Liver Pathology Flashcards
What are the causes of cirrhosis?
etoh, viral hepatitis, biliary ds. hereditary hemochromatosis, wilsons ds. A1AT def, NAFLD
The 3 most common causes of death in cirrhosis?
hepatic failure
portal htn
hepatocellular carcinoma
List the some symptoms of hepatic failure
Jaundice, hypoalbunemia, bleeding, hyperammonemia, hypoglycemia, endocrine and renal failure, encephalopathy, pulmonary and portal htn
What is the most common cause of acute hepatic failure? Chronic?
acetaminophen OD
cirrhosis
Sinusoidal/central venous fibrosis, parenchymal nodules, arterial portal anastamoses adn hyperdynamic splanchnic circulation are all causes of what liver pathology?
Portal htn
Symptoms of portal htn?
ascites, splenomegaly, esophageal varices, hepatic encephalopathy
What would be seen on a liver biopsy fo a pt. with alcoholic steatosis?
enlarged lipid vacuoles
IF you see mallory bodies think this, yo.
Alcoholic hepatitis
What are the differences seen in imaging between early and late alcoholic cirrohsis?
Early- enlarged fatty liver w/micronodules
Late - shrunken, nonfatty, w/variable nodules
Causes of mortalitiy in alcoholic cirrhosis?
Hepatic encephalopathy Esopahgeal varices Infection Hetaptorenal syndrome Hepatocellular carcinoma
What is the diff between types of pt with non- alcoholic and alcoholic fatty liver disease?
Non-alcoholic - obese, T-II diabetes, dyslipidemia, and mucho insulin resistance
alcoholic - alcohol consumption
What is primary biliary cirrhosis?
inflammatory destruction of small and medium intrahepatic bile ducts
Dx tests for PBC?
ALP/GGT - elevated
AMA antibodies or (ANA and ASMA/AIH)
CD8+ T cells
What would a typical PBC look like and present as?
Middle age european female with pruritis, xanthelmsa/xanthoma, steatorrhea, osteomalacia/osteoporosis and other autoimmune ds.
Name causes of secondary billiary cirrhosis?
Stones, tumors, atresia, CFTR, choledocal cysts
What autoimmune disease is associated with PSC?
IBD - 70% of patients
What is the key finding for PSC?
Beaded cholangiogram and atypical p-ANCA
Describe Hereditary hemochromatosis.
AR decrease in hepcidin synth –> increased Iron absorption. Treated with phlebotomy and iron chelations. Also called bronze diabetes
What causes secondary hemochromatosis
parenteral overload
ineffective erythoproeisis
increased oral effective
Key difference in biopsy between hereditary and secondary hemochromatosis?
in hereditary iron in hepatocytes while in secondary it is in the Kupfer cells
what is the defect in Wilson’s disease?
AR defect in ATP7B- so you can secrete copper and ceruloplasmin into bile.
When would you suspect Wilson’s ds?
A teen with liver disease where all tests are coming up negative.
What would you see in a liver bx. in A1AT?
build up of A1AT in hepatocytes
Diagnosis of A1AT would involve what tests?
A1AT level, A1AT phenotype, liver bx. : PAS + cytoplasmic globular inclusions
What is the difference between a direct and unpredictable cause of drug induced liver injury?
direct: all individuals sustain the same level of injury from the same dose
unpredictable: level of damage is dependent on the individual
What are two causes of neonatal cholestasis?
biliary atresia and neonatal hepatitis
Describe neonatal hepatitis?
hepatitis caused by biliary atresia, A1AT inherited metabolic deficiency, tyrosinemia, CFTR, drug toxicity
What type of bilirubin accumulates in neonatal cholestasis?
conjugated
What are the causes of granulomatous hepatitis?
50% idiopathic, 20% Sarcoidosis, 5% drugs, 3% TB
Which liver enzyme is specific to hepatocellular damage?
ALT (alanine aminotransferase)
An AST:ALT >2 indicates what etiology of liver disease?
alcoholic
What are the liver function enzyme tests that would indicate a cholestatic etiology of liver disease?
ALP and GGT (ALP»_space;> ALT and AST)
If you see an increase in plasma cells on a liver bx., index of suspicion for what diseases are raised?
AIH and PBC (primary biliary cirrhosis)
Contrast the patterns seen on liver bx. for HBV and HCV
HBV- ground glass
HCV- periportal hepatitis and mild steatosis
What does grading of a liver bx. sample tell you?
the amount of fibrosis
When should you be concerned about Gilbert’s syndrome?
Never, it is benign, may have icterus and elevated bilirubin during stressed times
What is acute cholangitis? What can cause it?
secondary bacterial infection of biliary tree, may be caused by hepatocellular cholestasis
Centrilobular fibrosis caused by cor pulomonale, hepatic vein thrombosis, CHF and shock is called this
Chronic passive congestion
radiation, BMT, chemo damage the hepatic sinusoidal endothelium causing lesions of small veins, narrowing of central veins
sinusoidal obstruction syndrome
Cardiac sclerosis is caused by these two liver vascular problems
Chronic passive congestion
centrilobular hemorrhaic necrosis
What is portal vein thrombosis caused by?
extrahepatic = trauma, intrabdominal sepsis, pancreatitis, hypercoaguable disorder intrahepatic = cirrhosis and carcinoma
Blood filled spaces in liver caused by anabolic steroid or bartonella infection?
Peliosis hepatitis
What causes acute massive hepatic necrosis? Likley outocomes?
acute hep., drug/toxin, vascular disease, AIH, Wilson’s
Death or full recovery
Dx tools used for autoimmune hepatitis.
Type 1 - (ANA) (SMA) (anti-SLA/LP)
Type II - anti (ALKM-1), (ALC-1)
What does HELLP stand for?
hemolysis, eleveated liver enzymes, liver platelets
Dx sign of Acute fatty liver or pregnancy
microvesicalar steatosis
Intrahepatic cholestasis of pregnancy is caused by this normal effect of pregnancy
elevated estrogen
What are liver complications of a bone marrow transplant?
drug toxicity, sinusoidal obstruction syndrome, graft vs host ds
congenital dilation of the bile duct?
choledochal cyst
What disorders make up Caroli’s disease?
Intrahpetiac dilations + congenital hep fibrosis
AR non-cirrhotic liver disease of kids?
Congenital hepatic fibrosis
What is nodular regenerative hyperplasia?
diffuse nonfibrosing nodular hyperplasia
Typical patient for hepatocellular adenoma?
young woman on oral estrogen contraceptions
What is the big concern with bile duct hamartoma?
nodules look like metastatic carcinoma
benign proliferation of bile ducts
bile duct adenoma
Describe the gross signs of HCC
solitary large mass or multiple nodules, soft, hemorrhagic
What is ironic about fibrolamellar variant of HCC?
Young patients with no cirrhosis or hepatitis. Also a firm lesion
what things increase risk of intrahepatic carcinoma (cholangiocarcinoma)
liver flukes, PSC, carolis ds, congential hepatic fibrosis, choledochal cyst, viral hep b/c, NAFLD
what is perihilar/klastkin tumor?
tumor at R/L hepatic duct confluence
Why is the prognosis for distal extrahepatic cholaniocarcinoma worse than most others?
it infiltrates into surrounding tissue
Describe cholesterol stones
water soluble, supersaturated bile, usually drugs cause these stones
common causes of pigment stones
bacterial and parasitic infection, disorders of hemolysis
Symptoms of acute cholecystitis
epigastric RUQ pain, leukocytosis
What condition is always present in chronic cholecystisit?
cholestatis
dystrophic calcification of the gallbladder wall is called this
porcelain glalbladder
describe cholesterolosis
accumulation of lipif laden macrophages (foamy) and yellow flecks
Mucocele/hydrops of the gallbladder involves this finding?
distended gallbladder with atrophic wall
This thickening of the gall bladders wall is not a true neoplasm.
Adenomyoma of the gallbladder
Why is gallbladder carcinoma so dangerous?
Often silent, already metastasized to liver at diagnosis.
this benign growth of the gall bladder can progress into adenocarcinoma
adenoma of gallbladder
