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Advanced Pathology Liver & Gallbladder

Terms in this set (86)

dysphagia
failure of the muscular function of the esophagus causing difficult swallowing
Achalasia
Lack of ganglion cells causing decreased peristalsis of the esophagus
Hiatal hernia
A hernia of the stomach through an enlarged esophageal hiatus (opening) in the diaphragm
Reflux esophagitis
esophageal injury caused by regurgitation of gastric content- commonly from a sliding hiatal hernia
Barrett esophagus
A change from squamous epithelium in the esophagus to columnar epithelium from chronic reflux of gastric content. Precursor for adenocarcinoma. Risk factors include drinking, smoking, and tobacco use.
Esophageal varices
dilated veins directly beneath the esophageal mucosa that are prone to rupture and hemorrhage.
-usually secondary to portal HTN r/t liver cirrhosis
Histologically what cells are usually present in esophageal cancers? What are these changes associated with?
1. squamous cell carcinomas
2. environmental factors
Congenital pyloric stenosis
Narrowing of the pyloric canal which obstructs the outlet of the stomach. More common in males then females. Most common cause of abdominal surgery within the 1st 6 months of life.
Acute erosive gastritis & risk factors
the presence of focal necrosis of an otherwise normal stomach.
Risk factors include excessive aspirin intake, NSAIDs and alcohol intake.
Acute non-erosive gastritis
ranges from superficial to sever atrophy. Causes can be autoimmune, idiopathic and infectious.
Infectious gastritis
most common type of gastritis in the US which is caused by Helicobacter Pylori
Peptic ulcer disease
a break in the mucosa of the stomach and proximal duodenum produced by gastric secretions
What is a risk factor for stomach cancer?
over consumption of smoked foods and pickled vegetables because they contain benzpyrene which is a potent carcinogenic agent. Intestinal metaplasia.
Pseudomembranous colitis
inflammatory disease of the colon that is caused by Clostridium difficile
Diverticulosis
outputting of the intestines that causes retention of fecal manner, when the herniations become infected it is called diverticulitis
Crohn disease
a grantulatomatus inflammatory bowel disease of unknown etiology that causes diarrhea, fever and abdominal pain. Skip lesions present.
Ulcerative colitis
a disease of the larger intestines that is associated with chronic diarrhea and rectal bleeding. Extends from the more pistol part of the rectum. No skip lesions present like Crohns disease.
Ischemic colitis
caused by atherosclerosis and usually someone over the age of 50 yo
Adenomatous polyps
adenomas of the colon that arise from the mucosal epithelium and project into the lumen of the gut. Most colon cancers are thought to arise in preexisting adenomatous polyps.
Adenomatous polyposis coli
is inherited as an autosomal dominant trait. It is characterized by the progressive development of multiple adenomatous polyps of the colon. Carcinoma is inevitable unless a total colectomy is performed.
Most common cancers in Men?
lung, colon, prostate
Most common cancers in women?
breast, lung, colon
Hirschsprung disease
formation of megacolon occurs and there is an inability to pass stool
Tracheoesophageal Fistulas
Trichobezar
Hair ball of the stomach caused from ingestion of hair. Rapunzel Syndrome.
Bilirubin: What is it? Where it comes from?
the end product of heme catabolism, scenscent erythrocytes are removed from circulation by the phagocytes in spleen and liver and bone marrow
What must bilirubin bind to to become conjugated in the liver?
bilirubin binds to albumin to become conjugated in glucuronic acid within the liver- excreted into bile
Jaundice: What is it? Common cause?
condition of yellowing of the skin and sclera that is associated with excessive circulating bilirubin, commonly caused by hepatic failure
Why do nearly 70% of full term infants and almost all pre-term infants exhibit hyperbilirubinemia?
The liver in newborns assumes responsibility for bilirubin clearance before conjugation occurs, and excretory factors are not fully developed yet
Characteristics of hepatic failure?
jaundice
encephalopathy
What is hepatic failure?
clinical syndrome that occurs when the mass of the liver cells are diminished or completely impaired
Hepatic encephalopathy
neurological signs and symptoms that occur from liver failure
Hepatitis A
infection provides lifelong immunity
fecal-oral route of transmission
person to person
Hepatitis B: what is chronic hepatitis B?
virus causes acute and chronic liver failure- the presence of liver necrosis or inflammation for > 6 months
What are the 3 types (causes) of alcoholic liver disease?
1. fatty liver
2. alcoholic hepatitis
3. cirrhosis
Alcoholic hepatitis
necrotizing lesions characterized by necrosis of hepatocytes and cytoplasmic hyaline inclusions within hepatocytes (mallory bodies)
Mallory bodies
cytoplasmic hyaline inclusions that occur within hepatocytes in alcoholic hepatitis
What are clinical features of alcoholic fatty liver? (5)
malaise
anorexia
fever
abdominal pain
jaundice
Cirrhosis
occurs from repeated bouts of hepatitis (liver necrosis/inflammation) that causes nodule formation on the liver- represents end stage liver disease
In liver disease the presence of cirrhosis (nodule formation) represents what stage of the disease?
end stage liver disease
primary biliary cirrhosis
a chronic liver disease characterized by the destruction of the intrahepatic bile ducts and cholestasis (bile flow is disrupted)
What is a disease that is similar to primary biliary cirrhosis but instead of affecting the smaller duct of the liver it affects the larger ones?
Primary Sclerosing Cholangitis
What is a complication of cholestasis (bile flow disruption)?
pruritus- from bile salts in the skin
If cholestasis is present what will be visible to the histologist?
bile lakes
What is a diagnostic test for primary biliary cirrhosis and what population is most affected by it?
circulating antimitochondrial antibodies
-middle aged women with autoimmune diseases
Hereditary Hemochromatosis
inherited iron disorder where excessive iron is absorbed causing toxic accumulation of iron in the liver and spleen
Portal HTN
increased portal venous pressure caused by obstruction to blood flow, common in cirrhosis
What are complications of portal HTN? 3
esophageal varices
splenomegaly
ascites
Budd-Chiari Syndrome
liver disease caused by occlusion caused by thrombosis of the hepatic veins
Most common malignant visceral tumor of the liver?
heptaocellular carcinoma
Where is the most common place for metastatic cancers to spread to ?
Liver
Cholelithiasis
the presence of gallstones within the gallbladder or the biliary tree
Icterus
another term for jaundice
Pancreatitis
an inflammation of the pancreas that results from injury to acinar cells can range from mild and self limiting to fatal with hemorrhage and necrosis
Acute Pancreatitis
acute episode of inflammation of the acinar cells that has an unknown etiology but can be associated with alcohol abuse
What are serum markers that are elevated in an act pancreatitis episode? 3
serum amylase
serum Lipase
pre pancreatic fat necrosis
Chronic Pancreatitis
progressive destruction of the pancreas associated with chronic inflammation and fibrosis
What is the most common cause of a chronic calcifying pancreas?
longstanding alcohol abuse
carcinoma of the pancreas
virtually incurable neoplasm
Insulinomas
most common islet cell neoplasm, they release excessive amounts of insulin causing episodes of hypoglycemia (sweating nervousness and hunger).
Acute renal failure
an acute decline is GFR with resultant increased in BUN and Creatinine
What can cause acute renal failure?
lower urinary tract obstruction with reflux
hypotensive shock
cystic renal dysplasia
a congenital birth defect characterized by the presence of numerous cysts within the kidney
Adult polycystic kidney disease: clinical presentation?
progressive expanding cysts within the kidney that usually present as bilateral flank masses with blood clots in the urine.
Nephrotic syndrome: characteristics (4)
characterized by proteinuria, hypoproteinemia (hypoalbumemia), peripheral edema and hyperlipidemia
Nephritic sundrome: characteristics (6)
Hematuria, proteinuria, oliguria, and decreased GRF, HTN and edema
Minimal change nephrotic syndrome
clinical presents as nephrotic syndrome (edema, proteinuria, hypo albumemia and hyperlipemia) but pathologically presents as fusion of epithelial foot processes
-usually the cause of nephrotic syndrome in children
Membranous Nephropathy
presents as nephrotic syndrome with peripheral edema, hyperlipdemia, proteinuria and hypoalbumemia but is characterized by thickening of the glomerular basement membrane
-usually the cause of nephrotic syndrome in adults
What stain is used to identify membranous nephropathy?
immunofluorescence
Diabetic glomerulosclerosis
hyperglycemia causes progressive accumulation of basement membrane material causing enlargement of the glomeruli
What stain tests for sugar?Would be able to indicate diabetic glomerulosclerosis.
PAS stain
Renal amyloidosis
deposits of protein
Glomerulonephritis
inflammatory lesions of the glomerulus theater characterized by nephritic syndrome
Acute glomerulonephritis
nephritic syndrome post Group A beta hemolytic streptococci
IgA nephropathy
IgA immune complexes are deposited in the glomeruli causing a glomerulonephritis to occur
Crescentic glomerulonephritis
ominous morphological pattern (in a crescent) in which cells accumulate in the Bowman's capsule and cause fulminant glomerular damage
Goodpasture syndrome
-an antiglomular basement membrane antibody disease (autoimmune) that causes rapidly progressive crescentic glomerulonephritis that involves both kidneys and lungs
Pyelonephritis: how it occurs (3)
-acute vs . chronic
inflammation of the parenchyma, calyces and renal pelvis developing occurs from microorganisms infecting the urine, reflux of infected urine into ureters and entry of urine into the renal parenchyma
-acute: resolves with proper care, risk for papillary necrosis
-chronic: gross scaring of the kidney occurs
What is a complication of acute pyelonephritis? What population is generally most affected by it?
papillary necrosis
-elderly diabetic population with urinary obstructions
acute tubular necrosis
acute injury of the renal tubules that results in renal failure
Benign nephrosclerosis
occurs from hypertension causing renal ischemia. Decreased blood flow causes atrophy and bilateral fine granulation
Hydronephrosis
dilation of the renal pelvis caused by urinary tract obstruction
Urolithiasis
presence of stones in the collecting system of the kidneys
Wilms Tumor
Most common solid kidney tumor in very young children
renal cell carcinoma
neoplasm of the kidney that secretes renin and erythropietin
How will a patients blood work present in renal cell carcinoma?
increase in RBC (erythocytosis)
increase in Hct
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