15.9 Pathology: Patterns of liver injury 3

Question 1

What is autoimmune hepatitits?

Answer 1

An aggressive form of chronic hepatitis that can progress rapidly to cirrhosis (85% of untreated patients over 5 years)

Question 2

What are the two types of autoimmune heptatitis?

Answer 2

Type 1 (most common): adult women, associated with ASMA (anti-smooth muscle antibodies)

Type 2: children/teenages, associated with LKM-1 (anti-liver kidney hormone)

Question 3

How does AIH present and progress?

Answer 3

Presents as acute hepatitis (severe early phase destruction of liver cells)

Fibrosis develops rapidly in area of collapes

Question 4

What is the definition of cirrhosis?

Answer 4

Conversion of liver into nodules of regenerating hepatocytes surrounded by bands of fibrous tissue

(diffuse-whole liver)

Question 5

What is end stage chronic liver failure associated with?

Answer 5

Most often cirrhosis (not always)

Question 6

What are some causes of cirrhosis in adults? (7)

Answer 6

ALD
NASH
HBV, HCV
AIH
Chronic biliary disease
Metabolic
Drugs

Question 7

What is a very common complication in cirrhosis?

Answer 7

Thromobis of vessels, especially portal veins

Question 8

Can we tell the cause of cirrhosis by looking at a section?

Answer 8

No, different patterns provide little information about the cause. Need clinical history etc.

Question 9

Is hepatocellular death directly resulting from cirrhosis important?

Answer 9

Hepatocellular death due to direct effect of insult is unimportant (cells can be replaced by mitotic division of hepatocytes)

Question 10

Why does fibrous septa and scarring develop in cirrhosis?

Answer 10

Develop where hepatocytes have dropped out as a result of inflammatory injury to the portal veins

Question 11

What is progression to cirrhosis driven by?

Answer 11

Parenchymal extinction (caused by vascular inflammation and thrombosis)

Question 12

Who do hepatocellular carcinomas often develop in?

What is the greatest risk?

Answer 12

Patients with cirrhosis (esp. cirrhosis due to alcohol, HBV/HCV, haemochromatosis)

Question 13

How much hepatic blood flow does the portal vein account for?

How much of total liver oxygen supply

Answer 13

2/3rds of hepatic blood flow

Question 14

Wehre does the portal vein carry blood from and to?

Answer 14

GI tract, pancreas and spleen to the sinusoids of the liver

Question 15

What is the definition of portal hypertension (2)?

Answer 15

Absolute increase in blood pressure within portal vein (>8mm Hg)

OR

Increase in pressure gradient (between portal vein/hepatic vein) of 5mmHg+

Question 16

What is the most common cause of portal hypertension in our community?

Answer 16

Cirrhosis

Question 17

What is this referring to?

1. Splanchnic circulation: hyperdynamic
2. Vascular SM/stellate cells contract
3. Hepatic vein directly compressed
4. Small portal vein branches trapped by scar tissue
5. Hepatic arterial blood shunts into portal vein via arterovenous anasomoses in fibrous septa

Answer 17

Pathogenesis of portal hypertension in liver cirrhosis

Question 18

What are 4 symptoms of portal hypertension (due to cirrhosis)

Answer 18

Ascites
Formation of porto-systemic anastamoses
Congestive splenomegaly
Hepatic encephalopathy

Question 19

Where are the main sites of porto systemic anastomoses? (3)

Answer 19

Oesophagus, rectum and around umbilicus

Question 20

What are oesophageal varacies?

Answer 20

Collateral veins that have dilated when portal blood flow is re-routed

Bleed EASILY (50% mortality if ruptured)