colon carcinoma. He hasn’t been to a doctor in three years since that note was written. An ultrasound is ordered on the right upper quadrant and the patient is being sent out to his original doctor for the colon issue. Ultrasound reveals several small masses on the liver. A biopsy of the tissue shows tissue resembling the colon. What is the likely diagnosis?

A

Left-sided colon carcinoma with hepatic metastasis

NYCC Visceral Pathology (40 decks)

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