Liver and Biliary Pathology Practice Questions

Q: A 44-year-old patient presented with jaundice and had a needle prick injury 2 years back. Based on the provided histological features of a liver biopsy, classify the type of hepatitis.

Hepatitis B virus induced hepatitis. ***Hepatitis B virus induced hepatitis*** - **Needle prick injury** 2 years ago with chronic presentation strongly suggests **HBV transmission**, as it's commonly transmitted through blood exposure and can cause chronic infection. - Histological features likely show **ground-glass hepatocytes** with **sanded nuclei** (Councilman bodies), which are pathognomonic for chronic HBV infection. *Hepatitis C virus induced hepatitis* - While HCV can also be transmitted through **needle prick injuries**, histological features typically show **lymphoid follicles**, **portal inflammation**, and **bile duct damage**. - HCV often presents with **steatosis** and **fibrosis** rather than the ground-glass appearance characteristic of HBV. *Hepatitis A virus induced hepatitis* - HAV is transmitted through the **fecal-oral route**, not through needle prick injuries, making this unlikely given the exposure history. - HAV causes **acute hepatitis** that resolves completely within weeks to months, not chronic disease lasting 2 years. *Hepatitis E virus induced hepatitis* - HEV is also transmitted via **fecal-oral route** and is not associated with parenteral transmission like needle prick injuries. - HEV typically causes **acute, self-limiting hepatitis** and rarely progresses to chronic infection, except in immunocompromised patients.

Q: The image shows stones found in the gall bladder. Which of the following conditions is associated with their formation?

All of the above. ***All of the above*** - All three mechanisms work synergistically in **cholesterol gallstone formation**: **bile stasis** from hypomotility, **nucleation** of cholesterol crystals, and **mucus hypersecretion** as a scaffold. - The pathogenesis involves **Admirand's triangle** disruption (cholesterol supersaturation) combined with these promoting factors leading to stone precipitation. *Hypomotility of gall bladder* - **Bile stasis** from reduced gallbladder contractility allows prolonged contact time for cholesterol precipitation and crystal growth. - While contributory, this alone is insufficient without **cholesterol supersaturation** and nucleating factors for stone formation. *Accelerated cholesterol crystal nucleation* - **Nucleation** is the initial step where cholesterol crystals form from supersaturated bile, but requires additional factors for stone development. - This process alone cannot sustain **stone growth** without bile stasis and mucus glycoproteins acting as a binding matrix. *Hypersecretion of mucus* - **Mucus glycoproteins** provide a nucleating scaffold and binding matrix essential for cholesterol crystal aggregation and stone formation. - Although crucial for stone development, mucus hypersecretion requires **cholesterol supersaturation** and stasis to be pathologically significant.

Question 1

Which of the following is not a histomorphological feature of cirrhosis of the liver?

Accepted Answer

Diffuse microvesicular steatosis

Answer

Regenerative nodules

Answer

Portal vein thrombosis

Answer

Dense bands of fibrosis

Question 2

Which of the following is NOT a histopathological feature of extrahepatic biliary atresia?

Accepted Answer

Bile lakes

Answer

Marked bile duct degeneration

Answer

Fibrosis of the hepatic duct

Answer

Parenchymal cholestasis

Question 3

A 43-year-old man has experienced progressive fatigue, pruritus, and icterus for 4 months. A colectomy was performed 5 years ago for the treatment of ulcerative colitis. On physical examination, he has generalized jaundice. The abdomen is not distended; on palpation, there is no abdominal pain and there are no masses. Laboratory studies show a serum alkaline phosphatase level of 285 U/L and an elevated titer of anti-neutrophil cytoplasmic antibodies. Cholangiography shows widespread intrahepatic biliary tree obliteration and a beaded appearance in the remaining ducts. Which of the following morphologic features is most likely to be present in his liver?

Accepted Answer

Concentric "onion-skin" ductular fibrosis

Answer

Copper deposition in hepatocytes

Answer

Granulomatous bile duct destruction

Answer

Interface hepatitis

Question 4

A patient presents with icterus and absent urine urobilinogen. What does this indicate?

Accepted Answer

Peri-hepatic obstruction

Answer

Hemolysis

Answer

Hepatitis

Answer

Liver failure

Question 5

Unconjugated hyperbilirubinemia is seen in all of the following except:

Accepted Answer

Dubin-Johnson syndrome

Answer

Crigler Najjar Syndrome

Answer

Physiological jaundice

Answer

Gilbe syndrome

Question 6

A 44-year-old patient presented with jaundice and had a needle prick injury 2 years back. Based on the provided histological features of a liver biopsy, classify the type of hepatitis.

Accepted Answer

Hepatitis B virus induced hepatitis

Answer

Hepatitis C virus induced hepatitis

Answer

Hepatitis A virus induced hepatitis

Answer

Hepatitis E virus induced hepatitis

Question 7

Ballooning of hepatocytes is not associated with which of the following conditions?

Accepted Answer

Chronic viral hepatitis

Answer

Non-alcoholic steatohepatitis

Answer

Alcoholic liver disease

Answer

Acute viral hepatitis

Question 8

Which clinical test is done to assess hepatic function related to bleeding disorders?

Accepted Answer

PTT

Answer

CT, BT

Answer

Factor 8

Answer

None of the above

Question 9

The image shows stones found in the gall bladder. Which of the following conditions is associated with their formation?

Accepted Answer

All of the above

Answer

Hypomotility of gall bladder

Answer

Accelerated cholesterol crystal nucleation

Answer

Hypersecretion of mucus

Question 10

OVAL cells are seen in the stem cells of which organ?

Accepted Answer

Liver

Answer

Skin

Answer

Cornea

Answer

Bone

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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