Gastrointes*nal and Liver Pathology. Kris*ne Kra5s, M.D.

Transcription

1 Gastrointes*nal and Liver Pathology Kris*ne Kra5s, M.D.

2 GI Pathology Outline Esophagus Stomach Intes*ne Liver Gallbladder Pancreas

3 GI Pathology Outline Esophagus Stomach Intes*ne Liver Hepa**s Alcoholic liver disease Hemochromatosis Wilson disease Carcinoma

4 Viral Hepa**s Caused by Hepa**s A, B, or C viruses Some cases asymptoma*c Some cases symptoma*c: Acute (jaundice) Chronic (may lead to cirrhosis and liver failure) Fulminant (liver failure)

5 Transmission Chronic Hepa**s Hepa**s A Hepa**s B Hepa**s C Fecal-oral Body fluids Needles Body fluids Needles None 5% >85% Carcinoma No Yes Yes Other stuff 50% of people > 50 are + Vaccine effec*ve New drugs are promising Bo\om line Benign, selflimited disease Most recover; small % die Nasty! Almost 10% die

6 Acute viral hepa**s

7 Chronic viral hepa**s

8 Chronic viral hepa**s: ground-glass hepatocytes

9 Bilirubin metabolism and elimina*on

10 Jaundice Yellow skin, eyes due to elevated bilirubin Conjugated hyperbilirubinemia causes: liver excre*on (hepa**s) bile flow (tumor blocking bile duct) Unconjugated hyperbilirubinemia causes: produc*on (hemoly*c anemia) uptake (hepa**s)

11 Jaundice

12 Laboratory Tests Hepatocyte integrity Biliary func*on Hepatocyte func*on Serum aspartate aminotransferase (AST) Serum alanine aminotransferase (ALT) Serum bilirubin (total and direct) Serum alkaline phosphatase Serum albumin Prothrombin *me

13 Cirrhosis Fibro*c, nodular liver Causes: alcoholism, hepa**s Leads to portal hypertension and liver failure Increased risk of liver carcinoma

14 Cirrhosis

15 Cirrhosis

16 Portal Hypertension Decreased blood flow through liver Biggest cause: cirrhosis Symptoms ascites venous shunts (varices, hemorrhoids) conges*ve splenomegaly hepa*c encephalopathy

17 Consequences of portal hypertension

18 Esophageal varices

19 Caput medusae

20 Medusa

21 Liver Failure End point of severe liver disease Causes: fulminant hepa**s, cirrhosis, drug overdose Symptoms: jaundice, edema, bleeding, hyperammonemia Mul*ple organ-system failure Hepa*c encephalopathy Hepatorenal syndrome

22 Oral Manifesta*ons of Liver Injury Hematomas, gingival bleeding Jaundiced mucosa Glossi*s (in alcoholic hepa**s) Reduced healing a5er surgery

23 Alcoholic Liver Disease 100, ,000 deaths/year Effects on liver: steatosis, hepa**s, cirrhosis How much do you need to drink? Short-term inges*on of 8 beers/day reversible steatosis Long-term inges*on of 5 beers/day severe injury Beer and binge drinking are risky

24 More youth with irreversible liver disease now

25 Alcoholic liver disease

26 Alcoholic steatosis

27 Alcoholic hepa**s: inflamma*on and Mallory bodies

28 Alcoholic cirrhosis

29 Alcoholic Liver Disease Abs*nence: 5ys is 90% Con*nued drinking: 5ys drops to 50-60% Causes of death in end-stage alcoholism: Liver failure Massive GI bleed Infec*on Hepatorenal syndrome Hepatocellular carcinoma

30 Hereditary Hemochromatosis Autosomal recessive disease: body iron Cause: muta*ons in hemochromatosis gene (regulates iron absorp*on) Cirrhosis, skin pigmenta*on, liver carcinoma Early detec*on and treatment (phlebotomy, iron chelators) = normal life expectancy

31 Skin bronzing in hemochromatosis

32 Wilson Disease Autosomal recessive disease: body copper Cause: muta*on in gene regula*ng copper excre*on Symptoms: acute and chronic liver disease, neuropsychiatric manifesta*ons, Kayser- Fleisher rings in cornea Treatment: copper chela*on therapy

33 Kayser-Fleischer Rings

34 Hepatocellular Carcinoma Strongly associated with hepa**s B and C, chronic liver disease, and aflatoxins Rapid increase in liver size, worsening ascites, fever and pain alpha fetoprotein level Median survival 7 months (death from bleeding, liver failure, cachexia)

35 Hepatocellular carcinoma

36 Hepatocellular carcinoma

37 Metasta*c Carcinoma Most common malignancy in the liver Usually mul*ple lesions Most common primaries: colon, lung, breast, pancreas, stomach.

38 Metasta*c carcinoma

39 GI Pathology Outline Esophagus Stomach Intes*ne Liver Gallbladder Cholelithiasis Cholecys**s

40 Cholelithiasis Common! (10% of adults in US) Cholesterol stones: Female, Fat, Fer*le, Forty Pigment (bilirubin) stones: Asian countries, hemoly*c anemia and biliary infec*ons Symptoms: None, or excrucia*ng pain Complica*ons: cholecys**s, empyema, perfora*on, fistula, obstruc*on, pancrea**s

41 Cholesterol gallstones

42 Pigmented gallstones

43 GI Pathology Outline Esophagus Stomach Intes*ne Liver Gallbladder Pancreas Pancrea**s Carcinoma

44 Normal Pancreas Exocrine pancreas Makes enzymes for diges*on Diseases: pancrea**s, cys*c fibrosis, tumors Endocrine pancreas Makes insulin, glucagon, other hormones Diseases: diabetes, tumors

45 Acute Pancrea**s Acute inflamma*on and reversible destruc*on of pancreas Symptoms: abdominal pain radia*ng to back Main causes: alcoholism, gallstones Labs: elevated serum amylase and lipase Prognosis: Most recover, but 5% die in first week

46 Cell injury (alcohol) Obstruc*on (gallstones)

47 Chronic Pancrea**s Longstanding, irreversible pancrea*c destruc*on Most are alcohol related, some idiopathic Symptoms: silent, or bouts of jaundice and pain Prognosis: poor (50% mortality over 20 years)

48 Pancrea*c Carcinoma 4th leading cause of cancer death in US Biggest risk factor: smoking Highly invasive Silent un*l late; then pain, jaundice Very high mortality: 5ys <5%

49 Pancrea*c carcinoma

50 Pancrea*c carcinoma