Pathogenesis of Cirrhosis/Liver Tumors Flashcards
dual blood supply to liver
hepatic artery and portal vein
is fibrosis reversible?
reversible in early stage, irreversible in late stage
regeneration + fibrosis –> eventual cirrhosis
what types of cells are important in leading to collagen deposition and cirrhosis?
stellate cells b/t hepatocyte and sinusoid
stages of cirrhosis
- portal
- periportan
- bridging
- cirrhosis
causes of cirrhosis
- chronic viral hepatitis
- NASH
- alcoholic liver disease
- biliary diseases
- metabolic storage diseases:
- A1AT deficiency
- primary hemochromatosis
- Wilson’s disease
intracellular A1 globules in A1AT deficiency
sx of hepatic failure
- jaundice
- hypoalbuminemia –> peripheral edema, ascites
- coagulopathy (2, 7, 9, 10) –> GI bleeds
- hyperammonemia –> encephalopathy –> coma
types of primary liver tumors originating from hepatocyte
benign: hepatic adenoma, focal nodular hyperplasia
malignant: HCC, hepatoblastoma
types of primary liver tumors resulting from biliary epithelium
benign: bile duct adenoma, biliary hamartoma
malignant: cholangiocarcinoma
hepatocellular adenoma
epi: mostly females, 20s-30s
Risk factors: assoc w/ oral contraceptives, androgenic steroids, mutations in HNF1alpha and beta-catenin, MODY3
presentation: RUQ mass, pain, hemorrhage
dx: CT, biopsy
tx: resection if large
hepatocellular adenoma
hepatocytes normal, but lackig portal area w/ bile ducts
vessels –> risk of hemorrhage
focal nodular hyperplasia
benign tumor of hepatocytes
usually asymptomatic
histology: fibrous septae, central scar, bile ductal proliferation – hard to distinguish from cirrhosis
focal nodular hyperplasia
- bile duct proliferation not seen in adenoma
- fibrous bands on trichrome stain
hepatocellular carcinoma - epi
malignant tumor of hepatocytes –> lots of deaths
male predominant
80% assoc w/ chronic HBV or HCV
cirrhotic liver with nodules. dysplastic nodules can lead to HCC.
HCC w/ portal vein invasion
fibrolamellar hepatocellular Ca
special type of HCC w/ no association to chronic liver disease
more common in age 20-40
better prognosis
cholangiocarcinoma
adenocarcinoma arising from bile duct epithelium
can be intrahepatic, hilar, or extrahepatic
etiology of cholangiocarcinoma
- primary sclerosing cholangitis
- liver flukes
- hepatolithiasis
- fibrocystic liver disease
hepatoblastoma
occurs mostly <5 yo
enlarging upper abdominal mass
elevated AFT (alpha-fetoprotein)
sx: virilization and precocious puberty b/c excess hCG production
intrahepatic cholangiocarcinoma
hilar cholangiocarcinoma
