More f@$%# liver. Flashcards
What causes HELP syndrome?
A rare complication of eclampsia in preganancy
Hemolysis
Elevated liver enzymes
Low
Platelets
What is acute fatty liver of pregnancy?
Disorder that occurs in preganancy>
ACUTE onset of LIVER DYSFXN (severe> acute hepatic failure/death)
What is seen on a liver biopsy of a pt with acute fatty liver of pregnancy?
microvesicular steatosis
What is intrahepatic cholestasis of pregnancy?
Estrogenic hormones and biliary secretory defects>
mild increase in serum conjugated bilirubin>
slightly increased risk of:
fetal distress
still births
prematurity
What 3 liver abnormalities can occur in pts receiving a bone marrow transplant?
- Drug toxicity
- sinusoidal obstruction syndrome
- graft vs host disease (portal inflammation> vanishing bile ducts w/ fibrosis and cirrhosis)
What type of liver abnormalities can occur in pts receiving a liver transplant?
- Preservation injury (oxygen radicals in hypoxic organ> damage sinusoid)
- anastomatic problems
- Rejection (acute or chronic)
What is the MC benign neoplasm of the liver?
Hemangioma
What is a lesion of DISCRETE RED BLUE HEMORRHAGIC NODULES composed of DILATED endothelial lined BLOOD FILLED channels that is often accidentially found?
Hemangioma
What is a simple liver cyst?
Single/small cluster of cysts
composed of atrophic BILIARYepithelium
What is polycystic liver disease?
multiple cysts assocaited w/ polycystic kidney disease
What is a choledochal cyst?
CONGENITAL dilation of the common BILE DUCT
What complications are associated w/ choledochal cysts?
Dilated common bile duct>
- biliary obstruction
- stones
- bile duct carcinoma
What is Caroli’s disease?
congenital disorder>
intrahepatic biliary dilations>
1. congenital hepatic fibrosis
2. increases risk of cholangiocarcinoma
What is congenital hepatic fibrosis?
AR
non cirrhotic fibrotic liver disease of children
Assoc w/ PCKD
Increases risk of cholangiocarcinoma
What is focal nodular hyperplasia?
Localized vascular occlusive event>
Proliferation of liver parenchyma (CV, hepatocytes, portal triads)>
WELL DEMARCATED lesion
NOT malignant
What is nodular regenerative hyperplasia?
diffuse NONfibrosing hyperplasia of the liver
*pts are usually assumptomatic
What may be seen on angiography of focal nodular hyperplasia?
Peripheral filling pattern w/ central scar
What is a key complication of nodular regenerative hyperplasia?
Often assocaited w/ conditions that affect intrahepatic blood flow:
- solid organ transplant
- bone marrow transplant
- vasculitis
A young adult is asymptomatic but pathology of the liver reveals a mass w/ CENTRAL FIBROUS scar and STELLATE configuration.
Dx?
Focal nodular hyperplasia
What is hepatocellular adenoma?
well circumscribed BENIGN neoplasm composed of well differentiated hepatocytes>
hemorrhagic necrosis>
massive bleed
What population commonly gets hepatocellular adenomas?
Young reproductive age women
Assoc: OCP w/ high estrogen and anabolic steroids
What is the difference between a bile duct hamartoma and a bile duct adenoma?
hamartoma- MULTIPLE small white nodules
adenoma- SOLITARY, benign proliferation of bile ducts
Describe a CT image finding of a malignancy metastatic to the liver.
Multiple hepatic metasteses
solitary liver mass
How are metastatic tumors diagnosed?
Usually multiple tumors from carcinomas of the: lung GI tract breast and pancreas
What are the RF for hepatocellular carcinoma?
- hepatotrophic viruses (HBV, HCV)
- hepatocarcinogens (toxin)
- Cirrhosis (EtOH)
*chronic liver diseases
Grossly, _____________, appears as a diffusely infiltrative, SOFT and HEMORRHAGIC, solitary mass or multiple nodules.
HCC
How does the occurance of HCC in the US compare to that in SE Asia/Africa?
US- age 60, 80-95% assoc. w/ CIRRHOSIS
Africa/SE Asia- age 20-40, endemic HBV
What procedure can be used to screen for HCC?
High resolution US or CT
HIGH risk (cirrhosis/HBV) screen every 6 mos w/ liver US
How does fibrolamellar HCC differ from typical HCC?
Occurs in YOUNG adults w/ cirrhosis or chronic hepatitis, but has a BETTER prognosis than typical HCC
What is the characteristic microscopic appearance of fibrolamellar HCC?
POLYGONAL oncoytic tumor cells in
NESTS and CORDS
separated by
LAMEALLAR FIBROUS STROMA
What is a cholangiocarcinoma?
carcinoma arising from INTRA or EXTRA hepatic bile ducts
**ALWAYS adenocarcinoma
What are some RF for intrahepatic cholangiocarcinoma?
> 60
NO pre-existing conditions
- chronic cholangitis
- chronic HBV/HCV
What do you have to exclue before you can make a dx of intrahepatic cholangiocarcinoma?
metastases
What is a hepatoblastoma?
Rare tumor that occurs in infants or <3 children
Malignancy of imm. hepatocytes
What is an angiosarcoma of hte liver?
AGGRESSIVE
malignancy of endothelial cells>
tumor of anastomosing vascular channels lined by malignant endothelial cells
What cancer is associated w/ exposure to thorotrast, vinyl chloride and arsenic?
angiocarcinioma
What is a phrygian cap?
FUNDUS of gallbladder is FOLDED
What are the RF for the formation of a cholesterol gall stone?
N european, N/S american heritage
+ fam hx
FORTY, FAT, FEMALE, FERTILE
What are hte RF for the formation of pigment gall stone?
E asian
+ fam hx
Increased hemolysis
increased biliary tract infections
What imaging modality is used to detect gall stones?
Ultrasound
What are some complications of gallstones?
- biliary colic (pain w/ a fatty meal)
- acute cholecystitis
- chronic cholecystitis
- choledocholithiasis= stones in common bile duct
- ascneding cholangitis (bacterial infxn of intrahepatic BD)
What are complications of acute cholecystitis?
Perforation bile peritonitis acute cholanitis sepsis biliary enteric fistula gallstone ileus
What is choledocholithiasis?
stones in the common bile duct
What is the MCC of extrahepatic biliary obstruction?
stones in common bile duct
Are most gallstones symptomatic?
NO
70-80% are asymptomatic
What is chronic cholecystitis?
chronic inflamm. of the GB is almost always asssociated w/ cholelithiasis (stone obstruction)
Often caused by SUPERSATURATED BILE> chronic inflammation and formation of stones
What is a porcelain gallbladder?
dystrophic calcification of gallbladder wall
What is the gross appearance of cholesterolosis?
yellow mucosal flecks
What is the gross appearance of cholesterol polyps?
yellow small polyps
What is the gross appearance of mucocele?
distended GB w/ atrophic wall
What is an adenoma of hte GB?
BENIGN NEOPLASM
What is an adenomyoma of the GB?
gallbaldder diverticulae w/ focal muscular hypertrophy>
intramural thickening of the fundic wall
*usually located at hte fundus
Is an adenoma or adenomyoma neoplastic?
adenoma is a BENIGN neoplasm
adenomyoma is NOT a true neoplasm
What is a RF for GB carcinoma?
> 50
Female
cholelithiasis (irrative trauma, chronic inflamm)
Why is the survival rate for carcinoma of the GB so low?
SILENT TUMOR
by the time sxs appear has usually spread to liver or LN
What are the 3 types of cholangiocarcinomas?
- Intrahepatic (LC)
- Extrahepatic (MC)
- Distral extraheaptic
What other name is sometimes used for perihilar cholangiocarcinoma?
Extrahepatic (MC)
What is periampullary carcinoma?
from upper border of pancreas to ampulla
What are some RF for extrahepatic cholangiocarcinoma?
conditions> chronic cholangitis
- liver fluke infxn
- PSC
- choledochal cysts
- stones
What is the clinical presentation and lab findings of extrahepatic cholangiocarcinoma? Is it similar to that seen in carcinoma of the head of hte pancreas?
Painless jaundice secondary to obstruction
increased ALP/GGT
Why is the prognosis poor for extrahepatic cholangiocarcinoma and better for periampullary carcinoma?
prognosis is VERY POOR…idk why prognosis is better for the other guys
