Liver Pathology I

Question 1

Bile is produced in the

1. Small Intestine
2. Pancreas
3. Liver
4. Stomach
5. Gallbladder

Answer 1

3. Liver

Question 2

Oxygenated blood is supplied to the liver via the:

1. Portal and Hepatic Vein
2. Hepatic Vein and Hepatic Artery
3. Portal Vein and Hepatic Artery
4. Hepatic artery only
   

Answer 2

3. Portal Vein and Hepatic Artery

Question 3

What comprises the portal triad?

Answer 3

• Hepatic Artery
• Bile Duct
• Portal Vein

Question 4

Which hepatocytes are the most susceptible to ischemic injury?

Answer 4

Zone 3 - those closest to the hepatic vein

Question 5

What fluid flows within hepatic sinusoids?

1. Bile
2. Lymph
3. Venous blood from intestine and spleen
4. Arterial blood from hepatic artery
5. Mixed arterial and venous blood

Answer 5

5. Mixed arterial and venous blood

Question 6

What are some of the key proteins synthesized by the liver?

Answer 6

• Albumin
• Acute Phase Proteins
• Clotting Factors
• Alpha-1 Antitrypsin

Question 7

Ballooning Degeneration

Answer 7

Swelling of hepatocytes

Question 8

Feathery Degeneration

Answer 8

Retained biliary material in swollen hepatocytes

Question 9

Macrovesicular Steatosis

Answer 9

Accumulation of fat droplets in hepatocytes where the large droplets push the nuclei to one side

Question 10

Microvesicular Steatosis

Answer 10

Accumulation of fat droplets in hepatocytes that are smaller so the nuclei remain in the central position

Question 11

Interface Hepatitis

Answer 11

If inflammation passes the interface then it is

considered to be interface hepatitis

Question 12

What is interface hepatitis specific for?

Answer 12

Autoimmune Hepatitis

Question 13

What cells are responsible for collagen deposition in the liver?

Answer 13

Stellate Cells

Question 14

What are ALT levels more specific for?

Answer 14

Hepatocyte damages

Question 15

What is the ratio of ALT:AST like in most liver diseases?

Answer 15

ALT is greater than AST

Question 16

When is AST greater than ALT?

Answer 16

• Alcoholic liver disease

- Wilson’s disease

Question 17

What is the most common cause of MARKEDLY elevated AST and ALT levels?

Answer 17

Acetaminophen overdose

Question 18

What will increase with cholestasis?

Answer 18

Alkaline phosphatase

Question 19

Cholestasis

Answer 19

Loss of ability to excrete bile acids

Question 20

What are the common causes of fulminant (acute) liver failure?

Answer 20

Drugs, Viral Hepatitis, Autoimmune Hepatitis

Question 21

What is the common cause chronic liver failure?

Answer 21

Cirrhosis

Question 22

50 yo man with known ETOH abuse and a history of chronic back and joint pains comes for an office visit. Labs show AST 6145, ALT 5090, T.bili is 4.6, INR is 2.3.
Most likely diagnosis?

• 1. Alcoholic Hepatitis
• 2. Acetaminophen Toxicity
• 3. Acute hepatitis A
• 4. Ischemic hepatitis
• 5. Choledocholithiasis

Answer 22

• 2. Acetaminophen Toxicity

Question 23

What is the most common route to hepatic failure?

Answer 23

Cirrhosis

Question 24

Acute Liver Failure

Answer 24

Sudden loss of hepatic function in a person without evidence of preexisting liver disease

• Coagulopathy (INR > 1.5) AND
• Any degree of Hepatic Encephalopathy
• Both occurring within 24 weeks of the first onset of symptoms in patients without underlying liver disease

Question 25

Cirrhosis

Answer 25

A diffuse process with fibrosis and a conversion of normal tissue into abnormal nodules

Question 26

What stain can be used to better visualize cirrhosis?

Answer 26

Trichrome to see the collagen

Question 27

Pericellular Fibrosis

Answer 27

Fibrosis surrounds each cell - alcohol and non-alcohol liver disease both can present like this

Question 28

What are some causes of cirrhosis?

Answer 28

- Alcohol Liver Disease - Viral Hepatitis - Non-alcohol Liver Disease - Biliary Disease

Question 29

What are the clinical symptoms of cirrhosis?

Answer 29

Most are asymptomatic until liver failure develops. Others will have non-specific symptoms.

Question 30

How does cirrhosis lead to portal HTN?

Answer 30

- Increased vascular resistance – Distortion of vascular architecture with increase in vascular tone - Increased portal influx from splanchnic vasodilation

Question 31

What are the consequences of portal HTN?

Answer 31

* Portal hypertension leads to the development of intra- and extrahepatic venous collaterals * Shunts are created to allow blood to by-pass the intrahepatic resistance to blood flow

Question 32

A 60 yo woman with a long-standing history fo cirrhosis develops esophageal varices and hepatic encephalopathy. An abdominal ultrasound reveals thrombosis of the portal vein. Which of the following pressure measurements would you most likely expect to find? 1. Normal hepatic vein pressure gradient 2. Elevated wedged hepatic vein pressure 3. Elevated free hepatic vein pressure 4. Elevated hepatic vein pressure gradient 5. Low wedged hepatic vein pressure

Answer 32

4. Elevated hepatic vein pressure gradient

Question 33

What are some of the complications of cirrhosis?

Answer 33

``` – Ascites – Variceal bleeding – Hepatic encephalopathy – Hepatorenal syndrome – Hepatocellular carcinoma ```

Question 34

A 55 yo man with chronic hepatitis C related cirrhosis presents to the Liver Transplant clinic for an evaluation. He has had a large esophageal variceal bleed in the past and is now bothered by ascites. Which of the following best characterizes this patient’s circulation? 1. Low peripheral vascular resistance, low cardiac output, high rate of blood flow to splanchnic circulation 2. Low peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation 3. Low peripheral vascular resistance, high cardiac output, low rate of blood flow to the splanchnic circulation 4. High peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation

Answer 34

2. Low peripheral vascular resistance, high cardiac output, high rate of blood flow to the splanchnic circulation

Question 35

Which of the following lab tests is the most reliable indicator of liver function? 1. GGT 2. AST 3. Lipase 4. Indirect Bilirubin 5. Prothrombin Time(INR) 

Answer 35

5. Prothrombin Time(INR)