4- pathology of liver

Question 1

can liver regenerate?

Answer 1

yes, as long as no structural problems

Question 2

what is cirrhosis appearance macroscopically?

Answer 2

bands of fibrosis separating regenerative nodules of hepatocytes
= alteration of hepatic microvasculature (the zones etc)

Question 3

what are complications of cirrhosis?

Answer 3

• portal hypertension = leads to oesophageal varices, caput medusa (veins from umbilicus), haemorrhoids
• ascites
• liver failure

Question 4

what is pathophysioloogy of alcoholic liver disease?

Answer 4

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

Question 5

what is length of progression of normal liver to cirrhosis in alcohol?

Answer 5

fatty liver (2-3 days) →hepatitis (4-6 weeks)→fibrosis (months →years) →cirrhosis

Question 6

what histological appearance of fatty liver in alcoholic hepatitis?

Answer 6

fat vacuoles on fatty liver

Question 7

what are histological appearances on alcoholic hepatitis when drinking weeks to months?

Answer 7

• hepatocyte necrosis
• neutrophils
• mallory bodies (bright pink areas on hepatocytes)
• pericellular fibrosis

Question 8

what is histological appearance of alcoholic hepatitis when months to years?

Answer 8

collagen (blue) laid around cells

Question 9

what is NAFLD?

Answer 9

non alcoholic fatty liver disease = pathologically identical to alcohol related but more with people for diabetes, obesity, hyperlipidemia

Question 10

what are obesity related liver diseases?

Answer 10

• NAFLD (non alcoholic fatty liver disease)
• NASH (non alcoholic steatohepatitis)
• metabolic syndrome

Question 11

what hepatitis infection spreads blood borne?

Answer 11

hep B&C
= dense portal chronic inflammation

Question 12

what hepatitis infection spreads faecal oral? and histological appearance

Answer 12

hep A&E
= individual necrotic cells

Question 13

what are the 3 main autoimmune diseases that affect the liver?

Answer 13

• primary biliary cholangitis (PBC)
• autoimmune hepatitis
• primary sclerosing cholangitis

Question 14

what is primary biliary cholangitis?

Answer 14

rare autoimmune disease, unknown aetiology
- associated with autoantibodies to mitochondria
= INFLAMED BILE DUCTS - granuloma around it

Question 15

what is autoimmune hepatitis?

Answer 15

autoimmune disease with chronic hepatitis pattern, some triggers like drugs

Question 16

what is histology of autoimmune hepatitis?

Answer 16

• numerous plasma cells im portal tracts = they infiltrate and cause collapse
• autoantibodies to smooth muscle

Question 17

what is primary sclerosing cholangitis?

Answer 17

= chronic inflammatory process affecting intra & extra hepatic bile ducts which leads to periductal fibrosis, duct destruction jaundice & fibrosis
- associated with ulcerative colitis

Question 18

what is chronic drug induced hepatitis?

Answer 18

similar to other hepatitis but may trigger autoimmune hepatitis

= loads of different drugs can affect the liver

Question 19

what are examples of liver storage diseases?

Answer 19

• haemochromatosis
• wilson’s disease
• alpha 1 antitrypsin deficiency

Question 20

what is
a) primary haemochromatosis?
b) secondary haemochromatosis?

Answer 20

a) genetic condition, increased absorption of iron
b) iron overload from diet, transfusion, iron therapy

Question 21

what is pathophysiology of primary haemochromatosis?

Answer 21

• 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

Question 22

what can result from primary haemochromatosis?

Answer 22

cirrhosis, carcinoma, diabetes, cardiac failure, impotence

Question 23

what is histology of primary haemochromatosis?

Answer 23

A brown rusty pigment is visible in liver cells (hemosiderin)

Question 24

what is wilson’s disease?

Answer 24

• Inherited autosomal recessive disorder of copper metabolism
• Copper accumulates in liver and brain (basal ganglia)

Question 25

what are kayser fleischer rings?

Answer 25

rings from wilson’s disease at corneal limbus

Question 26

what biochemical test can help diagnose wilsons disease?

Answer 26

low serum caeruloplasmin

Question 27

what does wilson’s disease cause?

Answer 27

chronic hepatitis and neurological deterioration

Question 28

what is alpha 1 antitrypsin deficiency?

Answer 28

Inherited autosomal recessive disorder of production of an enzyme inhibitor
= Cytoplasmic globules of unsecreted globules of protein in liver cells

Question 29

what does alpha 1 antitrypsin deficiency?

Answer 29

Causes emphysema and cirrhosis

Question 30

what are primary tumours of liver?

Answer 30

• Hepatocellular adenoma
• Hepatocellular carcinoma (Hepatoma)

Question 31

what is hepatocellular adenoma?

Answer 31

• benign but can become large and rupture or bleed
• most remain asymptomatic
• common in females because associated with oestrogen

Question 32

what is hepatocellular carcinoma?

Answer 32

• associated with cirrhosis due to any cause
• usually presents as a mass, pain, obstruction

Question 33

what are 2 patterns to look for when looking down microscope?

Answer 33

1. hepatocytic = cancer of liver cells
2. cholangiocarcinoma = bile duct cancer

Question 34

what metastatic carcinoma?

Answer 34

= 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