Pathoma: Liver Cirrhosis and Tumors

Question 1

The classic description of cirrhosis on histologic exam is ________________.

Answer 1

broad bands of fibrosis with regenerative nodules in between

Question 2

Fibrosis in the liver is mediated by which cell type?

Answer 2

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

Question 3

What is hypersplenism?

Answer 3

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

Question 4

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.

Answer 4

estrogen

Question 5

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

Answer 5

A heavy, greasy liver

Question 6

_____________ can lead to acute hepatitis from excess acetaldehyde.

Answer 6

Binge drinking

Question 7

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

Answer 7

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

Question 8

What presentation is characteristic of acute hepatitis from alcohol?

Answer 8

Painful hepatomegaly with AST greater than ALT

Question 9

True or false: all alcohols will eventually develop cirrhosis.

Answer 9

False. Only about 20%

Question 10

How would you diagnose NASH?

Answer 10

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.

Question 11

Differentiate hemochromatosis and hemosiderosis.

Answer 11

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

Question 12

What is the most common genetic cause of primary hemochromatosis?

Answer 12

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

Question 13

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

Answer 13

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.

Question 14

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

Answer 14

Cirrhosis, secondary diabetes, and bronze skin

Late adulthood

Question 15

What lab findings are indicative of iron overload?

Answer 15

Increased ferritin
Decreased TIBC
Increased serum iron
Increased iron saturation

Question 16

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

Answer 16

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

Question 17

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

Answer 17

Defect in the ATP7B gene that pumps iron into bile

Question 18

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

Answer 18

Wilson’s

Question 19

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

Answer 19

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

Question 20

________________ presents as granulomatous destruction of intrahepatic bile ducts.

Answer 20

Primary biliary cholangitis

Question 21

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

Answer 21

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

Question 22

What lab value is often positive in those with PSC?

Answer 22

p-ANCA (just like UC!)

Question 23

What cellular dysfunction is involved in Reye syndrome?

Answer 23

Mitochondrial damage

Question 24

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

Answer 24

Nausea and vomiting
Hypoglycemia
Elevated liver enzymes

Question 25

What liver neoplasm is associated with OCP use?

Answer 25

Hepatocellular adenoma

Question 26

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

Answer 26

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

Question 27

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

Answer 27

False. It is the hepatic vein.

Question 28

HCC presents with elevation of what serum marker?

Answer 28

Alpha-fetoprotein