Pathology of the Liver
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| Blood supply of the liver | (1) portal veins - venous blood from pancreas, spleen, stomach, small/large intestines (2) hepatic artery - usually supplied by celiac trunk
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| Venous drainage of the liver | Hepatic vein
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| Components of the portal triad | (1) hepatic artery branch (2) portal vein branch (3) bile duct
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| Lobule | Histological organizational unit of the liver. The unit is bounded by the portal triads (tracts) and oriented about a central vein
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| Inflammation and hepatocyte injury with biochemical or serological evidence of hepatitis for < 6 months | Acute hepatitis
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| Most common etiology of hepatitis | Viral (Hepatitis A, Hepatitis B, Hepatitis C)
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| Inflammation and hepatocyte injury with biochemical or serological evidence of hepatitis for > 6 months | Chronic hepatitis
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| Etiology of acute hepatitis | (1) Viral (2) Drugs (3) Idiopathic
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| (T or F) Hepatitis A is a common etiological agent of chronic hepatitis | False. Majority of chronic hepatitis is due to Hepatitis B and C. Hepatitis A is a more common cause of acute hepatitis.
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| A common cause of liver disease in the US. Common morphologic findings include: steatosis, hepatocyte necrosis, infiltrates of neutrophils, Mallory hyaline bodies, and sclerosing hyaline necrosis | Alcohol-related liver disease
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| A form of chronic liver disease with morphologic features of steatosis, hepatitis, and firbrosis. A major risk factor is obesity. | Non-alcohol-related fatty liver disease
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| Chronic, progressive inflammatory destruction of the extrahepatic biliary tract leading to fibrosis and cirrhosis. Higher incidence in males and strong association with uclerative colitis. | Primary sclerosing cholangitis (PSC)
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| What inflammatory bowel disease is associated with Primary Sclerosing Cholangitis? | Ulcerative colitis
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| The diagnostic feature of PSC found on ERCP | Alternating strictures and dilatations and beading of intra and extraheptic bile ducts
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| Chronic progressive inflammatory destruction of intrahepatic biliary tract leading to fibrosis and cirrhosis. Primariliy affects middle-aged females. Characterized by the presence of antimitochrondrial antibodies | Primary biliary cirrhosis (PBC)
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| Pathologic features found on biopsy samples of PBC | (1) Portal chronic inflammatory infiltrate (2) Lymphocyte infiltration of bile duct epithelium (3) Bile duct necrosis and destruction (4) Portal-based non-necrotizing granulomas
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| Chemical agents that are directly toxic to some cellular components of the liver. Causes injury in virtually every exposed individual in a dose-related manner | Intrinsic hepatotoxins
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| Chemical agents with unpredictable liver toxicity. Produces liver injury in a small proportion of exposed individuals and does not exhibit a dose-related response | Idiosyncratic hepatotoxins
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| End-stage result of chronic injury to the liver. Diffuse process characterized by fibrosis and the conversion of the normal hepatic architecture into regenerative nodules | Cirrhosis
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| (T or F) Portal hypertension is a common finding in end-stage liver disease | True. Synthetic and metabolic capacity of the liver is also affected.
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| (T or F) The etiology of liver damage in a cirrhotic liver can be determined based on teh gross or microscopic appearance of the liver. | False. Cirrhosis is ettiologically non-specific.
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| A bengin lesion characterized as a hamartoma of hepatocytes and bile ducts. Predominantly found in females. Exhibits "blushing" on angiographic studies. | Focal nodular hyperplasia (FNH)
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| A solitary subcapsular liver mass composed of disorganized nodules of hepatocytes surrounded by fibrous septae that contain bile ductules and chronic inflammatory cells. Has a central scar that contains numerous thick-walled blood vessels. | Focal nodular hyperplasia (FNH)
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| Benign neoplasm of the liver that predominantly occurs in females. Has a strong association with oral contraceptive use and anabolic steroid use. | Hepatic adenoma
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| Why must all hepatic adenomas be excised? | Hepatic adenomas have a propensity to hemorrhage which can be fatal.
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| Symptoms include abdominal pain, ascites, and hepatomegaly. Lab tests show elevated alpha-fetoprotein (AFP). | Hepatocellular carcinoma
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| Risk factors of hepatocellular carcinoma | (1) Cirrhosis (2) hepatotrophic viruses (3) hemochromatosis
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| What is the 5-yr survival of hepatocellular carcinoma? | Overall 5-yr survival is 3% in the US
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| (T or F) Hepatocellular carcinoma is histolotically distinct from metastatic adenocarcinoma from a distant primary site | False. Morphologic features of hepatocelluar carcinoma is nearly indistinguishable from adenocarinoma metastasis to the liver.
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| A variant of hepatocellular carcinoma found in young patients without cirrhosis. Typically has a better prognosis thatn routine hepatocellular carcinoma | Fibrolamellar hepatocellular carcioma
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| May grossly resembles metastatic disease to the liver with diffusely scattered small whitish nodules. Usually an incidental finding consisting of a hamartomatous growth of bile ducts in the liver. | Bile duct hamartoma (von Meyenburg complex)
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| Benign tumor of the bile ducts. | Bile duct adenoma
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| A malignant tumor of hte intrahepatic bile cuts. An adenocarcinoma consisting of duct and gland-like structures lined by cuboidal-to-columnar cells with varying degrees of cytologic atypia. Poor prognosis. | Cholangiocarcinoma
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| Most common benign tumor of the liver | Hemangioma - a benign vascular tumor of the liver
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| Malignant vascular tumor of the liver | Angiosarcoma
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| (T or F) Metastases occur with equal prevalence in both cirrohtic and non-cirrhotic livers | False. Metastatic disease is rare in cirrhotic livers. Mass lesions arising within a cirrhotic liver are typically of hepatic origin.
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