Cirrhosis: Pathology review
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Cirrhosis: Pathology review
Pathology
Liver, gallbladder and pancreas disorders
Biliary atresia
Crigler-Najjar syndrome
Dubin-Johnson syndrome
Gilbert's syndrome
Rotor syndrome
Acute cholecystitis
Ascending cholangitis
Biliary colic
Cholangiocarcinoma
Chronic cholecystitis
Gallbladder cancer
Gallstone ileus
Gallstones
Alcohol-induced liver disease
Alpha 1-antitrypsin deficiency
Autoimmune hepatitis
Benign liver tumors
Budd-Chiari syndrome
Cholestatic liver disease
Cirrhosis
Hemochromatosis
Hepatic encephalopathy
Hepatitis
Hepatocellular adenoma
Hepatocellular carcinoma
Jaundice
Neonatal hepatitis
Non-alcoholic fatty liver disease
Portal hypertension
Primary biliary cirrhosis
Primary sclerosing cholangitis
Reye syndrome
Wilson disease
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Acute pancreatitis
Chronic pancreatitis
Pancreatic cancer
Pancreatic pseudocyst
Lower gastrointestinal tract disorders
Bowel obstruction
Gallstone ileus
Intestinal adhesions
Volvulus
Colorectal cancer
Colorectal polyps
Familial adenomatous polyposis
Gardner syndrome
Juvenile polyposis syndrome
Peutz-Jeghers syndrome
Gastroschisis
Hirschsprung disease
Imperforate anus
Intestinal atresia
Intestinal malrotation
Intussusception
Meckel diverticulum
Necrotizing enterocolitis
Omphalocele
Abdominal hernias
Femoral hernia
Inguinal hernia
Crohn disease
Microscopic colitis
Ulcerative colitis
Ischemic colitis
Small bowel ischemia and infarction
Celiac disease
Lactose intolerance
Protein losing enteropathy
Short bowel syndrome (NORD)
Small bowel bacterial overgrowth syndrome
Tropical sprue
Whipple's disease
Carcinoid syndrome
Appendicitis
Diverticulosis and diverticulitis
Gastroenteritis
Irritable bowel syndrome
Anal fissure
Anal fistula
Hemorrhoid
Rectal prolapse
Upper gastrointestinal tract disorders
Cleft lip and palate
Congenital diaphragmatic hernia
Esophageal web
Pyloric stenosis
Tracheoesophageal fistula
Achalasia
Barrett esophagus
Boerhaave syndrome
Diffuse esophageal spasm
Eosinophilic esophagitis (NORD)
Esophageal cancer
Gastroesophageal reflux disease (GERD)
Mallory-Weiss syndrome
Plummer-Vinson syndrome
Zenker diverticulum
Cyclic vomiting syndrome
Gastric cancer
Gastric dumping syndrome
Gastritis
Gastroenteritis
Gastroparesis
Peptic ulcer
Aphthous ulcers
Dental abscess
Dental caries disease
Gingivitis and periodontitis
Ludwig angina
Oral cancer
Oral candidiasis
Parotitis
Sialadenitis
Temporomandibular joint dysfunction
Warthin tumor
Gastrointestinal system pathology review
Appendicitis: Pathology review
Cirrhosis: Pathology review
Colorectal polyps and cancer: Pathology review
Congenital gastrointestinal disorders: Pathology review
Diverticular disease: Pathology review
Esophageal disorders: Pathology review
Gallbladder disorders: Pathology review
Gastrointestinal bleeding: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Jaundice: Pathology review
Malabsorption syndromes: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
Pancreatitis: Pathology review
Viral hepatitis: Pathology review
Assessments
Cirrhosis: Pathology review
USMLE® Step 1 questions
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Questions
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Transcript
Content Reviewers
At the family medicine clinic, a 52- year- old male immigrant from Africa, named Jamar, came in for a checkup for the first time in a decade. On questioning, he admits to an extensive history of alcohol abuse. Physical examination reveals gynecomastia, palmar erythema and spider angiomata, as well as a palpable spleen.
Next, a 70- year- old Caucasian female, named Eleanor, with a history of chronic hepatitis C infection, is brought to the emergency department by paramedics due to altered mental status. She is completely disoriented and unable to provide an adequate history. Neurologic examination also reveals asterixis.
Lab tests of both show increased aspartate aminotransferase, or AST, and alanine aminotransferase or ALT. There’s also decreased albumin and increased prothrombin time. The difference is that Jamar has an AST level twice as high as ALT, in contrast with Eleanor, who has an ALT higher than AST. Eleanor, in particular, also has high serum levels of ammonia.
Both Jamar and Eleanor have cirrhosis. This is when chronic inflammation damages the liver causing it to become fibrotic. Normally, the liver is highly regenerative but scar tissue can replace liver cells which prevents regeneration and when this goes on for too long, it reaches the point where the damage is no longer reversible. If enough of the liver is replaced by scar tissue in advanced cirrhosis, a liver transplant might be needed. . Now, if we zoom into a hepatic lobule, we can see that it’s made of sheets of hepatocytes with sinusoids between them. The sinusoids are made of branches of the portal vein and hepatic artery, and together with the bile duct, form the portal triad which runs towards the central vein.
Now, there’s a space around each sinusoid, called the perisinusoidal space which contains stellate cells. When the hepatocytes are injured, they cluster together and form regenerative nodules. Here, they secrete paracrine factors that activate the stellate cells, which then proliferate, and start secreting transforming growth factor beta1, or TGF-beta. This causes them to produce collagen. The collagen builds up around the nodules and helps form scar tissue, leading to fibrosis.
Sources
- "Fundamentals of Pathology" H.A. Sattar (2017)
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "The Immunobiology and Pathophysiology of Primary Biliary Cirrhosis" Annual Review of Pathology: Mechanisms of Disease (2013)
- "Epidemiology of Alcoholic Liver Disease" Seminars in Liver Disease (2004)
- "Pathogenesis, Diagnosis, and Treatment of Alcoholic Liver Disease" Mayo Clinic Proceedings (2001)
- "Current concepts in the assessment and treatment of Hepatic Encephalopathy" QJM (2009)
- "Oxidative Stress and Epigenetic Instability in Human Hepatocarcinogenesis" Digestive Diseases (2013)
- "Involvement of DNA Damage Response Pathways in Hepatocellular Carcinoma" BioMed Research International (2014)
- "Hereditary Hemochromatosis — A New Look at an Old Disease" New England Journal of Medicine (2004)
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