Path: Liver and Biliary Tract

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created 7 years ago by jgaversa5
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1

what does the liver do

portal to systemic filter

2

what do the pancreas, liver, and gall bladder get derived from

outpocketing of foregut

3

what supplies the foregut with blood

celiac trunk

4

what supplies the midgut with blood

SMA

5

what supplies the hindgut with blood

IMA

6

what lobe is the biggest inthe liver

right lobe

7

what ligaments are on top of the liver

coronary ligament and left triangular ligament

8

what ligament separates the left and right lobe

falciform ligament

9

what ligament goes under the liver

ligamentum teres

10

what organ is below the liver

gallbladder

11

what is the wirsung duct

main bile duct

12

what is the santorini duct

accessory bile duct

13

if the liver were a hexagon what would form the vertices

portal vein, hepatic arteries, bile duct

14

if liver is a hexagon what would form the center

central vein

15

how much of liver's blood supply comes from portal veins

80%

16

how much of liver's blood supply comes from hepatic arterial system

20%

17

what is the direction of blood flow in the liver

portal vein to sinusoids to central vein to hepatic veins to inferior vena cava

18

is there fibrous tissue in the liver

no

19

what will the portal triad look like relatvie to the central vein

central vein will be more round and portal triad will be more oval

also many more portal veins than central veins

CT or bile around them: portal veins

20

what is the direction of venous blood flow

portal to central

21

what is indicated of the portal blood flow with regard to toxicity and ischemia

first to get toxic effects and last to get ischemia

22

what is the apex of the acinus

central vein

23

what are most cells in the lobule

hepatocytes

24

other than hepatocytes what are the cell in the liver

Kupffer cells

25

what is the pattern of hepatic degeneration

balooning, feathery degeneration, fat pigment (hemosiderin, bile, both)

26

what types of things result from liver inflammation

regeneration
fibrosis

27
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what is going on here

balooing degeneration

28

what is the balooning degeneration really

cloudy swelling from compromise of Na/K pump

29
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what is this

feathery degeneration

30

what is worse: balooning or feathering

feathering usually

31

what is another name for fatty metamorphosis

fatty change/steatosis

32

what things can bring on fatty liver

obesity
alcoholism
diabetes

33
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what is this

microvesicular steatosis

34

what happens in microvesicular steatosis

fat vacuoles are small enough to lie completley within the hepatocyte cytoplasm

35
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what is going on here

macrovesicular steatosis

36

what happens in macrovesicular steatosis

fat vacuoles whichare larger than hepatocytes

37

what is different between macro and micro vesicular steatosis

just a matter of severity

38

what are the three types of common gold pigment found in the body

hemosiderin, melanin, bile

39

which intrinsic pigment of the body stains blue in Prussian blue

hemosiderin

40

can bile and hemosiderin be confused in the liver unless you do a special stain

yes

41

what is the most common cause of hemosiderin in the liver

herat failure

42

what part of the liver will get toxic injuries first

portal vein area

43

what part of the liver is more likely to undergo hypoxic damag

central vein area

44
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what is going on here

card image

apoptosis

45

if we were witnessing apoptosis in hepatitis, what would we call the cells undergoing it

councilmann bodies

46

where are the two places that inflammation is going to strike in the liver

portal triads and sinusoids

47

is inflammation in portal triads or sinusoids going to be more severe

sinusoids

48
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what is this

mild triaditis

49

is most hepatitis (like mild triaditis) subclinical

yep

50

what is the classic concept of liver disease that signifies extent of invasion

disruption of limiting plate

51

what is the limiting plate

fence of CT which delineats a portal triad area from surrounding hepatocytes

when this is breached, the disese process is regarded as more severe

52

what is the most regenerative of all the organs

liver

53

what is the end stage of most chronic liver diseases

fibrosis

54

what are the two absolute criteria for diagnosis of cirrhosis

irregular nodules and fibrosis

55

what is fibrosis then

portal to portal fibrosis

normal hexagonal architecture is replaced by nodules

56

what is cirrhosis in regard to anything else

natural end stage irreversible diseas of anything that chronically damagees the liver

57

what can cause cirrhosis

liver
alcohol
biliary
Laennec's
advanced
post necrotic
micronodular
macronodular

58

what is Laennec's cirrhosis

nutritional cirrhosis

59

is all cirrhosis irreversible

yep

60

what is cirrhosis associated with

huge degree of nodular regeneration, and therefore represents a significant risk for primary liver neoplasm (hepatoma=hepatocellular carcinoma)

61

how can hepatomas be though of that arise from a cirrhosis background

regenerating nodules taht have lost growth control, usually not metastasizing but just causing further functional liver disaese

62

how can a blind man feel cirrhosis

anything that is hard or has tumors

63

what is the phrase that rules o ut most liver diseasa

liver surface is smooth and glistening

64

are there smooth areas between nodules in cirrhosis

nope

65

how would a blind man know that there is metastatic cancer on something and not macronodular cirrhosis even if he doesn't slice it

because of smooth parts between the nodules

66

where is there CT in the normal liver

small portal triad area

67
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what is this

CIRRHOSIS (portal to portal fibrous bands)

68

why are trichrome stains recommended for every liver biopsy

fibrin

69
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where are the central veins in cirrhosis

they dont have them they are destroyed by nodule formation

70
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what do you see in this trichrome stain

cirrhosis!

71

what is cirrhosis relative to liver failure

cirrhosis is the name of the disaes as demonstrated by the anatomic changes of the liver, whereas liver failure is the series and sequence of abnormal pathophysiologic events

72

what is the fluid wave test

where you push on the stomach and fluid moves from one side of the stomach to the other and swishes around

73

what are spider angiomas related to

cirrhosis

74

what are the common clinical/pathophysiological events associated with cirrhosis

portal hypertension
ascites
splenomegaly
jaundice
anemia
estrogenic effects
coagulopathies
encephelopathy

75

what are the hepatic enzymes indicative of hepatocyte damage

AST/ALT

76

what are the hepatic enzymes indicative of bile stasis/obstruction

alkphos
gamma-glutamyl transpeptidase
5nucleotidase

77

what will cholestasis give rise to

hepatocyte damage

78

what will hepatocyte damage (swelling) give rise to

stasis

79

what are the liver intracellular damage enzymes

AST/ALT/LDH

80

what are the liver membrane damage enzymes

alkphos/GGTP/5N

81

do intracellular liver pathologies result in membrane elevations

yes and vice versa

82

where are best places to see early jaundice

sclera and conjunctiva and palms

83

where will you see hemolytic jaundice

above liver

84

where will you see obstructive jaundice

below liver

85

is hemolytic jaundice conjugated

no

86

is obstructive jaundice conjugated

yes

87

what is jaundice from

excessive bilirubin production
reduced hepatic uptake
impaired conjugation
defective transportation

88

what are the types of neonatal jaundice

genetic anc nongenetic

89

what types of genetic neonatal jaundice are there

Gilbert syndrome
dubin johnson syndrome

90

what is the issue in gilbert syndrome

decreaed glucoronyl-transferas

91

what is the issue in Dubin Johnson syndrome

transport problem

92

what types of noenatal nongenetic jaundices are there

massive

93

what is cholestasis

suppression of bile flow

94

what is cholestaasis associated with

enzyme elevations (AP/GGTP/5N)

95

what is the bottom line for cholestasis

obstruction

96

are there many drugs that can cause cholestasis

yes lots

97
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how is this different from normal liver tissue

bile pigment everywhere

98
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what are these bile accumulations called

lakes

99

why does it look like a lot is between hepatocytes in early stages

canaliculi

100
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what is the disocloration in this liver

bile

101

what are the types of viral hepatitis

A-E

102

do the hepatitises look similar

yes: range from few extra portal triad lymphocytes to fulminant hepatitis with total collapse of lobules

103

what is viral hepatits associated with

full recovery, chronic progression over years leading to cirrhosis, hepatoma risk, or death

104

what hepatitises are of most clinical significance

B and C

105

what will viral hepatitis show in the stool and urine

chalky stool and dark urine

106

will people have jaundice in viral hepatitis

yes

107

what type of infection is usually associated with viral hepatitis

upper respiratory infection

108

what types of tests can be used to detect viral hepatitis

antigen and antibody serum tests

109

what would one like to find on a biopsy

councilman body

110
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what are some of these individual tiny red dots

central veins

111
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what is here

portal inflammation

112

where does inflammation of hepatitis start

portal triad areas

113

as portal inflammation gets more severe, where does it extend

sinusoids

114

what is fulminant hepatitis associated with

massive hepatic necrossi

115

what does fulminant hepatitis usually result in

death

116

why would a fulminant hepatitis liver be abnormally small

lobules collapse from necrosis

117

what could fulminant hepatitis be said to produce

hepatomicroly

118
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what is going on here

collapse of lobules in fulminant acute viral hepatitis

119

could fulminant hepatitis be mistaken for metastatis adenocarcinoma

yes

120
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what is being pointed out by these arrows

councilman bodies

121

are councilman bodies diagnostic of somethin

basically hep B

122

will you always find councilman bodies in hep B

nope

123

what does each councilman body represent

apoptotic death of a single liver cell

124

are most hep B's subclinical or very apparent

subclinical

125

how many people who get cirrhosis from hep B get hepatocellular Ca

10%

126

is hep C or hep B more common

less

127

is hep C less dangerous or more dangerous than hep B in the acute phase

less

128

is hep C or hep B more likely to go chronic

C

129

is hep C or Hep B more linked with hepatoma

C

130

what are some non-viral hepatitidies

staph aureus
gram negatives
parasitic
ameba
autoimmune
alcoholic hepatitis

131

what ia the main differential of nonviral hepatitis

toxic
autoimmune
nonviral infections

132

what are some drugs/toxins that have effects on the liver

alcohol
tylenol
BCPs, steroids

133

what can alcohol cause in the liver

steatosis
fibrosis/cirrhosis

134

what can tylenol cause in the liver

centrolobular necrosis

135

if a package insert recommends baseline transaminases before therapy, what is it probably

hepatotoxic

136

what are some metabolic liver diseases

steatosis
hemochromatosis
wilson's disease
alpha-1 antitrypsin
nneonatal cholestasis

137

what is steatossi

fatty change

138

what are the versions of hemochromatosis

hereditary
iron overloaad

139

where is the gene of the alpha-1 antitrypsin encoding gene

long arm of 14th chromosome

140

what is neonatal choestasis

persistent conjugated hyperbilirubinemia in newborn with conjugated bilirubin levels over 5 mg/dL of total bilirubin

141

what is neonatal cholestasis due to

either defects in bile excretion from hepatocytes or impaired bile flow

142
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what is going on here

PAS positive inclusions with alpha-1 antitrypsin deficiency

143

what does alpha-1 antitrypsin do

protects tissues (especially lung and liver) from natural protease

144

what would alpha-1 antritypsin lack be expected to cause

destructive changes in liver and lung

145

what is primary biliary cirrhosis

autoimmune disease of intrahepatic bile ducts

146

what is secondary biliary cirrhosis caused by

chronic obstruction/inflammation/both of intraheptatic bile ducts

147

what ia cholangitis

inflammation of intrahepatic bile ducts, associated with chronic bacterial (gm neg rods), infections, or Crohn's/ulcerative colitis

148

why would IBD be associated with cholangitis

biliary ductal cells are the same embryologic derivation as colonic mucosal cells and therefore subject to the same pathologic patterns of injury and causes

149

why are liver infarcts rare

because there is much accessrory circulation

150

whatis very common in CHF with the biliary tract

passive congestion with centrolobar necrosis

151

what is cardiac cirrhosis

passive congestion with centro lobar necrosis in CHF

152

what are some organs and areas that have various semi reliable clinical and anatomic findings with biliary circulatory disorders

portal veins
hepatic veins/IVC
hepatic arteries

153
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what is this

centrolobar necrosis

154

waht is the most common vascular disease and what is it secondary to

centrolobar necrosis secondary to CHF

155

what things are hepatic diseass often seen with

pregnancy and translants of BM or other drugs

156

what types of disesesa of pregnancy are seend with hepatic disease

pre-eclampsia (HTN, proteinuria, edema, coagulopaties, DIC)
fatty liver
cholestasis

157

what are some diseases that are often implicated with transpants

GVH and drug toxicities

158

what is another name for benign liver tumors

focal nodular hyperplasia or hepatic adenomas

159

what are benign liver tumors really in most cases

regenerative nodules

160

what are benign liver tumors linked to

BCPs

161

what can benign liver tumors be neoplasms of if they appear like angiomas

BVs

162

how many liver tumors are metastatic

99%

163

where are malignant liver tumors secondary to (when they are secondary)

portal drained organs

164

what types of malignancies will end up in the liver

just about all

165

what do primary liver malignancies often arise from

already very serious liver diseases like chronic hepatitis or cirrhosis

166

what is cholangiocarcinoma

malignancies of the intra-hepatic bile ducts

167

do cholangiocarcinomas or hepatomas look more like adenocarcinomas

cholangioarcinomas

168
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what is this

hepatic angioma

169
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how would a blind man know this is metastatic cancer and not macronodular cirrhosis

irregular and growing outward i think

170
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what is this

hepatocellular carcinoma/hepatoma

171
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what is this

hepatoma

172

will hepatoma cells look like hepatocytes

yep

173

what toxin from aspergillus is able to generate liver cancer

aflatoxin

174

where is hepatoma very common

china and west africa due to high aspergillus and hep B

175
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what is this

cholangiocarcinoma

176

what is always confused with a liver metastases

cholangiocarcinoma

177
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what is this tissue

gall bladder

178

what is the epithelium of the gall bladder

simple columnar

179

what are the main considerations of the gall bladder

anomalies, stones, choledocholithiasis, inflammation, cysts, neoplasms

180

what are gall stones from

cholesterol/bilirubin

181

what are some gall bladder anomalies

congenitally absent GB
duct duplications
bilobed gall bladder
phrygian cap
hypoplasia/agenesis

182
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what is this

phrygian caps

183

what is associated with cholelithiasis

bile supersaturated with cholesterol, hypomotility, cholesterol seeds in bile, excess mucus in gall bladder

184

what is cholelithiasis considered with

chronic cholecystitis

185
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what is this gall bladder coated with

cholesterol

186
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what is this

cholesterolosis of gall bladder mucosa

187

what is present in cholesterolosis of gall bladder mucosa

foam cells

188

what gives gall bladder a papillary appearance

foamy cells

189
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what two chemicals are here

cholesterol
bilirubin

190
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what one chemical is here

bilirubin

191

what are symptoms of cholecystis

fever
leukocytosis
RUQ pain

192

is their pain involved with chronic cholecystitis

not always

193

can ultrasound detect stones

yep

194

what goes hand in hand with cholecystitis

stones in gall bladder or ducts

195

what is most surgery of cholecystisis

laparoscopic

196

does cholecystits predispose to cholelithiasis

yep and vice versa

197

what are choledochal cysts

dilations of the common bile duct usually in children

198
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what is this

adenocarcinoma of the gall bladder

199

do you see long term survival with gall bladder carcinoma

nope