Wed Liver Pathology - AAW

Question 1

First aid in brainscape - AAW GI

Answer 1

check it

Question 2

primary biliary cirrhosis - what antibodies, what population

Answer 2

circulating antimitochondrial antibodies (AMA)

middle age female

Question 3

itching - “hallmark” of what type of disease according to nelson

Answer 3

cholestasis

Question 4

what do you see when you look at a bile canaliculus in someone with primary biliary cirrhosis

Answer 4

lymphocytic/granulomatous cholangitis

Question 5

PBC vs alcoholic cirrhosis - what does the regeneration of the liver nodes look like in each

Answer 5

in PBC, the nodes are less round

alcoholic, they are more round

Question 6

primary sclerosis cholangitis - 70% of cases are assc with what bowel thing.

average patient age/sex of that thing?

Answer 6

IBD, mostly ulcerative cholitis

male ~40 y/o

Question 7

“cholestatic injury pattern” labs

Answer 7

elevated alkaline phosphatase and GGT (gamma-glutamyltransferase)

seen in primary sclerosing cholangitis and primary biliary cirrhosis

Question 8

obliterative fibrosing cholangitis is “textbook” for what

Answer 8

primary sclerosing cholangitis

you can see a big fibrous plug next to an artery in the liver

Question 9

hereditary hemochromatosis - defeciency in what

Answer 9

decreased synthesis of hepcidin

Question 10

where does iron accumulate in the hepatocytes in early hemochromatosis

Answer 10

periportal region

Question 11

secondary hemochromatosis - where does the iron initially accumulate

Answer 11

in the kupffer cells (contrasted with in the hepatocytes in primary)

Question 12

best screening test for hemochromatosis

Answer 12

fasting transferrin saturation

Question 13

diagnostic tests in wilsons

Answer 13

24 hr copper excretion (increased)

lack of ceruloplasmin causes overall low serum copper

Question 14

what type of alpha 1 antitrypsin deficiency gives you the mostest liver disease

Answer 14

PiZZ

Question 15

stain the liver for A1AT with……………………………

Answer 15

PAS ya goof

Question 16

presence of obstructive, nonthrombotic lesions of the small (central) hepatic veins in patients exposed to radiation and/or hepatotoxins. marked narrowing and obliteration of central vein lumens by subendothelial swelling

called?
it patients who have had what done?

Answer 16

sinusoidal obstruction syndrome (hepatic veno-occlusive disease)

usually in BM transplant patients, chemo patients.

Question 17

prolonged conjugated hyperbilirubinemia in the neonate

Answer 17

neonatal cholestasis

due to:

biliary atresia: obstruction of lumen of extrahepatic biliary tree within first 3 months of life

neonatal hepatitis: due to A1AT, drugs, biliary atresia itself, etc.

Question 18

fatty, micronodular cirrhosis

what is wrong

Answer 18

this is the liver in early stages of alcoholic cirrhosis

Question 19

what type of steatosis is seen in reyes syndrome?

acute fatty liver of pregnancy? non-alcoholic fatty liver disease

Answer 19

microvesicular steatosis in reyes and AFLoP

macrovesicular in non-EtOH fatty liver

Question 20

AST:ALT ratio in alcoholic liver disease

Answer 20

greater than 2

80% of AST is found in mitochondria, and EtOH is a mitochondrial toxin

Question 21

ALP is high but you want to make sure its because of the liver and not something else

what do you test
what else would it be?

Answer 21

GGT

if GGT is negative, it could be bone instead of liver disease

Question 22

you WILL be tested on this

lab tests for

viral hep
autoimmune hep
wilsons
A!AT
hemochromatosis
primary biliary cirrhosis

Answer 22

viral hep - serology, nuclear testing (HBsAg, anti-HBc (total), HBV DNA, anti-HCV, HCV RNA)

autoimmune hep - ANA, anti-smooth muscle antibodies

wilson’s - ceruloplasmin

A1AT - A1AT level, phenotype

hemochromatosis - Fe, TIBC, Transferrin sat, genetics

primary biliary cirrhosis - anti-mitochondrial antibodies

Question 23

seen these on liver biopsy - what are you thinking

Ground glass hepatocytes
plasma cells
lymphocytic/granulomatous cholangitis
Fibrous obliterative cholangitis
periportal hepatitis with mild steatosis
globular hepatocyte inclusions

Answer 23

Ground glass hepatocytes - chronic viral hep B

plasma cells - autoimmune hep, primary biliary cirrhosis

lymphocytic/granulomatous cholangitis - primary biliary cirrhosis

Fibrous obliterative cholangitis - primary sclerosing cholangitis

periportal hepatitis with mild steatosis - chronic viral hepatitis C

globular hepatocyte inclusions - A1AT deficiency