Histology USMLE Step 1 Practice Question
A 45-year-old man with a 20-year history of heavy alcohol consumption presents to the clinic with progressive jaundice and right upper quadrant discomfort. He reports increased abdominal distension over the past 3 months. Vital signs are BP 134/88 mmHg, HR 88/min, RR 14/min, temperature 37.0°C. Physical examination reveals hepatomegaly, mild splenomegaly, and mild ascites. Laboratory studies show AST 285 U/L, ALT 95 U/L, alkaline phosphatase 180 U/L, total bilirubin 4.2 mg/dL, and albumin 2.8 g/dL. Abdominal ultrasound demonstrates a cirrhotic liver with heterogeneous echotexture and ascites. A liver biopsy is obtained to assess the stage of liver disease. Microscopic examination reveals extensive collagen deposition with bands of fibrous tissue spanning between portal triads and between portal areas and the hepatic venule, completely disrupting the normal hepatic architecture and replacing much of the normal parenchyma with regenerative nodules. Which histologic finding best explains the advanced stage of this patient's liver disease?
Answer choices
- APortal tract inflammation with focal hepatocyte apoptosis but preservation of the limiting plate
- BBridging fibrosis extending from portal tracts to central veins with disruption of hepatic architecture and formation of regenerative nodulesCorrect answer
- CPerisinusoidal fibrosis with a reticular (chicken-wire) pattern surrounding individual hepatocytes
- DKupffer cell hyperplasia with lipofuscin deposition and mild bile duct proliferation
- EMicrovesicular steatosis with inflammatory infiltration limited to portal tracts
- FPortal-to-portal fibrosis only, without involvement of the hepatic venule or disruption of the acinar architecture
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