Pathoma: Liver Cirrhosis and Tumors Flashcards

1
Q

The classic description of cirrhosis on histologic exam is ________________.

A

broad bands of fibrosis with regenerative nodules in between

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2
Q

Fibrosis in the liver is mediated by which cell type?

A

The stellate cells –also called Ito cells –that secrete TGFbeta

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3
Q

What is hypersplenism?

A

Congestion of the spleen (from ascites) can lead to an overactive spleen that destroys more RBCs than it should.

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4
Q

The liver plays a key role in removing __________ from the blood. As such, liver disease can lead to gynecomastia, palmar erythema, and spider angiomata from too much of this substance.

A

estrogen

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5
Q

What pathologic changes will you see in someone with fatty liver disease?

A

A heavy, greasy liver

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6
Q

_____________ can lead to acute hepatitis from excess acetaldehyde.

A

Binge drinking

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7
Q

What can cause accumulation of pink/red inclusions in hepatocytes? What are these?

A

Acute binge drinking (the stem describes Mallory bodies, also called acidophilic bodies); these are damaged intermediate filaments

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8
Q

What presentation is characteristic of acute hepatitis from alcohol?

A

Painful hepatomegaly with AST greater than ALT

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9
Q

True or false: all alcohols will eventually develop cirrhosis.

A

False. Only about 20%

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10
Q

How would you diagnose NASH?

A

Non-alcoholic steatohepatitis resembles alcohol-induced liver disease, but it occurs in the absence of drinking. It is more common in obese people, and ALT will be greater than AST.

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11
Q

Differentiate hemochromatosis and hemosiderosis.

A

Hemosiderosis is the deposition of iron in tissues, and hemochromatosis is the symptomatic presentation of the disease.

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12
Q

What is the most common genetic cause of primary hemochromatosis?

A

C282Y defect in the HFE gene –resulting in increased iron absorption from the duodenum

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13
Q

What normally regulates iron absorption? How is this disrupted in hemochromatosis?

A

Enterocytes normally absorb all the iron in the gut and hold it within their cytoplasm; they use HFE to detect when the blood iron level drops, and then they release iron into the blood. Defective HFE thus leads to all the iron being absorbed.

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14
Q

What is the classic triad of hemochromatosis? When does this usually present?

A

Cirrhosis, secondary diabetes, and bronze skin

Late adulthood

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15
Q

What lab findings are indicative of iron overload?

A

Increased ferritin
Decreased TIBC
Increased serum iron
Increased iron saturation

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16
Q

What is lipofuscin? How can you distinguish between this and iron?

A

A “wear-and-tear protein” within hepatocytes from peroxidized lipids; the Prussian blue stain

17
Q

What genetic cause is most often implicated in Wilson’s disease?

A

Defect in the ATP7B gene that pumps iron into bile

18
Q

What liver disease can present with Parkinson’s or chorea?

A

Wilson’s

19
Q

Three non-genetic tests can help diagnose Wilson’s disease: _______________.

A

(1) increased urinary copper, (2) decreased serum ceruloplasmin, and (3) copper deposition in a liver biopsy

20
Q

________________ presents as granulomatous destruction of intrahepatic bile ducts.

A

Primary biliary cholangitis

21
Q

True or false: primary sclerosing cholangitis only affects the extrahepatic bile ducts.

A

False. It affects both the intrahepatic and extrahepatic bile ducts.

22
Q

What lab value is often positive in those with PSC?

A

p-ANCA (just like UC!)

23
Q

What cellular dysfunction is involved in Reye syndrome?

A

Mitochondrial damage

24
Q

What is the classic presentation of a child with Reye syndrome?

A

Nausea and vomiting
Hypoglycemia
Elevated liver enzymes

25
Q

What liver neoplasm is associated with OCP use?

A

Hepatocellular adenoma

26
Q

Three big risk factors are associated with increased risk of hepatocellular carcinoma: __________________.

A

(1) chronic hepatitis
(2) cirrhosis
(3) aflatoxins from Aspergillus

27
Q

True or false: Budd-Chiari presents with thrombosis in the portal vein.

A

False. It is the hepatic vein.

28
Q

HCC presents with elevation of what serum marker?

A

Alpha-fetoprotein