Deck 14: Liver and Pancreaticobiliary System

Question 1

A 54 year old homeless male was brought to the Emergency Department vomiting blood.After he was stabilised,a physical exam revealed a hard,nodular liver.A biopsy was later performed,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Acute hepatitis
B)Cirrhosis
C)Haemochromatosis
D)Hepatocellular carcinoma
E)Metastatic carcinoma

Answer 1

Cirrhosis

Question 2

A 54 year old man with alcoholic cirrhosis was seen by a local physician for steadily worsening encephalopathy and ascites.A CT scan disclosed a distinct mass within his scarred liver.A needle biopsy was obtained,a representative section of which is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Alcoholic hepatitis
B)Hepatocellular carcinoma
C)Metastatic carcinoma
D)Normal liver histology
E)Primary biliary cirrhosis

Answer 2

Hepatocellular carcinoma

Question 3

An obese,40 year old mother of four complained of nausea,diarrhoea,and foul-smelling stools.Physical examination revealed tenderness in the right upper quadrant.A laparoscopic cholecystectomy was then scheduled and later performed.The gross specimen showed flecks of yellow on the red,inflamed mucosa of the gall bladder.A representative section is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Carcinoma of the gall bladder
B)Gallstones (cholelithiasis)
C)Granulomatous inflammation of the gall bladder
D)Strawberry gall bladder
E)Tuberculosis of the gall bladder

Answer 3

Strawberry gall bladder

Question 4

A 22 year old woman returned to the United States from a trip to Mexico.She suddenly became ill,with nausea and vomiting.She underwent a needle biopsy of the liver.Later,serology was found to be positive for hepatitis A virus.A representative section of her liver biopsy is shown in the accompanying photomicrograph.Which one of the following interpretations of the eosinophilic bodies denoted by the arrows marked "C" is most likely CORRECT?

A)Acute inflammatory cells
B)Apoptotic bodies
C)Bile ducts
D)Chronic inflammatory cells
E)Mallory's ("alcoholic")hyaline
F)Viral inclusion bodies

Question 5

A 47 year old woman presented to her local physician with complaints of nausea and fatigue.She appeared somewhat jaundiced,which was confirmed by serum tests,which showed elevated liver function tests and increased indirect bilirubin.A liver biopsy was performed.A representative section is shown in low and high power in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Alcoholic hepatitis
B)Ascending cholangitis
C)Cirrhosis
D)Chronic hepatitis
E)Primary biliary cirrhosis

Question 6

A 39 year old male was seen by his local physician for fatigue.Previously,the man had engaged in numerous sports activities,and appeared fit and well-tanned.Routine labs revealed an elevated blood sugar and an elevated liver function test.A liver biopsy was obtained,and a representative section (Perls' stain)is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Acute hepatitis
B)Cirrhosis
C)Haemochromatosis
D)Hepatocellular carcinoma
E)Metastatic carcinoma

Question 7

A 24 year old man returned from his trip to China only to find himself feeling fatigued,with night sweats.He had an acute bout of hepatitis B in China,but thought he had recovered.A liver biopsy was performed.A representative section is shown in the accompanying photomicrograph.Which one of the following is the best diagnosis?

A)Alcoholic hepatitis
B)Chronic hepatitis,low grade
C)Cirrhosis
D)Lobular hepatitis
E)Normal liver histology

Question 8

A 50 year old man was brought to the Emergency Department in a stupor by police.A history was unobtainable.An initial workup disclosed jaundice,elevated liver function tests,and a blood alcohol of 300 mg/dL (the legal limit is 80 mg/dL).In order to ascertain the extent of his liver problem,a needle biopsy of the liver was performed.A representative section of the biopsy is shown in the accompanying photomicrograph.Which one of the following is the most likely composition of the eosinophilic cytoplasmic substance labelled "H" in the high power view of the biopsy shown on the right?

A)Collagen
B)Cytokeratin
C)Fibrin
D)Hyaline
E)Vimentin