case 5 - pathological overview of the liver Flashcards
what does bacteriology of the liver look for
sepsis in liver failure
what is in the portal tracts in damaged liver
inflammatory cells
Damaged bile ductules
Fibrosis
what is in the hepatocellular lobules in liver damage
near normal (but functionally less normal)
Inflammatory cells
Hepatocytes full of fat (steatosis)
Masses
what happens to the portal tracts in hepatitis C
filled with lymphocytes and plasma cells
Making antibodies against the virus
what does inflammation at the interface with the lobules cause
loss of hepatocytes
what does bile ductule damage from hep c imitate
autoimmune liver disease
what are features of hepatocellular parenchyma
inflammatory cells
Lymphocytes damaging hepatocytes
hepatocytes full of fat (steatosis)
Not sure why this happens
But the combination of alcohol and hepatitis C is really bad
features of hep a
infectious
Epidemic
Oral-faecal transmission
2-6 weeks incubation period
features of hep b
serum
Sporadic
Blood borne
Sexual transmission
6 weeks to 6 months incubation period
features of hep c
transfusion related
Blood-borne transmission
2 weeks to 6 months incubation period
features of hep d
Needs hepatitis B for disease
features of hep e
very similar to HAV
what is EBV
Epstein-Barr virus - glandular fever
infectious mononucleosis
when is hepatitis chronic
after 6 months
how is ethanol absorbed
Absorbed from upper small intestine, then via portal vein to liver
Rate of metabolism variable
Related to weight, gender and body fat
Enzymes can be induced, so tolerance increases
what is the average elimination rate of ethanol
average elimination rate is 0.015g/dL/hr
From legal intoxication to undetectable takes about 5 hours
Alcoholic misusers may eliminate up to 0.05g/dL/hr
Post mortem production of alcohol up to 0.05g/dL/hr
what does alcoholic liver disease lead to
fatty change - reversible
Alcoholic hepatitis - reversible
Pericellular fibrosis - reversible up to a point
Cirrhosis - irreversible
what is Mallory’s hyaline
Mallory’s Hyaline - characteristic of alcoholic liver disease - cytoskeletal particles which have aggregated in the severely damaged hepatocytes
what does non-alcoholic fatty liver disease lead to
fatty change
Non-alcoholic steatohepatitis (NASH)
Fibrosis
Cirrhosis
what is cirrhosis
Disease of all of the liver with parenchymal nodules and surrounding fibrosis
what is micronodular cirrhosis
Less than or equal to 0.3cm
Typically alcohol
what is macronodular cirrhosis
Typically greater than or equal to 0.3cm
Typically viral
what are the causes of cirrhosis
alcohol
Viruses
Especially HBV and HCV
The stain for HBsAg is orecin and IHC
Metabolic diseases
Iron, copper, glycogen storage disease, lipid disorders, alpha-one antitrypsin deficiency, haemachromatosis
Autoimmune
‘Lupoid’, young woman: anti-nuclear and anti-smooth muscle antibodies
Primary biliary cirrhosis: middle aged women, anti-mitochondrial antibodies
what happens during liver failure
protein synthesis: low albumin
Coagulation factors: bleeding
Jaundice
Encephalopathy: confusion
what are there raised levels of in hepatocellular carcinoma
There are raised serum alpha-fetoprotein levels in hepatocellular carcinoma
