SFP: intrahepatic and extrahepatic biliary disorders Flashcards
What are some clinical consequences with portal HTN?
- Ascites from increased oncotic pressure
- Esophageal/rectal varices
- Enlarged spleen from backup on splenic vein
- Hepatic encephalopathy
What is passive congestion?
Obstruction of hepatic vein or right sided HF leading to a nutmeg looking liver from blood backing up and staying in the liver
In severe cases, outflow obstruction from the liver can cause…
Centrilobular necrosis
Describe cardiac sclerosis/cirrhosis.
Long-standing passive congestion due to right sided HF causing bridging fibrosis between central veins
What is peliosis?
Blood-filled spaces throughout the liver, often caused by drugs like steroids
What is Budd Chiari syndrome?
Thrombosis of hepatic veins with associated nutmeg liver (passive congestion)
Describe sinusoidal obstruction syndrome.
Thrombosis occurring at the central vein
What is typically associated with sinusoidal obstruction syndrome?
Typically associated with something that would cause endothelial damage
What is cholestasis?
Bile stopped up within the liver; can often see Kupffer cells filled with bile
What may cause obstruction of extrahepatic biliary tree?
Gallstones, biliary atresia, carcinoma, infection
In a general sense, what happens to liver tissue with prolonged extrahepatic biliary obstruction?
Bile duct proliferation, dilation of large ducts, and fibrosis/cirrhosis
When do we see bile lakes?
Biliary obstruction; seen in portal tract
Describe biliary cirrhosis.
Small, irregularly shaped nodules, feathery degeneration at the edge of nodules, bile duct proliferation
What is primary biliary cholangitis?
Immunologic attack on intrahepatic bile ducts in the liver
Is primary biliary cholangitis more common in men or women?
Women
What are florid duct lesions?
Areas of nonsuppurative granulomatous destruction seen in primary biliary cholangitis
What is the serum marker for primary biliary cholangitis?
Antimitochondrial antibody
What are the histologic stages with PBC?
- Florid duct lesion
- Duct proliferation with periportal hepatitis
- Scarring with bridging necrosis and septal fibrosis
- Cirrhosis
What is primary sclerosing cholangitis?
Destruction of large intrahepatic bile ducts
Is primary sclerosing cholangitis more common in men or women?
Men
What are findings associated with primary sclerosing cholangitis?
“Beading” of fibrosis and sclerosis and onion-skin fibrosis
What condition is associated with inflammatory bowel disease?
Primary sclerosing cholangitis
What is cholelithiasis?
Gallstones
What factors may be associated with gallstones?
Being female, pregnant, overweight, or taking OCPs
What are the two types of gallstones?
Cholesterol/mixed stones or pigment stones
What conditions are needed to make cholesterol/mixed stones?
- Supersaturation with cholesterol
- Favorable nucleation
- Time (bile stasis)
Differentiate between cholesterol and mixed stones.
Cholesterol stones are solitary, yellow, and round, while mixed stones are multiple, variable in color, and faceted
What are pigment stones?
Stones consisting of unconjugated bilirubin and abnormal insoluble calcium salt
Who often gets pigment stones?
Those with hemolytic disorders
What is the distribution of pain for cholelithiasis?
Colicky pain in the RUQ, back, and shoulder
Describe acute cholecystitis.
Enlarged gallbladder with edema, hemorrhage, necrosis, and neutrophils
Cholecystitis is often associated with…
Gallstones
What is seen histologically in chronic cholecystitis?
Fibrosis, inflammation, Rokitansky/Aschoff sinuses
What is porcelain gallbladder?
Chronic cholecystitis with calcification and fibrosis; egg-like lesion
What is ascending cholangitis?
Infection that goes up into the liver from the gallbladder
What is biliary atresia?
Extrahepatic biliary tree is lost, meaning the bile cannot leave the liver and get into the GI tract. Often occurs in preemies
What is the most common gallbladder cancer?
Adenocarcinoma
A tumor of the ___ causes jaundice.
Extrahepatic biliary tree
What is a klatskin tumor?
Adenocarcinoma that arises at the junction of the left and right hepatic duct
