Pathology 1

Question 1

What are the normal roles of the liver?

Answer 1

protein synthesis
bilirubin metabolism and excretion
metabolism of lipids, carbs, AAs, and vitamins
storage of vitamins, glycogen, etc.

Question 2

What is normally contained in the Space of Disse?

Answer 2

small amounts of collagen type IV, basement membrane proteins, minimal amounts of interstitial or fibril forming collagens
stellate cells - storage, can respond to stimuli to proliferate and become myofibroblast-like

Question 3

What are ballooning and feathering/foamy?

Answer 3

hepatocellular degeneration - look similar but feathery only in cholestasis

Question 4

What are the roles of lipofuscin pigment and metals (iron and copper) in liver injury?

Answer 4

can accumulate - Prussian blue stains for hemosiderin or iron, Rhodanine stains for copper

Question 5

What are the different forms of inflammation or hepatitis?

Answer 5

mononuclear
acute
mixed
granulomatous

Question 6

How does the process of regeneration begin?

Answer 6

oval cells in canals of Hering are reserve cell compartment for this and metaplastic ductular proliferation

Question 7

What can cause hepatocellular degeneration?

Answer 7

hypoxia, ROS, NO, bile acids, toxins, TNFalpha, immune processes and inflammation

Question 8

When does jaundice ensue?

Answer 8

when bilirubin levels exceed 2-3 mg/dl

Question 9

What are hereditary disorders associated with primarily conjugated hyperbilirubinemia?

Answer 9

Dubin-Johnson and Rotor syndrome

Question 10

What syndromes present with unconjugated hyperbilirubinemia?

Answer 10

Crigler-Najjar, Gilbert

Question 11

What is Gilbert syndrome?

Answer 11

mild fluctuating unconjugated hyperbilirubinemia due to decreased hepatocyte, bilirubin UDP-glucoronyl transferase activity
unremarkable clinical course

Question 12

What changes are seen in cirrhosis?

Answer 12

loss of material exchange between blood and hepatocytes, loss of microvilli, sinusoids become vascular channels, vascular shunts between hepatic arterial, portal venous, and hepatic venous circulations

Question 13

Which two types of cirrhosis look different than the others?

Answer 13

biliary tract diseases - nodules not as uniform and round

cardiac - starts as central vein associated, then bridging between central veins

Question 14

What are the major causes of cirrhosis?

Answer 14

chronic viral hepatitis
alcoholic or nonalcoholic steatohepatitis
autoimmune diseases
iron overload

Question 15

What are the features of portal HTN?

Answer 15

portal-systemic vascular shunts
ascites
congestive splenomegaly

Question 16

What are the four places that portal-systemic vascular shunts happen?

Answer 16

intrahepatic
gastroesophageal - varices and portal gastropathy
periumbilical - caput medusae
hemorrhoids

Question 17

What are the outcomes of viral hepatitis?

Answer 17

asymptomatic inf
symptomatic acute inf - anicteric or icteric dz, fulminant hepatitis
resolution and recovery
chronic hepatitis with or without progressive liver dz

Question 18

What happens during acute symptomatic hepatitis?

Answer 18

inflammation - portal and interface between portal tracts and parenchyma 
Kupffer activation and proliferation
cell degeneration +/- cholestasis
lobular disarray
regeneration

Question 19

What causes the symptoms and pathology of viral hepatitis?

Answer 19

immune response - cytotoxic t cells destroy virally infected liver cells

Question 20

What are liver biopsies used for in chronic hepatitis?

Answer 20

confirm histologic features of viral hepatitis
evaluate grade of inflammation and cell injury
evaluate stage of fibrosis present
can help guide treatment