systemic pathology

Question 1

The ___ lobule is composed of:
portal triads
hepatic sinuses,
terminal hepatic venule (central vein) and associated plates of hepatocytes

Answer 1

classic

Question 2

the terminal hepatic vein (CV) is at the center of a “lobule,” while the portal tracts (PV) are at the periphery

Answer 2

Lobular Model

Question 3

Pathologists refer to the regions of the parenchyma as “__ and ___.”

Answer 3

periportal

centrilobular

Question 4

Relies on the basis of blood flow, three zones can be defined, zone 1 being the closest to the blood supply and zone 3 being the farthest

Answer 4

Acinar Model

Question 5

The two models of the liver

Answer 5

hepatic lobular model and acinar model

Question 6

Functionally, the liver can be divided into three zones, based upon oxygen supply:

Answer 6

zone 1
zone 2
zone 3

Question 7

this zone encircles the portal tracts where the oxygenated blood from hepatic arteries enters

Answer 7

zone 1

Question 8

this zone is located around central veins, where oxygenation is poor

Answer 8

Zone 3

Question 9

these cells:
Line the sinusoids
Fenestrated, w/o tight junctions, w/o basement membrane

Answer 9

Endothelial Cells

Question 10

these cells are Bone marrow derived phagocytes

Immune and cytokine release functions.

Answer 10

Kupfer Cells

Question 11

these cells are Beneath endothelial cells In the space of Disse
Specialized storage capacities
Secrete ECM components

Answer 11

Stellate Cells

Question 12

Hepatocytes have three specialized surfaces

Answer 12

Sinusoidal
Lateral
Canalicular

Question 13

functions of the liver: (5)

Answer 13

metabolic
synthetic
storage
catabolic
Excretory

Question 14

this function of the liver maintaining glucose homostasis; Free Fatty acid oxidation and conversion to triglycerides and secretion as lipoproteins

Answer 14

Metabolic

Question 15

the liver synthesizes ___ proteins

Answer 15

serum

Question 16

the liver is storage point for :

Answer 16

glycogen
triglycerides
iron
copper
lipid-soluble vitamin

Question 17

in the liver, Endogenous substances are catabolized to maintain balance; detoxification of ___.

Answer 17

xenobiotics

Question 18

the liver excretes ___

Answer 18

bile

Question 19

the end stage of chronic liver disease

Answer 19

Cirrhosis

Question 20

The central pathogenic processes in cirrhosis are:

Answer 20

Injury/death of hepatocytes
Extracellular Matrix deposition
Vascular reorganization

Question 21

Cirrhosis is defined by three main morphologic characteristics:

Answer 21

Bridging fibrous septa
Parenchymal nodules.
Disruption of the architecture of the entire liver

Question 22

Major Causes of Cirrhosis: (6)

Answer 22

Alcoholic Liver Disease
Chronic Hepatitis
Biliary Disease
Nonalcoholic Fatty Liver Disease  (NAFLD)
Metaboloic Disease
Cryptogenic

Question 23

types of chronic hepatitis: (3)

Answer 23

Chronic Viral Hepatitis

Autoimmune Hepatitis

Drugs

Question 24

types of Biliary Disease

3

Answer 24

Extrahepatic Biliary Obstruction

 Primary Biliary Cirrhosis

 Sclerosing Cholangitis

Question 25

examples of metabolic diseases are (8)

Answer 25

Hemochromatosis Wilson Disease Hereditary Fructose Intolerance Glycogen Storage Disease Tyrosinemia Glactosemia α1-Antitrypsin Deficiency Hereditary Storage Diseases

Question 26

contains small, regenerative nodules of parenchyma and fatty change.

Answer 26

Micronodular Cirrhosis

Question 27

in this situation the liver is misshapen, and the cut surface reveals irregular nodules and connective tissue septa of varying width.

Answer 27

Macronodular Cirrhosis

Question 28

The major clinical consequences in the setting of cirrhosis, shown for the male is

Answer 28

portal hypertension

Question 29

In women, oligomenorrhea, amenorrhea, and sterility are frequent, as a result of ___.

Answer 29

hypogonadism

Question 30

A daily intake of more than __ gm of alcohol in men and __ gm in women significantly increases the risk of cirrhosis

Answer 30

60 | 20

Question 31

Alcoholic liver disease spans three major morphologic and clinical entities:

Answer 31

``` Fatty liver (Hepatic Steatosis) Alcoholic Hepatitis (Alcoholic Steatohepatitis) Cirrhosis ```

Question 32

___ is the accumulation of intrahepatocyte fat and it is directly dependent on the intake of alcohol, since it is fully and rapidly reversible on discontinuation of alcohol ingestion. Virtually all chronic alcoholics have this

Answer 32

Steatosis

Question 33

Signs and Symptoms of Alcoholic Fatty Liver (Hepatic Steatosis)

Answer 33

few symptoms of liver disease, and does not by itself progress to more severe disease

Question 34

Treatment/Prognosis of Alcoholic Fatty Liver (Hepatic Steatosis)

Answer 34

The fatty change is completely reversible if there is abstention from further consumption of alcohol

Question 35

acute necrotizing lesion

Answer 35

Alcoholic Hepatitis

Question 36

Alcoholic Hepatitis is characterized by: (4)

Answer 36

Necrosis of hepatocytes Mallory bodies Neutrophilic inflammatory response Perivenular fibrosis.

Question 37

Signs & Symptoms

Answer 37

Presents with: malaise, anorexia, fever, right upper quadrant abdominal pain, and jaundice mild leukocytosis

Question 38

Serum aminotransferase activities are ___ elevated and Serum Alkaline Phosphatase activity is usually ___ in alcoholic hepatitis

Answer 38

moderately | increased

Question 39

treatment for alcohol hepatitis

Answer 39

no specific treatment

Question 40

__% of alcoholics develop cirrhosis

Answer 40

15

Question 41

continued exposure to alcohol can result in steatosis and eventually ____

Answer 41

cirrhosis

Question 42

____ and ___ can result in abstinence. in other words they are reversible

Answer 42

steatosis | hepatitis

Question 43

repeated attacks of hepatitis can lead to ___

Answer 43

cirrhosis

Question 44

severe exposure when having steatosis can lead to _____

Answer 44

hepatitis

Question 45

close resemblance to Alcoholic Liver Disease. the risk factors which appear to be the apparent triggers for the initiation of the liver disease (e.g., obesity, Type 2 Diabetes, and hyperlipidemia).

Answer 45

Nonalcoholic Fatty Liver Disease (NAFLD)

Question 46

The observed pathology of Alcoholic Liver Disease and ___ Liver Disease are mirrow images The treatment and the prognosis are different because they are driven by the different risk factors

Answer 46

Non-Alcoholic

Question 47

In ____ disease, signs and symptoms are asymptomatic with only moderate increases in serum liver enzymes

Answer 47

Nonalcoholic Fatty Liver Disease (NAFLD)

Question 48

About one-half of the people with both severe __ and ___ have Nonacoholic Steatohepatitis (NASH)

Answer 48

obesity | diabetes

Question 49

Two major categories to describe the patterns by which drugs cause injury:

Answer 49

Predictable pattern | Unpredictable pattern

Question 50

Drugs that cause injury in a dose-dependent manner refers to:

Answer 50

Predictable pattern

Question 51

Drugs that cause injury with low frequency, irrespective of dose and without obvious predisposition (idiosyncratic reaction)

Answer 51

Unpredictable pattern

Question 52

The main treatment for DILI is withdrawal of the offending ___ However, some types of liver injury can be associated with a progressive course, possibly leading to fibrosis or cirrhosis, despite discontinuation of the ___

Answer 52

drug | drug

Question 53

____ for treatment of tuberculosis, after 3 weeks, elevated the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in a patient.

Answer 53

isoniazid

Question 54

in alcoholic cirrhosis, the greenish tint of some nodules is due to __ ___

Answer 54

bile stasis

Question 55

In severe cases of __ the venules and perivenule sinusoids are obliterated and surrounded by dense fibrous tissue

Answer 55

Central Hyaline Sclerosis

Question 56

The sudden onset of alcoholic hepatitis suggests an ___ or physiologic co-factor, but none have been identified to date

Answer 56

environmental

Question 57

daily intake of more than 60 gm of alcohol in men significantly increases the risk of cirrhosis. this corresponds to __ oz. (180 ml) of 86 (__%) proof alcohol, three 8 oz. glasses of wine, or four-and-one-half 12 oz. bottles of bear.

Answer 57

6 | 43

Question 58

A daily intake of 20 gm of alcohol in women significantly increases the risk of cirrhosis. This corresponds to: 2 oz. (60 ml) of 86 (43%) proof alcohol, __ 8 oz. glasses of wine, or one-and-one-half __ oz. bottles of bear

Answer 58

one | 12

Question 59

In general, more than __ years of alcoholism is required to produce cirrhosis. Only __% of alcoholics develop cirrhosis

Answer 59

10 | 15