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64 Cards in this Set
- Front
- Back
three histologic fx of hepatitis
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1. Portal-based portal inflammation
2. Interface hepatitis = piecemeal necrosis 3. Focal necrosis – Foci of lobular inflammation & necrosis of single hepatocytes |
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how diagnose hep A, how determine if immunity
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IgM HAV for diagnosis
IgG HAV for immunity determination |
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type of virus : dna vs. rna HAV
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ss RNA, picornovirus
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type of virus: HBV
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partly ds DNA
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treatment for HBV
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α-interferon, lamivudine
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how diagnose HBV
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HBsAg or HBcAg
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see this, think
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ground glass hepatocytes: hep b (proliferating ER)
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two histo fx for HBV
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sanded nuclei (pink nuclear inclusions with HBcAg in it
ground glass cytoplasm (contains HBsAg and HBcAg) |
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histol fx for HCV
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fat, lymphoid aggregates and bile duct damage
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if see fat, lymphoid aggregates and bile duct damage, think
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HCV
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ab for AIM hepatitis
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ANA, ASMA, LKM1, soluble liver antigen or LP (liver
pancreas) antibodies |
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trx for AIM
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only hepatitis that responds to steroids
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histo fx for AIm hepatitis
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Marked interface inflammation with bridging necrosis (PT to CV)
and plasma cells!!! |
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how detect hep D
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can do ihc
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histologic fx of cholestasis
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– Portal based damage
– Dilated bile canaliculi with bile plug – pseudoxanthomatous change or feathery degeneration • Bile duct injury and loss • Ductular (cholangiolar) proliferation • Cholestatic Mallory bodies, zone I • Jigsaw cirrhosis (segmental disease) |
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clinical findings for cholestatic dz
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Elevated Alk phos, bilirubin, GGT
– Pruritis, jaundice, pale stools |
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ihc in cholestasis
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perivenular hepatocytes are CK7+
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two copper stains for cholestasis
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Rhodanine and victoria blue
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clinical associations PBC
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women, middle age, HLA DR type, AIM associations (scleroderma, Sjogren's)
often AMA positive elevated IgM |
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what
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primary biliary cirrhosis
-Cholestasis • Florid duct lesion – Bile duct injury • Granulomas |
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clinical findings/associations with PSC
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males, UC, cholangioca,
beading on ERCP |
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what
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Periductal fibrosis
– Ductopenia |
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macrovescicular steatosis causes (just read)
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Alcohol
– Diabetes – Drugs – Obesity – Deficient diet (TPN) |
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reye's
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fatty liver and encephalopathy
kids, flu-like illness, asa microvesicular/no inflammat |
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findings of steatohepatitis
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Steatosis
Ballooned hepatocytes Mallory-Denk bodies – Zone 3 (perivenular/pericentral) fibrosis -Inflammed lobules (neutrophils) Megamitochondria |
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what are mallory bodies composed of
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intermediate filaments, p62 and ubiquitin positive
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what are megamitochondria and where found
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in steatohepatitis, eosinophilic globules
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what is amiodarone a/w and what specific histologic findings
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steatohepatitis
Foamy granular hepatocytes from phospholipids which show lysosome inclusions by EM |
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histologic findings of acetaminophen
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hepatocellular necrosis with inflammation
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see granulomas in liver think
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infection MAI
cholestasis - PBC |
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see this, what to think
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Q fever, ring granuloma, Coxiella burnetii
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what
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echinococus, laminated layer (can be gms +)
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what
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echinococcus, scolex, gms+ hooklets, birefringent
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describe molecular allelic options for alpha 1 antitrypsin deficiency
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M - normal allele
PiS and PiZ- mutated alleles PIZZ is bad |
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mutations of heretidary hemochromatosis
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HFE gene mutations
2 most common – C282Y, highest iron overload - H63D |
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sx of hereditary hemochromatosis
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Cirrhosis, diabetes and skin pigmentation
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Hereditary hemochromatosis inheritance pattern
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autosomal recessive
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other HH mutations
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• 1 HFE
• 2A hemojuvelin- (kids) • 2B hepcidin (kids) • 3 transferrin receptor2 • 4 ferroportin |
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if see iron-free foci in HH, what should you think of
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HCC
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wilson dz mutation
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Mutated ATP7B gene, a copper transport protein in Golgi with accumulation of copper in liver and other organs
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tests for wilson dz
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↓Cerruloplasm—not sensitive or specific
– ↑Hepatic copper concentration— best test |
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histol fx of wilson's dz and stains
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Steatosis, hepatitis, glycogenated nuclei, abnormal mitochondria
Mallory hyaline, copper by Rhodanine or Orcein stains |
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see black pigment in liver think
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dubin-johnson syndrome
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mutation of dubin-johnson syndrom
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cMOAT/MRP2 gene mutation
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lab finding in dubin-johnson syndrome
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isolated conjugated hyperbilirubinemia
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histochemical stains to confirm dubin johnson syndrome
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PASD and Fontana Masson stain
pigment |
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ischemic affects what zone first
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zone 3 necrosis
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gross pathology of ischemic liver
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nutmeg liver (note can see in tylenol toxicity)
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histologic findings in budd-chiari
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Sinusoidal dilation and hepatocyte atrophy
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what is hepatoportal sclerosis
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weird process by which portal regions are abnormally close to central veins, non cirrhotic
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see nodular regenerative hyperplasia on histology, think what clinically
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portal HTN
recall: vague nodules, no fibrosis |
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hepatic adenoma: clinical associations
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ocps
glycogen storage dzs |
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treatment for hepatic adennoma
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surgery to prevent bleeding/rupture
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key fx of hepatic adenoma
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1-2 layers thick, no PT, dilated sinusoids
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histologic fx of FNH
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central stellate scar**
liver divided into nodules by thickwalled arteries in fibrous septa ductular proliferation (CK7+) |
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what is a high grade dysplastic nodule in liver
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in cirrhotic liver, a nodule >1 cm
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background and prognosis in fibrolamellar HCC
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noncirrhotic background
better prognosis |
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what's inside polygonal cells of fibrolamellar HCC
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- mito in cytoplasm
- pale body inclusions |
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ddx of central scar in liver
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fnh, fibrolamellar hcc
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ihc in cholangioca
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Mucicarmine+, CK7+, HepPar1-
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infectious a/w cholangioca
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Clonorchis sinensis, Opisthorchis),
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big thing for staging of hcc and cholangioca
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hcc - size (5cm)
cholangioca: periductal invasion |
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what, ihc
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hemangioma (dendritic) (intracytoplasmic
lumina/vacuoles w RBCs) CD34, Factor VIII |
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what, ihc
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epithelioid hemangioma (epithelial cells occlude vessels)
CD34, Factor VIII |