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GI > Pathogenesis of cirrhosis and liver tumors > Flashcards

Pathogenesis of cirrhosis and liver tumors Flashcards

1
Q

What’s different about the sinusoids of a cirrhotic liver?

A

No fenestrations!

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2
Q

What are the three main types of inflammation?

A
  1. Portal: Around portal tracts
  2. Interface: Spilling out of the focal area of inflammation into the parenchyma
  3. Lobular: Parenchymal inflammation
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3
Q

What is the process behind fibrosis of the liver?

A

Stellate cells in the space of disse are activated by kupffer cells, causing proliferation and production of collagen deposition

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4
Q

Histological appearance of a fibrotic liver:

A

Disappearance of lobules
bridging fibrous septa
parenchymal nodules

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5
Q

Features of hepatic failure

A
  1. Jaundice
  2. Hypoalbuminemia–>edema
  3. Coagulopathy
  4. Hyperammonemia
  5. Hyperestrogenemia (plamar erythema, spider aniomata, and hypogonadism+gynecomastia
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6
Q

What are two benign liver tumors originating from hepatocytes?

A
  1. hepatic adenoma

2. focal nodular hyperplasia

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7
Q

What are malignant tumors originating from hepatocytes?

A
  1. Hepatocellular carcinoma

2. Hepatoblastoma

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8
Q

What are the benign tumors originating from biliary epithelium? Malignant?

A

Benign: bile duct adenoma + biliary hamartoma
Malignant: Cholangiocarcinoma

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9
Q

What are benign tumors originating from mesenchyme?

A

Benign: hemangioma/angiomyolipoma
Malignant: Angiosarcoma

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10
Q

Typical pt with hepatocellular adenoma?

A

Female 30-40’s

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11
Q

What is hepatocellular adenoma associated with?

A

Oral contraceptive steroids

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12
Q

How does hepatocellular adenoma present?

A

RUQ mass, pain, hemorrhage

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13
Q

How do you diagnose hepatocellular adenoma?

A

CT

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14
Q

How do you treat hepatocellular adenoma?

A

Resection if it’s larger than 5 cm

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15
Q

What does hepatocellular adenoma look like on histology?

A

normal looking hepatocytes, but no bile ducts or portal tracts.

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16
Q

What are you most worried about with hepatocellular adenoma?

A

They are benign, but can cause massive intra-peritoneal hemorrhage

17
Q

What is your typical pt with focal nodular hyperplasia?

A

All ages, more common in men

18
Q

What does focal nodular hyperplasia look like on histology?

A

JUST LIKE CIRRHOSIS. Therefore, you need to know whether your sample is seen all over the liver or just in a single mass lesion

19
Q

What is your typical pt with hepatoblastoma?

A

Under 5 years of age. More common in males

20
Q

How does hepatoblastoma present?

A

Rapidly enlarging upper abdominal mass

  • -Fever, N/V, diarrhea
  • -Elevated AFP
  • -High HCG–>virilization and precocious puberty
21
Q

What are the different types of hepatoblastoma?

A
  1. Embryonic type (looks like a PNET)
  2. Fetal (clear cytoplasm)
  3. Cholangioblastic (lots of ducts)
  4. Mixed (stromal component with bone)
22
Q

How do you treat hepatoblastoma?

A

Surgery + chemotherapy

23
Q

What are common causes of HCC?

A
  1. Hep B
  2. Aflatoxin
  3. Hep C
  4. Alcoholic liver dz
  5. NASH
24
Q

What is the MOST common cause of HCC in the US?

A

HCV

25
Q

What are the different types of HCC?

A
  1. Solid
  2. Trabecular
  3. Acinar
  4. Mixed
26
Q

Fibrolamellar hepatocellular Ca

A

no association with chronic liver disease. It has a better prognosis. Will see lots of fibrous bands

27
Q

What is cholangiocarcinoma related to?

A

Associated with primary sclerosing cholangitis (NO relation to cirrhosis)

28
Q

What serum marker is elevated in HCC? cholangiocarcinoma?

A

HCC=Alpha fetoprotein

cholangiocarcinoma=CEA

29
Q

What are other differences btw HCC vs cholangiocarinoma?

A

Cholangiocarinoma:

  • -no liver cell dysplasia
  • -Absent bile production
  • -Mucin secretion is present…can stain for this
  • -On gross, looks hard and white (as opposed to soft and hemorrhagic)
  • -Spreads through lymphatics

GI (27 decks)

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