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
alcoholic cirrhosis (quick)
micronodular, shrunken liver w/ “hobnail” appearance;
zone III sclerosis around central vein
jaundice, hypoalbuminemia;
irreversible
Patient presents w/ long term consumption of alcohol. He has jaundice, a tender hepatomegaly, ascites and is hypoglycemic. What would be expected on CBC?
elevated Hct (increase RBC); increased alpha fetoprotein
how does hepatocellular carcinoma spread?
hematogenously
What is most common 1’ malignant tumor of liver in adults?
hepatocellular carcinoma / hepatoma
Hepatocellular carcinoma is seen in association in what?
hep B and C (only chronic heps) Wilson's disease; hemochromatosis; a1-antitrypsin deficiency; alcoholic cirrhosis carcinogens
What are findings assoc w/ hepatocellular carcinoma?
jaundice; tender hepatomegaly; ascites; polycythemia; hypoglycemia
A homeless man has jaundice, tender hepatomegaly, ascites and is hypoglycemia. You think hepatocellular carcinoma but none of the causes are present. He does state that food is scarce and often has to eat food that has been thrown out. How could this cause his cancer?
aflatoxin from Aspergillus on molded bread, potatoes
What is a common benign liver tumor occuring bw ages 30-50 that should not be Bx? why?
Cavernous hemangioma => Bx causes a risk of hemorrhage
A 25yr old girl has been taking oral contraceptives for 10yrs. What liver tumor is she at risk for? What is the invasion risk of this tumor? and how should it be treated?
Hepatic adenoma
benign liver tumor
regresses spontaneously
A 60yr old man is a farmer who mixes his own pesticides. He finds out arsenic is a major part of the pesticide. what liver tumor is he at risk for? what is invasion risk of this tumor?
Angiosarcoma;
malignant tumor of endothelial origin so may invade
cavernous hemangioma (quick)
benign
age 30-50;
risk of hemorrhage => NO Bx
hepatic adenoma (quick)
benign
oral contraceptive or steroid use
regresses spontaneously
angiosarcoma (quick)
malignant endothelial tumor
arsenic, polyvinyl chloride exposure
What is the risk associated w/ hepatic adenoma?
rupture of risk in pregnancy causing intraperitoneal hemorrhage
Define nutmeg liver. What are common causes?
backup of blood into liver;
R sided HF and Budd-Chiari syndrome
Describe appearance of nutmeg liver
liver appears mottled like a nutmeg
If liver congestion (nutmeg liver) persists, what is the final pathway?
centrilobular congestion and necrosis result in cardiac cirrhosis
Define Budd-Chiari syndrome. What does it cause?
occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis => congestive liver disease
What are the presentation of Budd-Chiari syndrome?
hepatomegaly, ascites, abdominal pain, eventual liver failure;
If occlusion of IVC or hepatic veins occurs as in Budd-Chiari, how does the body compensate?
develops varices and have visible abdominal and back veins but NO JVD
The occlusion leading to Budd-chiari syndrome may be caused by what?
hypercoagulable state (obese, OCP, non-mobile); polycythemia vera (increase RBC => increase Hct); pregnancy (increase estrogen=> increase clotting); hepatocellular carcinoma (mechanical block)
A patient has emphysema and cirrhosis but does not smoke. What is Dx?
alpha-1 antitrypsin deficiency
Define alpha-1 antitrypsin deficiency
misfolded gene product protein aggregates in hepatocellular ER
How can alpha-1 antitrypsin deficiency be proven?
cirrhosis w/ PAS positive globules in liver
What is alpha-1 antitrypsin deficiency cause in lung?
lack of functioning enzyme => decreases elastic tissue => panacinar emphysema
alpha-1 antitrypsin is associated w/ what type of genetic inheritance?
codominant trait
