Liver Pathology 2

Question 1

Fibrous deposition in alcoholic steatosis begins where in hepatocyte

Answer 1

around central vein

Question 2

Non-alcoholic fatty liver disease/hepatic steatosis is most often due to

Answer 2

metabolic diseases
DM, hyperlipidemia, obesity
insulin resistance –> steatosis

Question 3

Primary biliary cirrhosis

Answer 3

autoimmune destruction of intrahepatic bile ducts (extrahepatic bile ducts are spared)

Question 4

AMA + disease

anti-mitochondrial antibody

Answer 4

primary biliary cirrhosis

Question 5

Secondary biliary cirrhosis

etiologies

Answer 5

prolonged extrahepatic bile duct obstruction

Question 6

Primary sclerosing cholangitis

association

Answer 6

ulcerative colitis

Question 7

Primary sclerosing cholangitis

pathology

Answer 7

autoimmune fibroinflammatory destruction of intrahepatic AND extrahepatic bile ducts
fibrous plugs in place of bile ducts in portal canal

Question 8

Complications of primary sclerosing cholangitis

Answer 8

strictures of bile ducts at different locations

Question 9

Hemochromatosis

pathology

Answer 9

mutation of HFE gene
hepcidin not produced when iron is high
ferroportin not degraded on apical surface of intestinal epithelium
excess iron absorbed

Question 10

Skin in hemochromatosis

Answer 10

slate gray skin

hemosiderin and malnin buildup in dermal macrophages

Question 11

Where does Fe build up in hemochromatosis

Answer 11

1˚: periportal hemosiderin

2˚: in Kuppfer cells

Question 12

Bronze diabetes

Answer 12

hemochromatosis DM + skin pigmentation

also cirrhosis

Question 13

Screening for hemochromatosis

Answer 13

fasting transferrin saturation

diagnostic: liver Bx w/ quantitative Fe

Question 14

Wilson’s disease mutation

Answer 14

ATP7B mutation
cannot get Cu into bile
so cannot excrete

Question 15

Test results in Wilson’s

Answer 15

decreased ceruloplasmin

increased urinary Cu

Question 16

Liver disease in A1AT deficiency

Answer 16

not in null-null: no A1AT produced, so does not build up

mutated protein –> builds up (ZZ and MM homozygotes)

Question 17

Mechanisms of drug-induced hepatotoxicity

Answer 17

direct hepatotoxicity (dose-dependent)
unpredictable/idiosycratic: unpredictable

Question 18

Budd-Chiari syndrome

Answer 18

hepatic vein thrombosis

hepatomegaly, ascites, abdominal pain

Question 19

Granulomatous hepatitis

possible etiology

Answer 19

sarcoid

Question 20

HELLP syndrome

Answer 20

hemolysis, elevated liver enzymes, low platelets

in pre-eclampsia

Question 21

BM transplants and liver

Answer 21

graft vs host

sinusoidal obstructive syndrome

Question 22

ALT and AST

information

Answer 22

hepatocyte damage

ALT > AST more specific for liver damage

Question 23

Alkaline phosphatase

information

Answer 23

cholestasis/damage to bile duct epithelium

also due to bone pathologies

Question 24

GGT

information

Answer 24

when alkaline phosphatase may be due to bone disease

Question 25

Wilson’s usually presents by this age

Answer 25

30 y/o

consider in all liver disease

Question 26

PE in Wilson’s

Answer 26

ring of copper at cornea limbus

Kayser-Fleischer ring

Question 27

A1AT inheritance

Answer 27

autosomal co-dominant

Question 28

A1AT balances

Answer 28

neutrophil elastase in lungs

Question 29

Tests for:
viral hep:
autoimmune hep:
Wilson's:
A1AT:
hemochromatosis:
1˚ biliary cirrhosis:

Answer 29

viral hep: serology, nuclear DNA/RNA
autoimmune hep: ANA, anti-sm muscle Ab
Wilson’s: ceruloplasmin
A1AT: A1AT level, phenotype
hemochromatosis: Fe, TIBC, transferring sat, genetics
1˚ biliary cirrhosis: anti-mitochondrial Ab

Question 30

Grade vs State

Answer 30

grade: amt of lymphocytic piecemeal and lobular necrosis
staging: degree of necrosis

Question 31

Cirrhosis vs fibrosis

Answer 31

cirrhosis: fibrosis w/ nodular regeneration