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PCM Exam 4 > Pathology of GIT: Liver > Flashcards

Pathology of GIT: Liver Flashcards

1
Q

fibrosis due to _______ starts from the central vein

A

alcoholic liver disease

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2
Q

liver tumors most commonly metastasize to the ______

A

colon

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3
Q

hepatic adenoma is associated with the use of _____ or _____

A

oral contraceptives or anabolic steroids

NORMAL AFP

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4
Q

Hepatitis ___ and ____ are risk factors for developing HCC

A

hepatitis B and C

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5
Q

↑ levels of _____ is seen in HCC

A

AFP

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6
Q

which zone in the liver is closest to the central vein?

A

zone 3

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7
Q

if a patients serum level show the presence of anti mitochondrial antibodies, what cholangiopathy should you be thinking

A

primary biliary cholangitis

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8
Q

vascular diseases predominately affected zone ____ of the liver

A

zone 3

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9
Q

global distribution of HCC is strongly related to the prevalence of _____ (virus) and highest frequencies are in _____, ____, and _____

A

HBV; Taiwan, Mozambique and China

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10
Q

a common cause of central necrosis of the liver is __________ (drug)

A

acetaminophen (massive necrosis with little inflammation)

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11
Q

what are some causes of macrovesicular steatosis in hepatic injury

A
  • alcohol

- malnutrition

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12
Q

what are some risk factors for non alcoholic fatty liver disease (NAFLD)

A
  • obesity
  • insulin resistance
  • diabetes
  • hyperlipidemia
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13
Q

what are the two autoimmune cholangiopathies

A
  • primary biliary cholangitis

- primary sclerosing cholangitis

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14
Q

how would you treat autoimmune hepatitis?

A

give corticosteroids are soon as possible to prevent fulminant hepatitis

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15
Q

describe the histological finding of cholangiocarcinoma

A
  • follows bile duct system
  • ducts are dilated with pale tissue around them
  • irregular, atypical ducts surrounded by loose desmoplastic stroma
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16
Q

what are some major features of portal hypertension?

A
  • ascites
  • splenomegaly (thrombocytopenia)
  • esophageal/gastric varicies
  • caput medusae
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17
Q

copper deposits in the brain are typically deposited in the ___________ in Wilson’s disease

A

basal ganglia

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18
Q

Wilson disease is a ________ (mode of inheritance) disease due to a mutation on ______ gene leading to _________

A

autosomal recessive disorder with a mutation on the ATP7 gene on chromosome 13 leading to toxic levels of copper in the liver, brain and eyes

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19
Q

what are 3 genetic and metallic liver diseases that can cause chronic hepatitis?

A
  • alpha 1 antitrypsin deficiency
  • wilson disease
  • hemochromatosis
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20
Q

_______ is the most common tumor in the liver

A

hemangioma (non epithelial neoplasm)

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21
Q

low levels of ________ is indicative of Wilson’s disease

A

ceruloplasmin (copper carrying protein)

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22
Q

a diagnostic sign of focal nodular hyperplasia on CT/MRI is ________

A

central/focal scar

on H&E no mitosis or atypia

23
Q

which cholangiopathy has a strong association with IBD (ulcerative colitis) ?

A

primary sclerosing cholangitis

24
Q

________ is characterized by non necrotizing granulomatous destruction of small and medium sized bile ducts

A

primary biliary cholangitis

25
Q

describe the radialogical findings in someone with primary biliary cholangitis

A

normal, so must do biopsy to diangnose

beading is seen on radiology of primary sclerosing cholangitis

26
Q

mis-folded alpha 1 antitrypsin proteins are found in the ____ of the hepatocytes

A

ER

27
Q

on ERCP, you see dilation and beading of the biliary tree. what is the most likely diagnosis

A

primary sclerosing cholangitis

28
Q

________ antibodies are found in primary biliary cholangitis

A

anti- mitochondrial antibodies

29
Q

in what age group of patients do you usually see the fibrolamellar variant of HCC

A

younger age w/ no association with HBV or cirrhosis

30
Q

what conditions can you expect to see ↑ AFP levels

A
  • HCC
  • yolk sac tumors
  • germ cell tumors
  • cirrhosis
  • pregnancy with fetal neural tube defects
  • massive liver necrosis
31
Q

classify the types of autoimmune hepatitis based on the antibodies found

A

type 1 adults: anti nuclear and anti smooth muscle antibodies

type 2 children/teens: anti LKM (liver kidney microsomal type)

32
Q

presence of what marker is seen in primary sclerosing cholangitis

A

p-ANCA

33
Q

where is copper deposited in the eyes in Wilson’s diseases

A

Descemet membrane of the cornea → Kayser Fleischer ring

34
Q

what are some risk factors for extra hepatic cholangiocarcinoma

A
  • sclerosing cholangitis
  • gallstones
  • malformation of biliary system
  • chemicals: benzidine, nitrosamines
  • parasitic infections: clonorchis sinensis and opithorchis viverini
35
Q

HCC has a strong propensity for invading what structures in the liver?

A

vascular channels such as the portal vein or IVC

36
Q

mutations in _______ cause of hepatic adenoma has the most frequent associated with HCC (hepatocellular carcinoma)

A

mutations in β catenin

37
Q

Charcot’s triad is used with regard to ascending cholangitis. what are the three common signs and symptoms

A
  • Right upper quandrant pain
  • jaundice
  • fever
38
Q

which cholangiopathy has less inflammation and a layering form of fibrosis (“onion skin” lesion_

A

primary sclerosing cholangitis

39
Q

ALP/GGT tell you the function of _______

A

bile ducts
ALP is ↑ in biliary obstruction

look at GGT in kids but ALP is fine for adults

40
Q

_______ is the type of liver cirrhosis seen in hemochromatosis

A

micronodular liver cirrhosis

41
Q

HCC in children usually occur in conjunction with ______

A

occurs with a metabolic liver disease that can cause cirrhosis

42
Q

single hard tumor with fibrous bands transversing throughout it with well differentiated polygonal cells in cords/nests separated by fibrous septa is indicative of ______

A

fibrolamellar variant of HCC

will also be green in color due to bile production by tumor

43
Q

what are the mutations associated with the different subtypes of hepatic adenoma and their presentation on histology

A
  • mutation in hepatocyte nuclear factor 1 α = rich in fat and minimal risk for HCC
  • mutation in β catenin = cytologic atypica and high risk for HCC
  • mutation in IL-6 receptor pathway = sinusoidal dilation (look at CRP)
44
Q

primary sclerosing cholangitis mainly affects ______

A

extra hepatic and large intrahepatic ducts

45
Q

small and medium sized ducts are affected in ________

A

primary biliary cholangitis

46
Q

what are three characteristics of liver cirrhosis

A
  • bridging fibrous septa
  • parenchymal nodules created by regeneration
  • diffuse involvement of the liver
47
Q

what are some causes of microvesicular steatosis in hepatic injury

A
  • acute fatty liver of pregnancy
  • Reye syndrome
  • drugs
48
Q

what would you see on histology for HCC

A
  • bile production by tumor cells (MAIN FEATURE)→ cytoplasmic inclusions and gives it a green color
  • usually cirrhosis in adjacent liver parenchyma
  • well differentiated to poorly differentiated
49
Q

describe the test you would do to stain for α1 antitrypsin deficiency in the hepatocytes

A
  • add diastase with PAS because the cytoplasmic globules in the periportal hepatocytes are PAS positive and diastase resistant
50
Q

______ is a marker that is ↑ in hepatocellular carcinoma (HCC)

A

AFP (alpha fetoprotein)

51
Q

ALT/AST tell you the function of ________

A

hepatocytes; ALT is more specific for liver injury than AST

52
Q

alcohol usually causes _________ steatosis of hepatic injury

A

macrovesicular

53
Q

what liver diseases are AFP levels normal?

A
  • fibrolamellar variant of HCC

- cholangiocarcinoma

54
Q

describe the symptoms of Reynaud’s pentad

A

Charcot’s triad (RUQ pain, jaundice, fever) + hypotension/shock + confusion

PCM Exam 4 (44 decks)

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