Liver Pathology Exam

fatty infiltration is acquired and reversible

true

what is fatty infiltration

accumulation of triglycerides within the hepatocytes

what are the two variables for fatty infiltration

amount of fat and diffuse/focal

what are clinical symptoms of fatty infiltration

increased LFT, hepatomegaly, RUQ pain, or asymptomatic

how many grades of diffuse fatty infiltration are there

3

what is the difference between diffuse and focal infiltration

diffuse is spread across the entire liver; focal is in one specific spot

how do you determine which grade of diffuse fatty infiltration someone has using ultrasound

how echogenic it appears (increased echogenicity=higher grade)

what can focal fatty infiltration mimic

neoplastic lesions

focal fatty liver can be described as

infiltration or sparing

cirrhosis is irreversible

true

what does cirrhosis cause

loss of normal liver function and death of hepatocytes

what are the 3 major pathologic methods for cirrhosis

cell death, fibrosis, regeneration

what is the RISING most common cause of cirrhosis

hep C

what is the most common cause of cirrhosis

alcoholism

what are the symptoms for cirrhosis

abnormal LFT, malaise, weight loss, abdomen pain, skin changes, jaundice, hypoalbuminemia

what is the mean velocity for a doppler of the PV

15-18 cm/sec

what is the normal diameter for doppler of the PV

<13 mm

if the patient has severe HTN what will the doppler of PV diameter be

>13 mm

what is the normal pressure for the portal vein

5-10 mm Hg

what are the two categories for portal HTN

intrahepatic and extrahepatic

what develops when hepatopetal flow is impeded by thrombus or tumor invasion

extrahepatic

what is developed by schistosomiasis, cirrhosis, and hepatic vein thrombosis

intrahepatic

gastroesophageal junction collaterals are fatal if they hemorrhage

true

what is a recanalized umbilical vein

re-opening of the umbilical vein (ligamentum teres)

what are splenorenal and gastrorenal collaterals

tortuous veins seen in the splenic and renal hilum

what does the acronym for TIPS mean

transjugular intrahepatic portosystemic shunts

what are TIPS used for

relieve pressure in patients with portal HTN

where are TIPS inserted

jugular vein

where are TIPS placed between

hepatic and portal vein

what is hepatitis

inflammation of the liver

what is the most common cause of hepatitis

viral infections

how do you contract hep A

contaminated food/water, fecal/oral

how do you contract hep B

blood/body fluids, affects health care workers more

how do you contract hep C

blood/body fluids, IV drug use/needle sharing, blood transfusions

what are the symptoms of hepatitis

fatigue, dark urine, light colored stool, nausea, fever, jaundice, elevated labs (ALT/AST, bilirubin)

what is the appearance of acute hepatitis

starry night

what syndrome includes thrombosis of the hepatic vein with/wo occlusion of the IVC

budd-chiari syndrome

what are the symptoms for budd-chiari syndrome

abd pain, ascites, hepatomegaly, splenomegaly

what are congenital causes of budd-chiari syndrome

hepatic vein stenosis or hypoplasia

infarcted liver areas may become _____

fibrotic

what is the treatment for budd chiari syndrome

high mortality rate, anticoagulants, shunts, liver transplant

what is the most common benign tumor of the liver

cavernous hemangioma

cavernous hemangiomas are most common in

women

granulomas are most commonly seen in

immunocompromised patients

granulomas are an effect of

granulomatous disease

what is the 2nd most common benign liver mass

focal nodular hyperplasia (FNH)

FNH is most common in

females <40 yrs

what are benign epithelial tumors called

hepatic adenoma

what are hepatic adenomas associated with

glycogen storage disease

hepatic adenomas suggest surgical resection due to the risk of malignant transformation

true

hepatic adenomas are linked to females because

oral contraceptives, estrogen causes growth

how large can hepatic adenomas become

8-15 cm (entire liver)

what typically does not appear until 5th decade of life unless associated with ADPKD

true liver cysts

what does ADPKD stand for

autosomal dominant polycystic kidney disease

ADPKD is ____

inherited

what is ADPKD

multiple cysts of varying sized affection both kidneys

what is the most common primary malignancy of the liver

hepatocellular carcinoma (hepatoma)

hepatoma has higher prevalence where

in countries with high hep B exposure

in the US hepatoma is usually associated with _____ and ____

cirrhosis and alcoholism

hepatoma is most common in men over ___

50

hepatoma commonly invades the ____ and ____ veins

portal and hepatic

what is the 3rd most common abdominal malignancy in children after neuroblastoma and nephroblastoma (wilms tumor)

hepatoblastoma

hepatoblastoma is usually present before the age of ___

3

what is a clinical symptom of hepatoblastoma

increased alpha-fetoprotein levels

what is the most common form of neoplastic involvement of the liver

metastatic disease

what are the primary sites for metastatic disease

GI (54%), breast, lung, pancreas

echinococcal cyst (hydatid cyst) is related to what

parasitic tapeworms in animals

echinococcal cysts are caused by

echinococcus granulosus (tapeworm 3-6 mm long)

echinococcal cysts are most common in what countries

sheep and cattle raising countries

echinococcal lives in the _____ of the host

intestine

echinococcal cysts appear as what on a sonogram

honeycomb

what are the lab values for echinococcal cysts

increased WBC and alkaline phosphatase

a pyogenic abscess is ____

bacterial

where does bacteria enter to form a pyogenic abscess

biliary tract

what is amebic abscess

amoeba parasite, entamoeba, reaches the liver via the portal vein

where does amebic abscess’ occur

in poor sanitary regions

pyogenic abscess the patient will have history of

abdominal infarction

amebic abscess the patient will have a history of

traveling outside the US

fungal abscess is caused by the fungal infection ______ ______

candida albicans

fungal abscess most commonly affects ____________ patients

immunocompromised

fungal abscess invades bloodstream and affects organs causing

fever and pain

fungal abscess has the sonographic appears of

wheel within a wheel or bull’s eye

what is one of the most common parasitic infections

schistosomiasis

schistosomiasis is a major cause of _______ worldwide

portal HTN

schistosomiasis is limited to what zones

tropical

what yucky bug happens when eggs travel via portal vein and cause a granulomatous reaction resulting in periportal fibrosis

schistosomiasis