Liver pathology

Question 1

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

Answer 1

portal vein

Question 2

What is the anatomic unit of the liver?

Answer 2

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

Question 3

What is the functional unit of the liver?

Answer 3

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

Question 4

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

Answer 4

CYP450 enzymes

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

Question 5

What conditions show ballooning degeneration?

Answer 5

alcohol, drugs, toxins, ACUTE viral hepatitis

Question 6

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

Answer 6

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

Question 7

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

Answer 7

cholestasis

Question 8

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

Answer 8

iron; copper

Question 9

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

Answer 9

coagulative necrosis

Question 10

Coagulative necrosis is seen in the setting of _______

Answer 10

ischemia

Question 11

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

Answer 11

spotty necrosis

Question 12

Spotty necrosis is seen in _____ and damage due to ______

Answer 12

viral hepatitis; alcohol

Question 13

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

Answer 13

focal necrosis

Question 14

What conditions lead to focal necrosis?

Answer 14

ischemic injury
acetaminophen toxicity
venous outflow obstruction, Budd Chiari

Question 15

What is Budd Chiari syndrome?

Answer 15

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.

Question 16

_________ 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

Answer 16

massive necrosis

Question 17

What etiologies can cause apoptosis in hepatocytes?

Answer 17

viral hepatitis, drugs

Question 18

List the three leading causes of cirrhosis

Answer 18

alcohol
viral hepatitis
NAFLD

Question 19

Describe the gross appearance of the liver in alcoholic steatosis

Answer 19

swollen, yellow, greasy

Question 20

Describe the microscopic appearance of the liver in alcoholic steatosis

Answer 20

pure steatosis with no inflammation, most pronounced in zone 3

Question 21

Describe the microscopic appearance of alcoholic steatoheptatitis

Answer 21

steatosis with neutrophilic inflammation

Mallory bodies- degenerating cytokeratin intermediate filaments

Question 22

What sort of inflammatory infiltrate is seen in alcoholic steatohepatitis?

Answer 22

neutrophilic

Question 23

Alcoholic cirrhosis is initially characterized by uniform _________

Answer 23

micronodular cirrhosis

Question 24

List the clinical entities included within the category NAFLD

Answer 24

steatosis
NASH
Cirrhosis

Question 25

Describe the inflammatory infiltrate in viral hepatitis

Answer 25

mixed but predominantly lymphocytes

Question 26

Describe the histology of acute viral hepatitis

Answer 26

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

Question 27

Describe the histology of chronic viral hepatits

Answer 27

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

Question 28

The ________ appearance of hepatocytes is characteristic of chronic HBV infection

Answer 28

ground glass

Question 29

Describe the pattern of inflammation in chronic viral hepatitis

Answer 29

interface inflammation with lymphocyte predominance

Question 30

Describe the pattern of inflammation in autoimmune hepatitis

Answer 30

plasma cells

Question 31

Describe the histologic findings in hereditary hemochromatosis

Answer 31

brown iron pigment diffusely in all hepatocytes | increasing fibrosis or cirrhosis

Question 32

How does iron damage hepatocytes

Answer 32

Direct hepatotoxin, causes free radical injury to hepatocytes

Question 33

What other organs are affected by hereditary hemochromatosis?

Answer 33

pancreas skin myocardium endocrine organs

Question 34

In Wilson's disease, _______ levels are decreased

Answer 34

ceruloplasmin

Question 35

How does alpha 1 antitrypsin deficiency cause liver damage?

Answer 35

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

Question 36

What characteristic histologic feature is seen in A1AT deficiency

Answer 36

pink protein globules in hepatocytes, stain + for PAS

Question 37

How does congestive heart failure lead to liver damage?

Answer 37

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

Question 38

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

Answer 38

ascending cholangitis

Question 39

List signs and symptoms of biliary disease

Answer 39

cholestasis pruritis janudice increases in ALKP, GGT, conjugated bilirubin

Question 40

__________ antibodies are often seen in primary biliary cirrhosis

Answer 40

anti mitochondrial

Question 41

Describe the pattern of inflammation in PBC

Answer 41

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

Question 42

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

Answer 42

primary biliary cirrhosis, PBC

Question 43

Describe the findings in primary sclerosing cholangitis

Answer 43

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

Question 44

PSC is associated with an increased risk of:

Answer 44

cholangiocarcinoma

Question 45

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

Answer 45

Primary sclerosing cholangitis

Question 46

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

Answer 46

colon> lung> breast> pancreas> stomach

Question 47

List the major etiologic agents associated with hepatocellular carcinoma

Answer 47

``` chronic HBV or HCV chronic alcohol NASH Hereditary hemochromatosis aflatoxin ```

Question 48

Describe the histology of hepatocellular carcinoma

Answer 48

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

Question 49

List etiologic risk factors for cholangiocarcinoma

Answer 49

PSC | liver fluke opisthorchis sinensis

Question 50

Describe the microscopic appearance of cholagniocarcinoma

Answer 50

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.

Question 51

_________ invasion by malignant cells is common in cholangiocarcinoma

Answer 51

perineural

Question 52

______ is a pediatric malignant neoplasm composed of epithelial cells

Answer 52

hepatoblastoma

Question 53

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

Answer 53

angiosarcoma

Question 54

List risk factors for angiosarcoma

Answer 54

polyvinyl chloride arsenic thorotrast

Question 55

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

Answer 55

hepatic adenoma

Question 56

CCL4 exposure is a risk for development of:

Answer 56

fatty liver and necrosis

Question 57

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

Answer 57

esophageal squamous cell carcinoma and some gastric adenocarcinomas