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GI_EB > Liver pathology > Flashcards

Liver pathology Flashcards

1
Q

The ______ constitutes 70% of the afferent blood volume of the liver and is rich in nutrients but relatively poor in oxygen

A

portal vein

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2
Q

What is the anatomic unit of the liver?

A

liver lobule- histologically definable and divided into periportal, mid, and centrilobular areas

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3
Q

What is the functional unit of the liver?

A

Liver acinus (zones 1 to 3) occupies adjacent sectors of neighbor hexagonal liver lobules

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4
Q

The hepatocytes in zone 3 (the centrilobular area) have the highest levels of _________

A

CYP450 enzymes

= least oxygen and greatest levels of toxic eletrophilic metabolites generated by P450s

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5
Q

What conditions show ballooning degeneration?

A

alcohol, drugs, toxins, ACUTE viral hepatitis

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6
Q

In what conditions do triglycerides accumulate in injured but viable hepatocytes?

A

Alcohol, drug toxicity (aspirin- Reye’s in children), HCV, Wilson’s disease

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7
Q

In the setting of ______, visible bile pigment may occur in canaliculi and hepatocytes and the centrilobular hepatocytes may be ballooned

A

cholestasis

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8
Q

______ accumulates in hereditary hemochromatosis while _____ accumulates in Wilson’s disease

A

iron; copper

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9
Q

In _______, the outlines of dead hepatocytes perisist but the nuclei disappear leaving anucleate pink cells

A

coagulative necrosis

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10
Q

Coagulative necrosis is seen in the setting of _______

A

ischemia

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11
Q

In ______, individual hepatocytes undergo lytic necrosis due to severe osmotic disturbances and the space previously occupied by hepatocytes is filled by inflammatory cells.

A

spotty necrosis

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12
Q

Spotty necrosis is seen in _____ and damage due to ______

A

viral hepatitis; alcohol

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13
Q

In _______, zone 3 of the liver parenchyma is most affected

A

focal necrosis

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14
Q

What conditions lead to focal necrosis?

A

ischemic injury
acetaminophen toxicity
venous outflow obstruction, Budd Chiari

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15
Q

What is Budd Chiari syndrome?

A

Budd–Chiari syndrome is a condition caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites and liver enlargement. Examples of occlusion include thrombosis of hepatic veins.

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16
Q

_________ is severe diffuse liver injury involving most liver lobules and can be seen in acute liver failure, drugs, toxins, poisons, severe viral infection, and severe autoimmune hepatitis

A

massive necrosis

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17
Q

What etiologies can cause apoptosis in hepatocytes?

A

viral hepatitis, drugs

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18
Q

List the three leading causes of cirrhosis

A

alcohol
viral hepatitis
NAFLD

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19
Q

Describe the gross appearance of the liver in alcoholic steatosis

A

swollen, yellow, greasy

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20
Q

Describe the microscopic appearance of the liver in alcoholic steatosis

A

pure steatosis with no inflammation, most pronounced in zone 3

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21
Q

Describe the microscopic appearance of alcoholic steatoheptatitis

A

steatosis with neutrophilic inflammation

Mallory bodies- degenerating cytokeratin intermediate filaments

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22
Q

What sort of inflammatory infiltrate is seen in alcoholic steatohepatitis?

A

neutrophilic

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23
Q

Alcoholic cirrhosis is initially characterized by uniform _________

A

micronodular cirrhosis

24
Q

List the clinical entities included within the category NAFLD

A

steatosis
NASH
Cirrhosis

25
Q

Describe the inflammatory infiltrate in viral hepatitis

A

mixed but predominantly lymphocytes

26
Q

Describe the histology of acute viral hepatitis

A

Mixed inflammation throughout the liver in parenchyma and portal tracts
Ballooning of hepatocytes
Apoptotic bodies

27
Q

Describe the histology of chronic viral hepatits

A

Portal inflammation with lymphocyte predominance
Interface inflammation extending from periphery of portal tract into parenchyma
Ground glass hepatocytes in HBV
no ballooning

28
Q

The ________ appearance of hepatocytes is characteristic of chronic HBV infection

A

ground glass

29
Q

Describe the pattern of inflammation in chronic viral hepatitis

A

interface inflammation with lymphocyte predominance

30
Q

Describe the pattern of inflammation in autoimmune hepatitis

A

plasma cells

31
Q

Describe the histologic findings in hereditary hemochromatosis

A

brown iron pigment diffusely in all hepatocytes

increasing fibrosis or cirrhosis

32
Q

How does iron damage hepatocytes

A

Direct hepatotoxin, causes free radical injury to hepatocytes

33
Q

What other organs are affected by hereditary hemochromatosis?

A

pancreas
skin
myocardium
endocrine organs

34
Q

In Wilson’s disease, _______ levels are decreased

A

ceruloplasmin

35
Q

How does alpha 1 antitrypsin deficiency cause liver damage?

A

PiZZ genotype

abnormally folded protein accumulates in hepatocytes leading to cell death, fibrosis, cirrhosis

36
Q

What characteristic histologic feature is seen in A1AT deficiency

A

pink protein globules in hepatocytes, stain + for PAS

37
Q

How does congestive heart failure lead to liver damage?

A

increased pressure in vena cava–>
increased pressure in hepatic veins–>
dilation of terminal hepatic vein and sinusoids (nutmeg liver)–>
pressure atrophy and necrosis of perivenular hepatocytes–>
perivenular fibrosis leading to cirrhosis

38
Q

________ is due to infection of the biliary tree with enteric bacteria

A

ascending cholangitis

39
Q

List signs and symptoms of biliary disease

A

cholestasis
pruritis
janudice
increases in ALKP, GGT, conjugated bilirubin

40
Q

__________ antibodies are often seen in primary biliary cirrhosis

A

anti mitochondrial

41
Q

Describe the pattern of inflammation in PBC

A

inflammation is centered on the bile dugs giving rise to florid bile duct lesions (lymphocytes and granulomas near bile duct)

42
Q

Lymphocytic infiltration and formation of granulomas near the bile duct is characteristic of ______

A

primary biliary cirrhosis, PBC

43
Q

Describe the findings in primary sclerosing cholangitis

A

segmental acute inflammation and periductal fibrosis
strictures and beading
onion skin lesions with periduductal concentric fibrosis

44
Q

PSC is associated with an increased risk of:

A

cholangiocarcinoma

45
Q

Histologic finding of onion skin lesions with periduductal concentric fibrosis is highly suggestive of:

A

Primary sclerosing cholangitis

46
Q

Metastatic tumors of the liver are more common than primary liver tumors. What primary tumors most commonly metastasize to the liver

A

colon> lung> breast> pancreas> stomach

47
Q

List the major etiologic agents associated with hepatocellular carcinoma

A 
chronic HBV or HCV
chronic alcohol
NASH
Hereditary hemochromatosis
aflatoxin
48
Q

Describe the histology of hepatocellular carcinoma

A
  • well differentiated: cells arranged in trabeculae or cords or tubular acini
  • poorly differentiated: cells arranged in sheets
  • nuclei are larger, darker, atypical appearing
49
Q

List etiologic risk factors for cholangiocarcinoma

A

PSC

liver fluke opisthorchis sinensis

50
Q

Describe the microscopic appearance of cholagniocarcinoma

A

The carcinoma cells are arranged in tubules (acini) or are in solid nests or sheets.
They are associated with an intense fibrous stroma, called a desmoplastic response.

51
Q

_________ invasion by malignant cells is common in cholangiocarcinoma

A

perineural

52
Q

______ is a pediatric malignant neoplasm composed of epithelial cells

A

hepatoblastoma

53
Q

_______ is a mesenchymal neoplasm of the liver formed by vascular channels lined by malignant endothelial cells

A

angiosarcoma

54
Q

List risk factors for angiosarcoma

A

polyvinyl chloride
arsenic
thorotrast

55
Q

_______ is a benign neoplasm of hepatocytes with a bland cytology and is common in young women on oral contraceptives or men using anabolic steroids

A

hepatic adenoma

56
Q

CCL4 exposure is a risk for development of:

A

fatty liver and necrosis

57
Q

nitrosamines in smoked foods are a risk factor for development of:

A

esophageal squamous cell carcinoma and some gastric adenocarcinomas

GI_EB (39 decks)

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