4- pathology of liver Flashcards
can liver regenerate?
yes, as long as no structural problems
what is cirrhosis appearance macroscopically?
bands of fibrosis separating regenerative nodules of hepatocytes
= alteration of hepatic microvasculature (the zones etc)
what are complications of cirrhosis?
- portal hypertension = leads to oesophageal varices, caput medusa (veins from umbilicus), haemorrhoids
- ascites
- liver failure
what is pathophysioloogy of alcoholic liver disease?
depends on extent of alcohol abuse & individual factors
= ethanol metabolised in liver, the breakdown products of this are toxic→chronic consumption = ROS release →damage of cellular structures →inflammation→activates hepatic stellate →promote fibrosis
what is length of progression of normal liver to cirrhosis in alcohol?
fatty liver (2-3 days) →hepatitis (4-6 weeks)→fibrosis (months →years) →cirrhosis
what histological appearance of fatty liver in alcoholic hepatitis?
fat vacuoles on fatty liver
what are histological appearances on alcoholic hepatitis when drinking weeks to months?
- hepatocyte necrosis
- neutrophils
- mallory bodies (bright pink areas on hepatocytes)
- pericellular fibrosis
what is histological appearance of alcoholic hepatitis when months to years?
collagen (blue) laid around cells
what is NAFLD?
non alcoholic fatty liver disease = pathologically identical to alcohol related but more with people for diabetes, obesity, hyperlipidemia
what are obesity related liver diseases?
- NAFLD (non alcoholic fatty liver disease)
- NASH (non alcoholic steatohepatitis)
- metabolic syndrome
what hepatitis infection spreads blood borne?
hep B&C
= dense portal chronic inflammation
what hepatitis infection spreads faecal oral? and histological appearance
hep A&E
= individual necrotic cells
what are the 3 main autoimmune diseases that affect the liver?
- primary biliary cholangitis (PBC)
- autoimmune hepatitis
- primary sclerosing cholangitis
what is primary biliary cholangitis?
rare autoimmune disease, unknown aetiology
- associated with autoantibodies to mitochondria
= INFLAMED BILE DUCTS - granuloma around it
what is autoimmune hepatitis?
autoimmune disease with chronic hepatitis pattern, some triggers like drugs
what is histology of autoimmune hepatitis?
- numerous plasma cells im portal tracts = they infiltrate and cause collapse
- autoantibodies to smooth muscle
what is primary sclerosing cholangitis?
= chronic inflammatory process affecting intra & extra hepatic bile ducts which leads to periductal fibrosis, duct destruction jaundice & fibrosis
- associated with ulcerative colitis
what is chronic drug induced hepatitis?
similar to other hepatitis but may trigger autoimmune hepatitis
= loads of different drugs can affect the liver
what are examples of liver storage diseases?
- haemochromatosis
- wilson’s disease
- alpha 1 antitrypsin deficiency
what is
a) primary haemochromatosis?
b) secondary haemochromatosis?
a) genetic condition, increased absorption of iron
b) iron overload from diet, transfusion, iron therapy
what is pathophysiology of primary haemochromatosis?
- inherited autosomal recessive condition = gene defect
- excess iron absorption of iron from intestine, abnormal iron metabolism
- iron deposited in liver and eventually deposited in portal connective tissue and stimulates fibrosis
what can result from primary haemochromatosis?
cirrhosis, carcinoma, diabetes, cardiac failure, impotence
what is histology of primary haemochromatosis?
A brown rusty pigment is visible in liver cells (hemosiderin)
what is wilson’s disease?
- Inherited autosomal recessive disorder of copper metabolism
- Copper accumulates in liver and brain (basal ganglia)
what are kayser fleischer rings?
rings from wilson’s disease at corneal limbus
what biochemical test can help diagnose wilsons disease?
low serum caeruloplasmin
what does wilson’s disease cause?
chronic hepatitis and neurological deterioration
what is alpha 1 antitrypsin deficiency?
Inherited autosomal recessive disorder of production of an enzyme inhibitor
= Cytoplasmic globules of unsecreted globules of protein in liver cells
what does alpha 1 antitrypsin deficiency?
Causes emphysema and cirrhosis
what are primary tumours of liver?
- Hepatocellular adenoma
- Hepatocellular carcinoma (Hepatoma)
what is hepatocellular adenoma?
- benign but can become large and rupture or bleed
- most remain asymptomatic
- common in females because associated with oestrogen
what is hepatocellular carcinoma?
- associated with cirrhosis due to any cause
- usually presents as a mass, pain, obstruction
what are 2 patterns to look for when looking down microscope?
- hepatocytic = cancer of liver cells
- cholangiocarcinoma = bile duct cancer
what metastatic carcinoma?
= This is the commonest explanation for liver tumours especially if multiple. The primary lesion can be almost anywhere within the body
- usually incurable but if small then sometimes curable
