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BLOCK E - DIGESTION > Essentials: Liver Pathology (Summary Slides) > Flashcards

Essentials: Liver Pathology (Summary Slides) Flashcards

1
Q

Microvesicular steatosis (definition)

A

Accumulation of numerous small lipid droplets in hepatocytes (liver cells).

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2
Q

Pathogenesis: Microvesicular steatosis is associated with 3 conditions/etiologies

A
  1. Acute fatty liver of pregnancy (AFLP)
  2. Reye’s syndrome
  3. Drugs (aspirin)
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3
Q

How dangerous is microvesicular steatosis?

A

Acute liver failure is common with this condition! This is a life-threatening condition (emergency)!

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4
Q

Macrovesicular steatosis (definition)

A

Accumulation of large fat vacuoles in hepatocytes (liver cells)

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5
Q

Pathogenesis: Macrovesicular steatosis is associated with 4 main etiologies

A
  1. Alcohol abuse
  2. Obesity
  3. Drug abuse
  4. Type II diabetes & hyperlipidemia

Alson seen in hepatitis C

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6
Q

Macrovesicular steatosis can progress to…

A

steatohepatitis (if inflammation and liver injury develop)

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7
Q

Steatohepatitis (definition)

A

fat buildup in the liver that leads to inflammation of the liver.

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8
Q

3 types of steatohepatitis

A

Alcohol
ASH: Acoholic steatohepatitis

Metabolic syndromes:
NASH: Non-alcoholic steatohepatitis

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9
Q

Alcoholic and non-alcoholic steatohepatitis: macroscopic appearance

A

Pale, greasy & enlarged liver

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10
Q

Alcoholic and non-alcoholic steatohepatitis: key histologic features (3)

A
  • Injured hepatocytes (balloon cells)
  • Mallory-Denk bodies
  • Chicken wire fibrosis
  • Inflammation! (lymphocytes, neutrophils)
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11
Q

Non-alcoholic fatty liver disease (NAFLD) (definition)

A

NAFLD is a spectrum of liver disease (metabolic syndrome) that includes NASH (non-alcoholic steatohepatitis)

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12
Q

Autoimmune Hepatitis (definition)

A

Chronic liver disease characterized by immune-mediated hepatocyte damage.

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13
Q

3 key histologic features of autoimmune hepatitis

A
  • Interface hepatitis (inflammation at the junction of the portal tracts and hepatic lobules)
  • Plasma cell infiltration
  • Rosetting of liver cells (hepatocytes form flower-like pattern)
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14
Q

How do we treat autoimmune hepatitis?

A

Autoimmune hepatitis responds very well to STEROIDS.

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15
Q

Autoimmune hepatitis is more common in…

A

more common in (Caucasian) women than men

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16
Q

3 auto-antibodies present in autoimmune hepatitis

A

ANA
SMA
Anti-LKM1

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17
Q

Primary biliary cholangitis (PBC) (definition)

A

Autoimmune attack on intra-hepatic bile ducts causing inflammation.

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18
Q

Key histological feature of primary biliary cholangitis (PBC)

A

Florid duct lesions with granulomas (around the intra-hepatic bile ducts)

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19
Q

Antibody that is a hallmark of primary biliary cholangitis (PBC)

A

AMA
(presence of AMA is highly specific for PBC)

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20
Q

Primary biliary cholangitis is most commonly seen in…

A

middle-aged females (50s)

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21
Q

3 main symptoms of primary biliary cholangitis

A
  • Fatigue
  • Pruritus (itching)
  • Jaundice
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22
Q

Key histological feature of primary sclerosing cholangitis (PSC)

A

Onion skin fibrosis

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23
Q

Primary sclerosing cholangitis (definition)

A

Chronic liver disease that causes inflammation and scarring of the bile ducts

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24
Q

Which type of cholangitis affects both intra and extra hepatic ducts

A

Primary sclerosing cholangitis

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25
Q

Primary sclerosing cholangitis usually affects…

A

young males (30s)

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26
Q

How do we confirm primary sclerosing cholangitis (PSC)?

A

By identifying fibrosis and structuring of medium-large bile ducts on ERCP or MRCP

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27
Q

70% of patients with primary sclerosing cholangitis (PSC) also have…

A

ulcerative colitis (IBD)

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28
Q

Patients with primary sclerosing cholangitis (PSC) are at risk of…

A

cholangiocarcinoma

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29
Q

Hereditary hemochromatosis (definition)

A

Genetic disorder (homozygous recessive) that causes the body to store too much iron in organs and tissues (iron overload disease).

Iron depositis in the liver, pancreas, skin (bronzed colour), etc.

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30
Q

Most common gene mutation causing hereditary hemochromatosis

A

HFE gene mutations (C282Y)

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31
Q

Form of diabetes caused by hereditary hematochromatosis

A

“Bronzed” diabetes

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32
Q

How does hereditary hematochromatosis affect the liver and heart?

A

Liver: cirrhosis
Heart: cardiomyopathies

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33
Q

If a patient develops liver cirrhosis secondary to hereditary hemochromatosis, they are at very high risk of developing…

A

hepatocellular carcinoma

34
Q

How do we treat hereditary hemochromatosis?

A

Phlebotomy (draw blood)

Screen the patient’s family!

35
Q

Alpha-1 antitrypsin deficiency (definition)

A

Autosomal recessive genetic disorder causing decreased levels of alpha-1 antitrypsin (a protein which normally protects the liver and lungs from damage).

36
Q

Key histologic feature of alpha-1 antitrypsin deficiency

A

Hyaline globules within zone 1 hepatocytes, representing misfolded alpha-1 antitrypsin protein aggregates.

Visualized using the PAS-diastase stain!!!

37
Q

What is alpha-1 antitrypsin

A

An anti-protease

38
Q

What is a common genotype of alpha-1 antitrypsin deficiency? Describe it

A

PiZZ (abnormally folded alpha-1 antitrypsin protein cannot migrate from organelles and cannot exit the cytoplasm, so it accumulates in liver cells)

39
Q

What is the #1 genetic cause of pediatric liver disease (hepatitis)?

A

Alpha-1 antitrypsin deficiency

40
Q

How can alpha-1 antitrypsin deficiency affect the lungs?

A

It can cause emphysema

41
Q

Wilson’s disease (definition)

A

Autosomal recessive genetic disorder characterized by the excess buildup of copper in the body.

42
Q

What mutation causes Wilson’s disease? Explain.

A

Mutations in ATPB7 gene (the enzyme that normally incorporates copper into ceruloplasmin and excretes copper into bile).

43
Q

How does Wilson’s disease affect the liver?

A

Copper overload in the liver leads to cirrhosis and acute liver failure/necrosis.

44
Q

Key histological feature of Wilson’s disease?

A

Copper in zone 1 hepatocytes

45
Q

How can Wilson’s disease affect the eyes?

A

Causes Kayser-Fleischer ings in the cornea

46
Q

Budd Chiari syndrome (definition)

A

Vascular disease causing impaired blood flow OUT from the liver due to THROMBOSIS of major hepatic veins!!

47
Q

What blood vessels are affected by budd-chiari syndrome?

A

Outflow veins: central veins/IVC

48
Q

Budd-chiari syndrome usually affects…

A

women (30s)

49
Q

2 common causes of budd-chiari syndrome

A

Polycythemia rubra vera (rare blood cancer that causes the body to produce too many red blood cells, which thickens the blood and can lead to blood clots)

Drugs

50
Q

Drug-induced liver injury: What is the #1 drug that can cause liver toxicity?

A

Acetaminophen (#1 cause of fulminant hepatic failure)

51
Q

1 cause of fulminant hepatic failure

A

Acetaminophen (drug toxicity)

52
Q

How does acetaminophen injure the liver?

A

Causes massive hepatic necrosis (zone 3)

53
Q

Causes of fulminant hepatic failure (medical emergency, severe liver injury) (6)

A

1 ACETAMINOPHEN

Viral (Hep A, Hep B)
Wilson’s disease
Ischemia
Microvesicular steatosis
Malignancy

54
Q

Cirrhosis (definition)

A

Acute condition of the liver in which the liver is scarred and permanently damaged.

55
Q

Common causes of liver cirrhosis (3)

A
  • Alcohol
  • Hep C
  • Non-alcoholic fatty liver disease
56
Q

Rare causes of liver cirrhosis (4)

A
  • Hepatitis B
  • Hemochromatosis
  • Biliary disease
  • Autoimmune hepatitis
57
Q

Key symtpoms of liver cirrhosis (2)

A
  • Failure of liver metabolic functions
  • Portal hypertension
58
Q

Cirrhosis increases the risk of…

A

hepatocellular carcinoma (HCC)

59
Q

3 key histologic features of liver cirrhosis

A
  • diffuse liver involvement
  • fibrous septation
  • nodular regeneration
60
Q

Name 5 types of liver growths neoplasms (benign and malignant)

A
  1. Focal nodular hyperplasia
  2. Hemangioma
  3. Adenoma
  4. Metastasis
  5. HCC
61
Q

Focal nodular hyperplasia is…
a) neoplastic
b) non-neoplastic

A

b) non-neoplastic

62
Q

Name benign liver neoplasms (2)

A

Hemangioma
Adenoma

63
Q

Name malignant liver neoplasms (2)

A

Hepatocellular carcinoma
Metastasis

64
Q

Focal Nodular Hyperplasia (definition and cause)

A

Asymptomatic benign liver tumour due to vascular hyperperfusion to the liver.

65
Q

Focal nodular hyperplasia usually affects…?

66
Q

Focal nodular hyperplasia treatment?

A

Treatment is rarely required (NO resection).
Monitor, watch and wait.

67
Q

Focal nodular hyperplasia appearance

A

Solitary, well-circumscribed tumour with central scar

68
Q

Hemangioma (definition)

A

Non-cancerous neoplastic tumour causing benign vascular lesions

69
Q

1 liver tumour

A

Hemangioma

70
Q

How can we diagnose hemangioma?

A

Easily diagnosed on CT

71
Q

Hepatocellular adenoma (definition)

A

Uncommon solitary neoplastic tumour of the liver, usually affecting women (oral contraceptive pill is a risk factor).

72
Q

What is the risk of a hepatocellular adenoma becoming malignant?

A

low risk of malignancy

73
Q

Hepatocellular adenoma treatment

A

Stop OCP (oral contraceptive pill)
Surgery (resect the tumour)

74
Q

1 liver MALIGNANCY in Canada

A

Metastasis (it is more common than primary liver malignancy)

75
Q

Cancer metastasis to the liver is usually caused by…

A

ADENOCARCINOMA of…
* lung
* colon
* pancreas
* breast

76
Q

Describe the appearance of metastases in the liver

A

You will see multiple masses and liver enlargement (potentially with liver failure)

77
Q

Hepatocellular carcinoma (definition)

A

Primary cancer of the liver

78
Q

Hepatocellular carcinoma stains positively with…

A

alpha fetoprotein (normal hepatocytes do not)

79
Q

Rare variant of hepatocellular carcinoma: Name and description

A

Fibrolamellar HCC (large solitary mass in young patients, no cirrhosis)

80
Q

Main risk factor for hepatocellular carcinoma

A

CIRRHOSIS (any cause of cirrhosis)

BLOCK E - DIGESTION (30 decks)

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