Path Winter Liver Back And Forth

Front 1

single large droplet which displaces nucleus

Back 1

macrovesicular steatosis

Front 2

microvescular steatosis

Back 2

multiple tiny droplets which do not displace nucleus

Front 3

foamy degeneration

Back 3

retained biliary material

Front 4

ballooning degeneration

Back 4

swollen hepatocytes (toxic/immunologic damage)

Front 5

Ischemic Coagulative Necrosis

Back 5

Cells Poorly Stained
Mummified
Lysed Nuclei

Front 6

Apoptosis following Toxic/Immunologic Damage

Back 6

Isolated Cells round up and form shrunken, pyknotic, eosinophilic councilman bodies containing fragmented nuclei

Front 7

Lytic Necrosis

Back 7

cells osmotically swell and rupture

Front 8

Focal Necrosis

Back 8

Necrosis Limited to Scattered Cells within Lobules

Front 9

Interface Hepatitis

Back 9

necrosis limited to interface between periportal parenchyma and inflammed portal tracts

Front 10

Bridging Necrosis

Back 10

necrosis of contiguous hepatocytes psanning adjacent lobules in portal-to-portal, portal-to-central, or centeral-to-central manner

Front 11

Submassive Necrosis

Back 11

necrosis of entire lobules

Front 12

Massive Necrosis

Back 12

necrosis of most ofthe liver

Front 13

Hepatitis

Back 13

Injury with influx of actue or chornic inflammatory cells

Front 14

reserve cells

Back 14

oval cells, progenitors for both hepatocytes and bile duct cells

Front 15

Cirrhosis

Back 15

liver subdivided into nodules of regenerating hepatocytes surrounded by scar tissue

Front 16

Ductular Reaction

Back 16

increases in number of intrahepatic bile ducts and canals of hering
associated with fibrosis and inflammation

Front 17

Erythroblastosis fetalis

Back 17

increased unconjugated bilirubin in brain → severe damage = kernicterus

Front 18

Cholestasis

Back 18

systemic retention of bilirubin and other solutes eliminated in bile

Front 19

asterixis

Back 19

nonrhythmic rapid extension-flexion movement of head & extremities

Front 20

bridging fibrous septa
parenchymal nodules (micro to macro)
disruption of architecture of entire liver

Back 20

What three characteristics define cirrhosis?

Front 21

Death of hepatocytes, ECM deposition, vascular reorganization

Back 21

The Three Changes in the Pathogenesis of Cirrohsis

Front 22

Pt has eaten Polar Bear Liver
HA, Vomiting, Stupor, Papilledema; Carotemia: yellowing of the skin which resembles jaundice w/o icterus.

Back 22

acute vitamin A toxicity

Front 23

Pt has eaten a diet of Halibut, Cod Liver, Supplements

Dryness of lips, Epistaxis, Bone & Joint Pain w/ hyperostosis, fracture, hepatomegaly, psychatric manifestations

increased circulating lipids, hyperCa²⁺emia from osteoclastic bone destrx

Back 23

Chornic Vitamin A Toxicity

Front 24

Amanita phalloides Mushroom poisoning

Back 24

Massive increases in AST & ALT
Prolonged PT, Increased Bilirbutin
Metabolic Acidosis, Hypotension
Hepatic encephalopathy, oliguric renal failure, ARDS death

Front 25

Macrovesicular steatosis
hepatomegaly 4+ kg, yellow & greasy

± elevated AST, ALT, Bilirubin
↑↑↑ elevated GGT & AP

Back 25

alcoholic steatosis

Front 26

tender hepatomegaly
↑AST> ↑ALT 2:1
↑ GGT, ±↑AP
↑ Bilirubin
Neutrophilic Leukocytosis
balloon cell
mallory bodies

Back 26

alcoholic hepatitis

Front 27

spider angiomas
palmar erythema
gynecomastia

Back 27

Alcoholic Cirrhosis
Manifestations of ↑ Estrogen

Front 28

bleeding esophageal varices
hemorrhoids
splenomegaly ± hypersplenism (cytopenias esp thrombocytopenia)
ascites
caput medusa

Back 28

Alcoholic Cirrhosis
Manifestations of ↑ Portal Htn

Front 29

brown, shrunken Liver with "hobnail" nodules

Back 29

cirrhosis
macroscopic morphology

Front 30

cirrhosis microscopic morphology

Back 30

micro& macornodules of trapped & regenerative hepatocytes surrounded by fibrous tissue

Front 31

Labs of Alcoholic Cirrhosis

Back 31

↑ AST & ALT, ± ↑ AP
Hyperbilirubinemia, mostly unconjugated,
hypoproteinemia
prolonged PT
Anemia
thrombocytopenia

Front 32

Obseity, T2DM, HyperTAGemia, Hyperinsulinemia w/ IR

Back 32

risk factors for nonalcoholic fatty Liver disease

Front 33

elevated AST/ALT w/ ~ 1:1 ratio

Back 33

Labs of Nonalcoholic Fatty Liver Disease

Front 34

pigment cirrhosis, diabetes millitus, skin pigmentation

Back 34

classic triad of late hemochromatosis

Front 35

ceruloplasmin

Back 35

major copper carrying protein. stuffed with copper in liver.

Front 36

vonMeyenberg Complex

Back 36

common & sporadic
clinically insignificant bile duct hamartoma:
proliferation of small ducts adjacent to protal tract

Front 37

Polycystic Liver dieases:

Back 37

AD, assoc. w/ AD polycistic kidney disease
Cysts in multiple organs: liver, pancrease, kidneys;
pregnant women
multiple cysts throughout liver lined by cuboidal cells and filled with straw colored fluid.
die of renal failure

Front 38

Congential Hepatic Fibrosis

Back 38

AR: assoc w/ AR polycycstic Kidney disease
Portal htn w/ cirrhosis
ducts in fibrous poliferations along septal margins
risk of cholangiocarcinoma

Front 39

Caroli Disease

Back 39

AR; portal htn, intrahepatitic cholestasis, cholelithiasis, & cholangitis;
segmental dilation of large bile ducts
risk for cholangiocarcinoma;

Front 40

Alagille syndrome

Back 40

Portal tract bile ducts absent
aka syndromic paucity of bile ducts
Risk for liver failure & hpetocellular carcinoma

Front 41

Banti syndrome

Back 41

infarction 2° to umbilical vein catheterization as a neonate, else omphalitis

Front 42

Passive congestion of heart failure

Back 42

Grossly: nutmeg liver (from centrilobular hemorrhagic necrosis)
Micro: centrilobular hemorrhagic necorsis
Chronic: cardiac sclerosis = centrilobular fibrosis

Front 43

sinusoidal obstruction syndrome

cause, symptoms and outcomes

Back 43

aka veno-occlusive disease

Cause: 1st weeks after bone marrow transplant
Sx: tender hepatomegaly, ascities, weight gain, jaundice
Prognosis: 30% fatal, 70% spontaneous recovery; no Tx

Front 44

↑ LDH
↑ AP
nothing else

Back 44

LFT of space occupying lesion of the liver

Front 45

↑ AST, ↑ ALT,↑ LDH

ASt, ALT > 10x upper limit & AST, ALT >AP

Back 45

LFT of Liver Cell Necrosis

Front 46

↑ AST = 2x ↑ ALT
↑ GGT, ↨ AP

Back 46

Liver Fnx Test of Alcoholic Liver Disease

Front 47

↑ AP
↔bilirubin

Back 47

LFT of partial biliary obstruction

Front 48

↑ AP
↑ bilirubin

Back 48

LFT of extensive biliary duct obstruction

Front 49

Pancreas divisum

Back 49

incomplete pancreatic duct fusion; most secrretions drain through small, stenotic pancreatic duct via a minor papilla; predispostion to chornic recurrent pancreatitis

Front 50

Annular pancreas

Back 50

pancreas surrounds duodenum may partially obstrx SI, gastric distention and vomiting

Front 51

Pancreatic Heterotopia

Back 51

Pancreatic Ts in the Somach, Duodenum, Jejunum, Meckel Diverticulum; pain and localized bleeding. site of 2% of islet tumors.

Front 52

morphology of pancreatitis.

Back 52

Pancreas with fat necrosis: chalky, white material
inflam-infiltrate, microvascular damage/edema

Front 53

Not-Late Stage Chronic Pancreatitis

Back 53

Pancreas with fibrosis & calcifications
loss of acini, islets of langerhans normal

Front 54

true cysts of the pancreas

Back 54

intra-pancreatic space range from microscopic to 5cm, lined by ductal epithelium

Front 55

Acute Viral Hepatitis
Morphology

Back 55

Balooning Degeneration of Hepatocytes
Councilman Bodies of Apoptosis
Macrophage Aggregates eating dead cells
severe confluent necrosis
Inflammatory infiltrates in portal tracts - interface hepatitis
cholestasis

Front 56

Chornic viral hepatitis morphology

Back 56

lymphoid infiltratres of portal trats, reactive bile duct changes
progression → interface hepatitis, bridging necrosis & fibrosis

Front 57

Malignant liver tumors arising from hepatocytes

Back 57

Hepatocellular Carcinoma

Front 58

Malignant liver tumors arising from bile duct

Back 58

Colangiocarcionma

Front 59

Biliary atresia

Back 59

complete obstrx of biliary tree

Front 60

Rokitansky-Aschoff sinuses

Back 60

outpouchings of mucosal epithelium through thickened fibrotic wall in the gallbladder ± inflammation

Front 61

Choledocholithiasis

Back 61

stone in extrahepatic bile duct

Front 62

Cholangitis

Back 62

bacterial infection in bild ducts

Front 63

ascending cholangitis

Back 63

bacterial infx ascending hepatobiliary tree

Front 64

suppurative cholangitis

Back 64

liver abscess 2* to biliary infx