pathology 8

Question 1

What two viral diseases are associated with an increased incidence of hepatocellular carcinoma?

Answer 1

Hepatitis B and C

Question 2

Excessive exposure to what two substances is associated with an increased incidence of hepatocellular carcinoma?

Answer 2

Alcohol (alcoholic cirrhosis) and carcinogens such as aflatoxin

Question 3

A 52-y/o man comes in with RUQ abdominal pain and is convinced that this could be liver cancer. What signs/symptoms could you check for?

Answer 3

Jaundice, tender hepatomegaly, ascites, polycythemia, anorexia

Question 4

A doctor suspects hepatocellular carcinoma in a patient. She orders what lab, expecting it to be elevated?

Answer 4

α-fetoprotein, because it is elevated in hepatocellular carcinoma

Question 5

How might a hepatocellular carcinoma predispose a patient to Budd-Chiari syndrome?

Answer 5

Via polycythemia (a hypercoagulable state leading to thrombosis in the hepatic vein) or by direct compression of the hepatic vein

Question 6

A woman with hemochromatosis develops jaundice and ascites and is found to have elevated serum α-fetoprotein levels. What is the diagnosis?

Answer 6

Hepatocellular carcinoma

Question 7

Under what circumstances would a liver biopsy for a patient with a liver tumor be contraindicated?

Answer 7

If the tumor is thought to be a cavernous hemangioma due to potential aspiration causing a life-threatening hemorrhage

Question 8

A liver mass is incidentally discovered in a 34-year-old man with no risk factors for carcinoma. Do go you straight to biopsy?

Answer 8

No, as this may be a cavernous hemangioma, commonly occurring in people 30–50 y/o for whom biopsy is dangerous due to bleeding risk

Question 9

A patient on oral contraceptives is discovered to have a benign liver tumor. What is she most likely to have?

Answer 9

Hepatic adenoma

Question 10

A patient often works with arsenic and polyvinyl chloride. He is found to have a malignant liver tumor. What liver tumor do you suspect?

Answer 10

Angiosarcoma

Question 11

A patient on anabolic steroids has a benign liver tumor. What are two outcomes for this tumor?

Answer 11

The tumor (a hepatic adenoma) either can regress spontaneously or can rupture, causing abdominal pain or shock

Question 12

A woman has a liver mass seen on ultrasound, and you are concerned that this could be a metastasis from a malignancy of which organs?

Answer 12

GI, lung, and breast tumors (metastases are the most common liver tumors)

Question 13

Blood backup to liver, commonly caused by right-sided heart failure and Budd-Chiari syndrome, leads to what liver finding?

Answer 13

Nutmeg liver (mottled liver appearance)

Question 14

The liver of your patient with hepatic vein thrombosis is mottled, similar to nutmeg. If this condition persists, what outcome might occur?

Answer 14

Centrilobular congestion and necrosis can be expected, possibly leading to cirrhosis if it persists (this is Budd-Chiari syndrome)

Question 15

In Budd-Chiari syndrome, there is occlusion of the ____ vena cava and/or the ____ veins.

Answer 15

Inferior; hepatic

Question 16

What liver region becomes congested and necrotic in Budd-Chiari syndrome?

Answer 16

The centrilobular region

Question 17

A patient with polycythemia vera develops new-onset ascites, abdominal pain, and elevation of liver enzymes. What do you suspect?

Answer 17

Congestive liver failure secondary to Budd-Chiari syndrome

Question 18

What medical conditions are often associated with Budd-Chiari syndrome?

Answer 18

Polycythemia vera, pregnancy (postpartum state), hypercoagulable states, hepatocellular carcinoma

Question 19

A patient with known hypercoagulability has developed ascites with visible abdominal and back veins. What exam finding can rule out HF?

Answer 19

Absence of JVD would support Budd-Chiari syndrome (the occlusion is distal) instead of HF

Question 20

In your patient with prolonged expiratory time, what type of emphysema is more consistent with α1-antitrypsin deficiency than with COPD?

Answer 20

Panacinar emphysema caused by breakdown of elastic fibers of the lungs (as opposed to centriacinar [centrilobular] emphysema in COPD)

Question 21

α1-antitrypsin deficiency can be diagnosed histologically by seeing what in liver biopsy samples?

Answer 21

PAS-positive globules

Question 22

A patient has panacinar emphysema and a liver tumor. He has a certain protein deficiency. What is the pattern of inheritance of this trait?

Answer 22

Codominant (this patient has α1-antitrypsin deficiency, which is a codominant trait)