Pathology of GIT: Liver Flashcards
fibrosis due to _______ starts from the central vein
alcoholic liver disease
liver tumors most commonly metastasize to the ______
colon
hepatic adenoma is associated with the use of _____ or _____
oral contraceptives or anabolic steroids
NORMAL AFP
Hepatitis ___ and ____ are risk factors for developing HCC
hepatitis B and C
↑ levels of _____ is seen in HCC
AFP
which zone in the liver is closest to the central vein?
zone 3
if a patients serum level show the presence of anti mitochondrial antibodies, what cholangiopathy should you be thinking
primary biliary cholangitis
vascular diseases predominately affected zone ____ of the liver
zone 3
global distribution of HCC is strongly related to the prevalence of _____ (virus) and highest frequencies are in _____, ____, and _____
HBV; Taiwan, Mozambique and China
a common cause of central necrosis of the liver is __________ (drug)
acetaminophen (massive necrosis with little inflammation)
what are some causes of macrovesicular steatosis in hepatic injury
- alcohol
- malnutrition
what are some risk factors for non alcoholic fatty liver disease (NAFLD)
- obesity
- insulin resistance
- diabetes
- hyperlipidemia
what are the two autoimmune cholangiopathies
- primary biliary cholangitis
- primary sclerosing cholangitis
how would you treat autoimmune hepatitis?
give corticosteroids are soon as possible to prevent fulminant hepatitis
describe the histological finding of cholangiocarcinoma
- follows bile duct system
- ducts are dilated with pale tissue around them
- irregular, atypical ducts surrounded by loose desmoplastic stroma
what are some major features of portal hypertension?
- ascites
- splenomegaly (thrombocytopenia)
- esophageal/gastric varicies
- caput medusae
copper deposits in the brain are typically deposited in the ___________ in Wilson’s disease
basal ganglia
Wilson disease is a ________ (mode of inheritance) disease due to a mutation on ______ gene leading to _________
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
what are 3 genetic and metallic liver diseases that can cause chronic hepatitis?
- alpha 1 antitrypsin deficiency
- wilson disease
- hemochromatosis
_______ is the most common tumor in the liver
hemangioma (non epithelial neoplasm)
low levels of ________ is indicative of Wilson’s disease
ceruloplasmin (copper carrying protein)
a diagnostic sign of focal nodular hyperplasia on CT/MRI is ________
central/focal scar
on H&E no mitosis or atypia
which cholangiopathy has a strong association with IBD (ulcerative colitis) ?
primary sclerosing cholangitis
________ is characterized by non necrotizing granulomatous destruction of small and medium sized bile ducts
primary biliary cholangitis
describe the radialogical findings in someone with primary biliary cholangitis
normal, so must do biopsy to diangnose
beading is seen on radiology of primary sclerosing cholangitis
mis-folded alpha 1 antitrypsin proteins are found in the ____ of the hepatocytes
ER
on ERCP, you see dilation and beading of the biliary tree. what is the most likely diagnosis
primary sclerosing cholangitis
________ antibodies are found in primary biliary cholangitis
anti- mitochondrial antibodies
in what age group of patients do you usually see the fibrolamellar variant of HCC
younger age w/ no association with HBV or cirrhosis
what conditions can you expect to see ↑ AFP levels
- HCC
- yolk sac tumors
- germ cell tumors
- cirrhosis
- pregnancy with fetal neural tube defects
- massive liver necrosis
classify the types of autoimmune hepatitis based on the antibodies found
type 1 adults: anti nuclear and anti smooth muscle antibodies
type 2 children/teens: anti LKM (liver kidney microsomal type)
presence of what marker is seen in primary sclerosing cholangitis
p-ANCA
where is copper deposited in the eyes in Wilson’s diseases
Descemet membrane of the cornea → Kayser Fleischer ring
what are some risk factors for extra hepatic cholangiocarcinoma
- sclerosing cholangitis
- gallstones
- malformation of biliary system
- chemicals: benzidine, nitrosamines
- parasitic infections: clonorchis sinensis and opithorchis viverini
HCC has a strong propensity for invading what structures in the liver?
vascular channels such as the portal vein or IVC
mutations in _______ cause of hepatic adenoma has the most frequent associated with HCC (hepatocellular carcinoma)
mutations in β catenin
Charcot’s triad is used with regard to ascending cholangitis. what are the three common signs and symptoms
- Right upper quandrant pain
- jaundice
- fever
which cholangiopathy has less inflammation and a layering form of fibrosis (“onion skin” lesion_
primary sclerosing cholangitis
ALP/GGT tell you the function of _______
bile ducts
ALP is ↑ in biliary obstruction
look at GGT in kids but ALP is fine for adults
_______ is the type of liver cirrhosis seen in hemochromatosis
micronodular liver cirrhosis
HCC in children usually occur in conjunction with ______
occurs with a metabolic liver disease that can cause cirrhosis
single hard tumor with fibrous bands transversing throughout it with well differentiated polygonal cells in cords/nests separated by fibrous septa is indicative of ______
fibrolamellar variant of HCC
will also be green in color due to bile production by tumor
what are the mutations associated with the different subtypes of hepatic adenoma and their presentation on histology
- 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)
primary sclerosing cholangitis mainly affects ______
extra hepatic and large intrahepatic ducts
small and medium sized ducts are affected in ________
primary biliary cholangitis
what are three characteristics of liver cirrhosis
- bridging fibrous septa
- parenchymal nodules created by regeneration
- diffuse involvement of the liver
what are some causes of microvesicular steatosis in hepatic injury
- acute fatty liver of pregnancy
- Reye syndrome
- drugs
what would you see on histology for HCC
- 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
describe the test you would do to stain for α1 antitrypsin deficiency in the hepatocytes
- add diastase with PAS because the cytoplasmic globules in the periportal hepatocytes are PAS positive and diastase resistant
______ is a marker that is ↑ in hepatocellular carcinoma (HCC)
AFP (alpha fetoprotein)
ALT/AST tell you the function of ________
hepatocytes; ALT is more specific for liver injury than AST
alcohol usually causes _________ steatosis of hepatic injury
macrovesicular
what liver diseases are AFP levels normal?
- fibrolamellar variant of HCC
- cholangiocarcinoma
describe the symptoms of Reynaud’s pentad
Charcot’s triad (RUQ pain, jaundice, fever) + hypotension/shock + confusion
