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83 Cards in this Set
- Front
- Back
zone of liver that has poorest oxygenation
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centrolobular
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portal triad
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portal vein, hepatic artery, bile duct
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most common liver disease in the US
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nonalcoholic fatty liver disease
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most common primary cancer of the liver
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hepatocellular carcinoma
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cirrhosis characteristics (3)
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fibrous septa
perenchymal nodules (regenerating hapatocytes) disruption of architecture of entire liver |
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3 main causes of cirrhosis in the US
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alcohol
viral nonalcoholic steatohepatitis other causes: biliary tract disease, hemochromatosis |
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active cirrhosis
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ongoing hepatic damage
peacemeal necrosis - slow infiltration and eating away of liver cells |
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inactive cirrhosis
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will not reverse damage - but no further damage occurs
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pathogenesis of cirrhosis
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cirrhosis is hepatic fibrosis
inflam cytokins, toxin, kupffer cells cause damage to hepatocytes stellate (Ito cells) proliferate and synth ECM component -> fibrosis |
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Ito cell
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stores vitamin A in liver
can be activated to synth collagen and ECM components -> fibrosis |
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cirrhosis causes of death
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liver failure
portal hypertension hepatocellular carcinoma |
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portal hypertension types
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prehepatic - portal vein thrombosis or stenosis
intrahepatic - cirrhosis posthepatic - right heart failure, hepatic vein obstruction |
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clinical consequences of cirrhosis
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hepatic encephalopathy
esophageal varicies splenomegaly other minor issues: ascities, caput maedusae |
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jaundice
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yellow discoloration of skin
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icterus
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yellow discoloration of sclerae
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hyperbilirubinemia
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increased unconjugated form due to excess production (hemolytic anemia), reduced hepatic uptake, or impared conjugation
increased conjugated form due to problem with canalicular transport, or impaired bile flow |
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cholestasis
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impaired bile formation or flow
bile gets backed up - form bile lake/infarct - leads to cirrhosis |
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liver enzyme tests
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AST, ALT
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bile canalicular tests
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alkaline phosphatase (AP) - also found in bone
gamma-glutamyl transferase (GGT) GGT will be elevated in liver disease, but normal in bone disease |
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acute viral hepatitis general morphology
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cell swelling
cytolysis apaptosis -> acidophil - councilman bodies inflammation - lymphocytes and macrophages maybe cholestasis |
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councilman bodies
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due to apoptosis of hepatocyte - creates acidophil
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acute hep B histological features
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ground glass hepatocytes
HBsAg stain you can tell hep B from other hep viral |
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acute hep C histological features
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steatosis, lymphoid aggregates
can't distinguish from other hep viral |
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chronic hepatitis definition
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persistance of increased serum liver enzymes (transaminases) > 6months
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chronic hepatitis morphology
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peacmeal necrosis - interface hepatitis
leads to... bridging necrosis - portal to protal or to central leads to... bridging fibrosis (this + regenerative nodules = cirrhosis) |
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most common blood borne infection in the US
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hep C
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Causes more chronic hepatitis - Hep B vs Hep C
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Hep C - also causes more cirrhosis and more hepatocellular carcinoma
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liver abscess
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through blood borne infection, ascending biliary, or through direct source
amoebae - anchovie paste |
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autoimmune hepatitis
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females
idiopathic T cell activation - often with concurrent autoimmune disorder autoantibodies - see increased plasma cells in liver type1 - antinuclear antibody and smooth muscle autoantibodies (most common in US) type2- anti-liver/kidney microsome1 antibody (pediatric, rare) NEGATIVE antimitochondial antibody (AMA) - differentiates from primary biliary cirrhosis |
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Ethanol induces which of the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
all of them
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acetaminophen induces which the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
necrosis
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CCl4 induces which the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
necrosis
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halothane induces which the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
necrosis
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methotrexate induces which the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
macrovesicular steatosis
fibrosis->cirrhosis |
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tetracycline induces which the following liver changes:
macrovesicular steatosis microvesicular steatosis necrosis fbirosis->cirrhosis |
microvesicular steatosis
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hepatic steatosis
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ethanol metabolism
mitochondrial damage -> fatty acid oxidation - accumuation of fatty acid microsomal dysfunction - increased lipid biosynth, decreased liporotein reversible |
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alcoholic hepatitis
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hepatocyte swelling/necrosis
mallory bodies (hyaline change) neutrophil reaction fibrosis steatohepatitis |
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nonalcoholic fatty liver disease
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most common cause of elevated liver enzymes in the US - increased aminotransferases, GGT
looks like alcohol induced disease - nonalcoholic steatohepatitis (NASH) associated with obesity, diabetes type2, metabolic syndrome unclear pathogenesis - net retention of lipids within hepatocytes |
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hemochromatosis
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excess total body iron accumulation -> organ damage
hereditary - auto rec - excess absorption acquired - ineffective erythropoesis stimulates absorption, transfusions, too much oral intake |
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iron toxicity pathogenesis
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free radial production - lipid peroxidation
activates hepatic stellate cells - collagen formation direct dna effects |
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hemochromatosis organ effects
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liver - cirrhosis, pigmentation
pancreas - diabetes, pigmentation myocardium/conduction system endocrine glands bronze skin "bronze diabetes" |
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wilson disease
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copper overload - formation of ROS
cirrhosis basal ganglia atrophy kayser-fleischer ring |
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alpha1 antitrypsin deficiency
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antiprotease protein made in liver
mutant form is abnormal polymerizes and accumulates in hepatocyte -> hepatitis in lung -> emphysema most common diagnosed genetic hepatic disorder in infants and children |
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secondary biliary cirrhosis
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extrahepatic biliary obstruction - cholethiasis, malignancies, strictures
children - biliary atresia, cystic fibrosis build up of bile acid |
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primary biliary cirrhosis (PBC)
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autoimmune
females, associates with other autoimmune disease automitochondrial antibodies (AMA) destruction of intrahepatic bile ducts |
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primary sclerosing cholangitis (PSC)
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unknown cause - autoimmune possible due to autoantibodies
anti-mitochondrial antibody NEGATIVE male predominance intra and extrahepatic bile ducts segmental periductal inflammation - looks like a string of beads onion skin histology complication - cholangiocarcinoma |
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onion skin lesion
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seen in primary sclerosing cholangitis
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von meyenburg complex
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bile duct harmatoma
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polycystic liver disease
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cysts lined with biliary epithelium
assocated with auto dom polycystic kidney disease |
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congenital hepatic fibrosis
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portal tracts enlarged by fibrous tissue - unusally shaped bile ducts
associated with auto rec polycystic kidney disease |
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caroli disease
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segmental dilation of bile ducts due to stones or abcesses
inc risk of cholangiocarcinoma |
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portal vein obstruction from thombosis or neoplasia
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extrahepatic -> portal hypertension
intrahepatic -> infarct of zahn |
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infarct of zahn
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pseudo-infract caused by obstruction of hepatic artery or portal vein (more common)
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most common cause of impaired blood flow through the liver
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cirrhosis
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right sided heart failure effect on liver
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passive congestion of the liver - nutmeg liver
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effects of left sided heart failure on the liver
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centrilobular necrosis, cardiac sclerosis
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budd-chiari syndrome
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multiple hepatic vein occulsion -> hepatomegaly, necrosis, fibrosis
triad: abdominal pain, ascites, hepatomegaly |
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sinusoidal obstruction syndrome
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veno occlusive disease due to toxin - sinusoidal obstruction by embolized sloughed endothelial cells
obliterated hepatic veins |
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liver transplant rejection (acute vs chronic vs hyperacute)
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acute - portal tract inflammation, bile duct injury, endotheliitis
chronic - obliterative arteritis hyperacute rejection is rare |
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von meyenburg complex
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bile duct hamartoma - dilated bile ducts, fibrous stroma
embryoinc bile duct remnants |
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noneoplastic hepatic masses
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von meyenburg complex
solitary biliary cyst nodular hyperplasia |
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nodular hyperplasias types (2)
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focal nodular hyperplasia
nodular regenerative hyperplasia |
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focal nodular hyperplasia
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lobulated central stellate scar
asymptomatic |
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nodular regenerative hyperplasia
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diffuse, atrophy/hyperplasia
associated with transplants, vasculities, HIV no cirrhosis, no fibrosis - has regenerative nodules |
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benign primary hepatic neoplasm
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cavernous hemangimoa - most common
hepatic adenoma |
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hepatic adenoma
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young women
associated with oral contraceptives can rupture -> hemorrhage if adenoma near to liver capsule - hemorrhage into peritoneum |
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primary hepatic malignancies
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hepatoblastoma - most common primary hepatic malignancy in pediatrics
angiosarcoma |
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hepatoblastoma
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most common primary hepatic malignancy in pediatrics
primative hepatocytes with or w/o mesenchyme (osteoid) |
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angiosarcoma
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adult neoplasm - associated with exposure to vinyl chloride - thorotrast
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hepatocellular carcinoma causes
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most common primary hepatic malignancy in US
alcohol, HBV, HBC, nonalcoholic steatohepatitis, aflatoxin |
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hepatocellular carcinoma pathogenesis
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due to cycles of cell death/regen -> accumulated mutation
viral integration (e.g. HBx protein from HBV), aflatoxins cirrhosis is not required for HCC, but certain types of cirrhosis can predispose |
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types of cirrhosis that increase risk of hepatocellular carcinoma
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hemochromatosis
postviral hep alcoholic |
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types of cirrhosis that DO NOT increase risk of hepatocellular carcinoma
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wilsons disease cirrhosis
autoimmune hepatitis cirrhosis primary biliary cirrhosis |
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hepatocellular carcinoma morphology
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look for - intracellular bile pigment
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fibrolamellar carcinoma
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young adults
variant of hepatocellular carcinoma no known risk factors |
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tumor marker for hepatocellular carcinoma
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alpha-fetoprotein
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cholangiocarcinoma
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adenocarcinoma with desmoplasia
intrahepatic metastases due to lymphatic and vascular invasion |
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cholangiocarcinoma vs hepatocellular carcinoma
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hepatocellular carcinoma is positive for intracellular bile and alpha fetoprotein stains
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cholangiohepatocellular carcinoma
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mixed form of hepatocellular carcinoma and cholangiocarcinoma
origin: oval cells |
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oval cells
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progenerator of hepatocytes and duct cells
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secondary neoplasms of liver
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more common than primary due to volume of blood flow -> increased metastases
look for multifocal involvement carcinomas usually - breast, colon, lung, pancreas |
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liver biopsy
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never done first - only if can't explain it with other tests or if need confirmation of diagnosis
chronic hep - use for prognosis not tumors - use fine needle aspiration |
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fine needle aspiration
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good for tumor diagnosis - don't need tissue architecture unless its benign
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