Pathology (liver, pancreas, gallbladder) Flashcards
50 yr old man complains of a “fat” stomach with no change in diet, painful hemorrhoids, and testicular atrophy. He admits to chronic alcohol abuse for 20yrs. On blood work, a decrease in clotting factors, anemia and increase in PT time is noted. What are the micro findings in the liver of this patient?
diffuse fibrosis and nodular regeneration destroys normal architecture of liver
Does cirrhosis increase risk of cancer?
increases risk for hepatocellular carcinoma
What are the primary causes of cirrhosis of the liver?
alcohol (60-70%);
viral hepatitis;
biliary disease;
hemochromatosis
Cirrhosis can lead to portal HTN. what are the effects of portal HTN?
esophageal varices => hematemesis, melena peptic ulcer => melena splenomegaly caput medusae, ascites portal hypertensive gastropathy hemorrhoids
Cirrhosis is end stage liver failure. what are the effects of liver cell failure?
coma scleral icterus fetor hepaticus (breath smells musty) spider nevi gynecomastia jaundice testicular atrophy liver "flap" => asterixis (coarse hand tremor) bleeding tendency => decrease clotting factors, increase PT time anemia ankle edema
How might the body compensate to alleviate effects of portal HTN?
esophageal varices;
caput medusae
give serum marker level for viral hepatitis
ALT > AST
give serum marker level for alcoholic hepatitis
AST > ALT
give serum marker level for obstructive liver disease (HCC), bone disease, bile duct disease
ALP
give serum marker level for various liver and biliary diseases. What will this rule out?
GGT
rules out bone disease w/ high ALP
give serum marker level for acute pancreatitis
elevated amylase and lipase
What cannot be ruled out if amylase is high?
parotid gland involvement such as MUMPS
give serum marker level in Wilson’s disease
DECREASE in Ceruloplasmin
A 5yr old has runny nose and sore throat and has been crying all night. The father of the child thinks the child is asleep so gives him aspirin bc it works when he has pain. What are the micro findings on the 5yr old?
Reye’s syndrome => mitochondrial abnormalities, microvesicular fatty change (fatty liver), hypoglycemia
What is the mechanism in which aspirin causes Reye’s syndrome?
aspirin metabolites decreases Beta oxidation by reversible inhibition of mitochondrial enzyme
Define Reye’s syndrome
rare, often fatal childhood hepatoencephalopathy associated w/ viral infection (VZV, influenza B) being treated w/ aspirin
What are findings associated w/ Reye’s syndrome?
mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma
To avoid Reye’s syndrome, what Rx should be avoided in children? what disease is only one where this Rx should be administered to children?
avoid aspirin in children;
Kawasaki’s disease is only disease w/ use for aspirin
What are the 3 types of alcoholic liver disease?
hepatic steatosis;
alcoholic hepatitis;
alcoholic cirrhosis
What will occur to the liver w/ moderate alcohol intake? Can it be reversed?
macrovesicular fatty change that is reversible upon alcohol cessation => hepatocytes filled w/ fat droplets
Patient comes in with regular, heavy alcohol alcohol use over the past 4 years. What are the lab findings? How does this present histologically?
AST > ALT (usually > 1.5)
swollen and necrotic hepatocytes w/ neutrophilic infiltration;
Mallory bodies present (intracytoplasmic eosinophilic inclusions)
Patient has been heavily drinking alcohol for 20 years. How will the liver present micro and gross? Can it be reversed?
micronodular, irregular shrunken liver w/ “hobnail” appearance;
Sclerosis around central vein (zone III);
final and irreversible alcoholic liver
Hepatic steatosis (quick)
short term moderate alcohol intake;
macrovesicular fatty change (reversible)
alcoholic hepatitis (quick)
long term consumption;
swollen, necrotic hepatocytes w/ neutrophils;
Mallory bodies (intracytoplasmic eosinophilic inclusions);
AST > ALT
