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42 Cards in this Set
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Nonalcoholic fatty liver disease:
Histologic features (steatosis and steatohepatitis) |
Steatosis:
Macrovesicular, no inflammn Steatohepatitis: Ballooned hepatocytes Apoptosis Inflammn Remember: Can't distinguish from alcoholic fatty liver |
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Chocolate liver
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Hemochromatosis
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How can you tell whether a liver affected by hemochromatosis is in early or late disease?
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If late-->cirrhosis (nodules)
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Wilson Disease:
Lab findings Histologic Features |
Dec'd serum ceruloplasmin
Inc'd urinary excretion of Cu Inc'd hepatic Cu content (most helpful for dx) Histo Features: Steatosis Ballooned hepatitis RHODANINE STAIN |
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Reye Syndrome:
What is it? Associated with? Histologic features |
Steatosis and encephalopathy seen in children under 4 post-viral illness
Present with vomiting, irritability, lethargy, hepatomegaly Associated with ASA Histo: Microvesicular steatosis (Swollen mitochondria on EM) |
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This disorder results in loss of mitochondrial function.
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Reye Syndrome
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Disorders of extrahepatic bile ducts:
Examples |
Choledocholithiasis
Cholangitis Congenital Biliary atresia |
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Disorders of intrahepatic bile ducts:
Examples |
Ascending cholangitis
Primary Biliary Cirrhosis (destruction of small/medium-sized bile ducts) |
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Cholestasis:
General histologic features Features specific to obstructive cholestasis |
General:
Enlarged hepatocytes Dilated canalicular spaces Apoptotic cells Bile in Kupffer cells Obstructive: BIle duct proliferation Portal edema Portal nphils |
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Neonatal Cholestasis:
Presentation Causes |
Neonates w/jaundice, dark urine, light or acholic stools, hepatomegaly
Causes: Extrahepatic biliary atresia Neonatal hepatitis |
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Primary Biliary Cirrhosis:
Pathophys Lab values |
Destruction of bile ducts by Ab's
AMA abs Elevated alk phos Often assocd w/other autoimmune dz's (Scleroderma, thyroiditis, RA) |
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This disorder presents with elevated AMA.
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Primary biliary cirrhosis
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This disorder features a florid duct lesion.
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Primary Biliary Cirrhosis
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This disorder is strongly linked to ulcerative colitis.
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Primary Sclerosing Cholangitis--70% of pts with PSC have UC
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This disorder features onion-skin fibrosis.
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Primary Sclerosing cholangitis
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Primary Sclerosing Cholangitis:
pathophys |
Lymphocytes (autoimmune) destroy bile ducts, progresses to cirrhosis
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This disorder is p-ANCA positive.
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Primary Sclerosing Cholangitis
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Why is hepatic infarct rare?
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Liver has double supply of blood (hepatic artery and portal vein)
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Infarct of Zhan is caused by ____.
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Impaired portal vein inflow
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Hepatic artery vs vein flow impairments:
Causes |
Artery: thrombosis, compression by PAN, embolism, neoplasia, sepsis
Vein: peritoneal sepsis, pancreatitis, surgical thromboses, HCC mets |
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Cardiac Sclerosis:
What is it? Cause? |
Centrilobular fibrosis
Due to long-term right-sided HF |
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Nutmeg liver:
Cause |
Left and Right-Sided HF (can't discern from acute Budd-Chiari or acetaminophen toxicity)
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This disorder is associated with use of anabolic steroids.
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Peliosis hepatis (primary sinusoidal dilation)
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Budd-Chiari Syndrome:
Presentation Histologic features |
Hepatomegaly
Weight gain Ascites Abdominal pain Centrilobular necrosis (just like L + R-HF, acetaminophen tox) |
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Sinuoisdal Obstruction Syndrome:
Cause |
(Toxic injury to sinusoidal endothelium)
Originally described by bush tea (Jamaica) Occurs primarily in first 20-30 days BM transplant Injury by drugs (cyclophosphamide) |
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How do hepatocellular nodules differ from cirrhotic nodules?
Cause? |
Hepatocellular nodules: usually an incidental finding in women of reproductive age
Nodules are well-localized and not diffuse Have a central scar Due to alterations in hepatic blood supply NOT NEOPLASTIC |
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How does nodular regenerative hyperplasis differ from cirrhosis?
Cause? |
No fibrosis
Caused by alteration in hepatic blood flow Causes portal HTN |
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How do high grade dysplastic nodules differ from low grade dysplastic nodules?
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High grade lzns consist of small cells
Low grade lzns consist of large cells |
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What is the most common benign tumor of the liver?
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Hemangioma
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This hepatic tumor is associated with OCP use.
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Hepatic adenoma
Note: may mimic hepatocellular carcinoma |
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beta-catenin mutation
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If found in hepatic adenoma-->risk of developing cance
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What is the most common malignant tumor of the liver?
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Metastatic tumors!
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Malignant tumors of the liver:
Examples |
HCC
Cholangiocarcinoma Hepatoblastoma Angiosarcoma |
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Major causes of malignant HCC.
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Chronic viral infections (HBV, HCV)
Chronic EtOH NASH Food contaminants |
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Aflatoxin
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Fungus found in peanuts, corn (food)-->binds DNA and can alter p53 gene
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Cirrhotic tumor that is green in color must be ________.
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Hepatocellular carcinoma
NOT cholangiocarcinoma (cholangiocarcinomas do not produce bile) |
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Alpha-fetoprotein can be elevated in this disorder.
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Hepatocellular Carcinoma
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Cholangiocarcinoma:
Where does it arise? Extra/intrahepatic? AFP levels |
Arise from bile cut cells
Mostly extrahepatic, but can be intrahepatic Normal AFP, elevated CEA |
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CEA can be elevated in this disorder.
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Cholangiocarcinoma
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Primary sclerosing cholangitis is a risk factor for this disorder.
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Cholangiocarcinoma
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Which nuts are associated with liver disease?
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Peanuts-->HCC
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HCC vs CCA:
Cell of Origin Geographic Distribution Age Predilection Sex Predilection Preferential Spread |
HCC:
Hepatocyte Marked variation in distribution Affects young persons Males Spreads via veins CCA: Originates in bile duct cells Worldwide distribution Affects older persons No sex predilection Spreads through lymphatics |
