Liver and Biliary Pathology Practice Questions

Q: "Onion-skin" fibrosis of bile duct is seen in?

Primary sclerosing cholangitis. **Explanation:** **Primary Sclerosing Cholangitis (PSC)** is the correct answer. The hallmark histopathological feature of PSC is **periductal "onion-skin" fibrosis** [1], [2]. This occurs due to chronic inflammation and concentric scarring around the medium and large-sized intrahepatic and extrahepatic bile ducts [1]. Over time, this progressive fibrosis leads to the obliteration of the duct lumen, a process known as **vanishing bile duct syndrome**, which gives a characteristic "beaded" appearance on cholangiography (MRCP/ERCP) [1]. **Analysis of Incorrect Options:** * **Primary Biliary Cirrhosis (PBC):** Characterized by the **"Florid duct lesion"** (granulomatous destruction of small intrahepatic bile ducts). It does not show concentric onion-skin fibrosis. * **Extrahepatic Biliary Obstruction:** Typically presents with bile stasis, bile lakes, and portal tract edema, but not the specific concentric periductal fibrosis seen in PSC. * **Congenital Hepatic Fibrosis:** Part of the fibrocystic liver disease spectrum (associated with ARPKD). It features diffuse periportal fibrosis and abnormally shaped bile ducts (ductal plate malformations) rather than periductal scarring. **High-Yield Clinical Pearls for NEET-PG:** * **Association:** Strong association with **Ulcerative Colitis** (approx. 70% of PSC patients have UC) [1], [2]. * **Markers:** p-ANCA is often positive (though not specific). * **Imaging:** "Beads on a string" appearance on MRCP/ERCP [1]. * **Risk:** Significantly increased risk of **Cholangiocarcinoma**. * **Epidemiology:** More common in males (unlike PBC, which is more common in females) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 864-866. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 393-394.

Question 1

"Onion-skin" fibrosis of bile duct is seen in?

Accepted Answer

Primary sclerosing cholangitis

Answer

Primary biliary cirrhosis

Answer

Extrahepatic biliary fibrosis

Answer

Congenital hepatic fibrosis

Question 2

Abnormalities in the synthetic function of the liver result in which of the following?

Accepted Answer

Prothrombin time (PT)

Answer

Hyperbilirubinemia

Answer

Decreased acute phase reactants

Answer

Disturbance in Kupffer cells

Question 3

All of the following are true about fibrolamellar carcinoma of the liver except?

Accepted Answer

Alpha-fetoprotein (AFP) levels are always greater than 1000

Answer

More common in females

Answer

Better prognosis than hepatocellular carcinoma

Answer

Occurs in younger individuals

Question 4

Which of the following is a risk factor for cholangiocarcinoma?

Accepted Answer

Opisthorchis sinensis infection

Answer

Obesity

Answer

Salmonella carrier state

Answer

HBV infection

Question 5

Mallory's hyaline is seen in which of the following conditions?

Accepted Answer

Indian childhood cirrhosis

Answer

Hepatitis C infection

Answer

Amoebic liver abscess

Answer

Autoimmune hepatitis

Question 6

Which of the following is NOT a metabolic cause of liver disease?

Accepted Answer

Histiocytosis

Answer

Hemochromatosis

Answer

Gaucher's disease

Answer

Wilson's disease

Question 7

Peripoal fibrosis is caused by which of the following agents?

Accepted Answer

Methotrexate

Answer

Phenytoin

Answer

Thorotrast

Answer

Halothane

Question 8

Which of the following are features of alcoholic liver disease?

Accepted Answer

All of the above

Answer

Fatty changes

Answer

Pericellular fibrosis

Answer

Mallory bodies

Question 9

Which of the following pigments accumulates in the liver in Dubin-Johnson syndrome?

Accepted Answer

Epinephrine metabolite

Answer

Monoglucuronate bilirubin

Answer

Bilirubin pigment

Answer

Melanotic pigment

Question 10

What is true about Hepatocellular Carcinoma?

Accepted Answer

Hepatitis B virus infection predisposes to its development

Answer

Most prevalent malignancy worldwide

Answer

Commonest primary liver tumor

Answer

Patients typically present in the early stage

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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