General Liver Pathology

Question 1

What is the basic structural unit of the liver?

Answer 1

Hepatic lobule

Question 2

Describe the three zones of the liver

Answer 2

Zone 1: closest to the portal triad, periportal hepatocytes receive the most oxygen
Zone 2: mid zone
Zone 3: closest to the terminal hepatic vein, periventricular hepatocytes are the most metabolically active and have the most liver enzymes

Question 3

Name the 3 constituents of the portal triad

Answer 3

Bile duct branches, hepatic artery, portal vein

Question 4

State at least 4 functions of the liver

Answer 4

Metabolism, protein synthesis, storage, hormone metabolism, bile synthesis, immune function

Question 5

Describe the liver’s metabolic functions

Answer 5

Involved in glycolysis, glycogen storage, glucose synthesis, amino acid synthesis, fatty acid synthesis, lipoprotein metabolism, and drug metabolism

Question 6

Describe the liver’s protein synthesis functions

Answer 6

Makes all circulating proteins, except gamma globulins, including albumin, fibrinogen, and coagulation factors

Question 7

Describe the liver’s storage functions

Answer 7

Stores glycogen, vitamins A, D, and B12 in large amounts. Stores vitamin K, folate, iron, and copper in small amounts

Question 8

Describe the liver’s hormone metabolism functions

Answer 8

Activates vitamin D by hydroxylating it to 25-hydroxy-vitamin D. Coagulates and excretes steroid hormones including oestrogen and glucocorticoids. Metabolises peptide hormones including insulin, GH, and PTH

Question 9

Describe the liver’s immune function

Answer 9

Kupffer cells phagocytose antigens from the gut

Question 10

Describe the effect of chronic inflammation on the liver

Answer 10

Loss of microvilli and activation of stellate cells, producing myofibroblasts which produce and deposit collagen in the space of Disse. Myofibroblasts also contract sinusoids, and increase vascular resistance

Question 11

Describe the histology of acute hepatitis

Answer 11

Spotty necrosis - small foci of inflammation and infiltrates

Question 12

What does staging and grading of chronic hepatitis represent?

Answer 12

Staging: severity of fibrosis
Grading: severity of inflammation

Question 13

Describe the histology of grade 1 chronic hepatitis

Answer 13

Portal inflammation

Question 14

Describe the histology of grade 2 chronic hepatitis

Answer 14

Interface hepatitis with piecemeal necrosis - cannot see the border between the portal tract and parenchyma

Question 15

Describe the histology of grade 3 chronic hepatitis

Answer 15

Lobular inflammation

Question 16

Describe the histology of grade 4 chronic hepatitis

Answer 16

Bridging from the portal vein to central vein

Question 17

What is hepatic adenoma associated with?

Answer 17

Oral contraceptive pill

Question 18

What is the most common benign liver lesion?

Answer 18

Haemangioma

Question 19

How do liver adenomas present?

Answer 19

Abdominal pain, intraperitoneal bleeding

Question 20

When should liver adenomas be resected?

Answer 20

If they are symptomatic, >5cm, or do not shrink when the oral contraceptive pill is stopped

Question 21

State at least 4 causes of hepatocellular carcinoma

Answer 21

Hepatitis B, hepatitis C, alcoholism, haemochromatosis, non-alcoholic fatty liver disease, aflatoxin, androgenic steroids

Question 22

What is the tumour marker of hepatocellular carcinoma?

Answer 22

Alpha-fetoprotein

Question 23

State at least 4 causes of cholangiocarcinoma

Answer 23

Primary sclerosing cholangitis, parasitic liver disease, chronic lover disease, congenital liver abnormalities, Lynch syndrome type II

Question 24

Name 4 types of liver cancer

Answer 24

Hepatocellular carcinoma, cholangiocarcinoma, haemangiosarcoma, hepatoblastoma

Question 25

What is cholangiocarcinoma?

Answer 25

Adenocarcinoma of the bile ducts, represents 10% of liver tumours, can be intra or extrahepatic

Question 26

What is the most common malignant liver lesion?

Answer 26

Metastases

Question 27

State the 3 most common origins of liver metastases

Answer 27

BBB: Bowel/GI tract, breast, brochus