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CVSOH BVSc4 > Hepatology - liver pathology > Flashcards

Hepatology - liver pathology Flashcards

1
Q

What appearance does a pig liver have?

A

Moroccan leather appearance - prominant interlobular connective tissue

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2
Q

What animals have non lobulated livers?

A

Cows and sheep

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3
Q

What is a hepatic lobule made up of?

A

Hepatic acinus - triangular region bounded by the ventral vein

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4
Q

What are the 3 main circulatory disorders affecting the liver?

A

Congenital portosystemic shunts
Post hepatic OUTFLOW conditions
Intra-hepatic/pre-hepatic conditions associated with abnormal portal vein INFLOW

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5
Q

What is a congenital portosystemic shunt?

A

Anomalous venous connection between the portal system and the venous systemic system - allows the portal blood to bypass the hepatic parenchymal sinusoids straight to the vena cava

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6
Q

What are the two different types of congenital portosystemic shunt?

A

Extra hepatic
Intra hepatic

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7
Q

What size dog gets an extra hepatic shunt? What size gets an intra-hepatic shunt?

A

Extra-hepatic - small (wEe) dogs breeds
Intra-hepatic - large (bIg) dogs breeds

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8
Q

Where does an intrahepatic congenital portosystemic shunt originate from and end at?

A

Originates at right or left portal vein branch
Into hepatic vein or directly into caudal vena cava

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9
Q

Where does an extrahepatic congenital portosystemic shunt originate from and end at?

A

Originates from left or right gastric vein or splenic vein
Into caudal vena cava or azygous vein

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10
Q

What are the functional consequences of congenital portosystemic shunts?

A

Reduced hepatic perfusion
Small liver - microhepatica
Poor growth
Hepatic encephalopathy - due to toxins

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11
Q

Will congenital portosystemic shunts result in increased blood pressure in the portal venous system (portal hypertension)?

A

No - lower resistance pathway so wont increase pressure in the portal venous system

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12
Q

What post hepatic conditions affect outflow of blood from the liver?

A

Heart disease - right sided congestive heart failure
Obstruction of hepatic vein/caudal vena cava - thrombus, wall thickening, compression

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13
Q

What are the consequences of impairment of post hepatic outflow?

A

Hepatic passive venous congestion - sinuses packed full of blood which enlarges liver - hepatomegaly
Nutmeg liver look

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14
Q

Can post hepatic conditions causing passive congestion of the liver cause portal hypertension?

A

Yes - increased pressure from the blockage

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15
Q

What conditions cause abnormal portal vein inflow?

A

Advanced chronic liver disease with fibrosis
Portal vein obstruction
Portal vein hypoplasia (smaller than normal)

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16
Q

What signalment is associated with portal vein hypoplasia?

A

Dogs - small breeds

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17
Q

Could intra/pre-hepatic conditions cause portal hypertension?

A

Yes - builds up pressure in portal system

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18
Q

What hepatic conditions cause portal hypertension?

A

Post hepatic outflow conditions
Intra/pre-hepatic conditions affecting inflow

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19
Q

What are the potential consequences of portal hypertension?

A

Ascites in peritoneal cavity
Acquired portosystemic shunts - make route of less resistance

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20
Q

What causes of portal hypertension cause acquired portosystemic shunts?

A

Intra and pre hepatic conditions
Not usually seen in post hepatic conditions such as heart failure

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21
Q

What is vacuolar hepatopathy?

A

Hepatocellular swelling and vacuolation

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22
Q

What can the vacuoles contain in vacuolar hepatopathy?

A

Lipid
Water
Glycogen

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23
Q

What are the gross changes associated with vacuolar hepatopathy?

A

Enlarged liver
Altered colour - pale yellow brown
Greasy - if lipid accumulation
More fragile

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24
Q

What causes lipid accumulation in vacuoles in the liver?

A

Reduced hepatocellular capacity to metabolise fats
Or excess delivery

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25
Q

What gross changes indicate lipid vacuolar hepatopathy?

A

Yellow/orange colour
Rounder enlarged liver
Floats in water rather than sinks

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26
Q

What causes water accumulation in the vacuoles of vacuolar hepatopathy?

A

Cellular injury:
Toxins
Metabolic insults
Hypoxia

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27
Q

What causes glycogen accumulation in vacuoles of vacuolar hepatopathy?

A

Hyperadrenocorticism
Or corticosteroid administration - steroid induced hepatopathy

28
Q

What are the 3 major patterns of necrosis in the liver?

A

Focal
Zonal
Massive

29
Q

What does focal necrosis of the liver look like?

A

White/grey foci randomly in the parenchyma

30
Q

What causes focal necrosis in the liver?

A

Infectious agents - bacteria, viruses, parasites etc.
May be of little functional significance

31
Q

What is zonal necrosis of the liver? Where is usually affected?

A

Where a zone of the acini is affected - usually zone 3 as recieves blood last so prone to hypoxic injury
Also called centrilobular or periacinar necrosis

32
Q

What causes zonal necrosis of the liver?

A

Hypoxia/ischaemia
Exposure to toxins
Viral infection - canine adenovirus 1

33
Q

What gross changes does zonal necrosis cause?

A

Mottles pattern to the liver

34
Q

What is massive necrosis in the liver?

A

Necrosis affecting all/majority of hepatocytes within the lobules

35
Q

What can cause massive necrosis in the liver?

A

Severe toxic injury
Vitamin E/selenium deficiency in pigs

36
Q

How does hepatocellular regeneration occur if there is a focal area of necrosis but the stromal framework is retained?

A

Surviving hepatocytes proliferate within the lobule to replace lost hepatocytes

37
Q

How does hepatocellular regeneration occur if there is a focal area of necrosis AND the stromal framework collapses?

A

Fibrosis and distortion of the lobule - cant restore function
Proliferation of hepatocytes in OTHER LOBULES restores hepatic mass

38
Q

How does hepatocellular regeneration occur if there is repeated episodes of necrosis?

A

Nodular regeneration with fibrosis
Causes distortion of hepatic architecture

39
Q

What forms due to fibrosis in the liver? What does this cause?

A

Fibrotic tracts which contain small blood vessels
Blood flows around lobules - reduced hepatic functional capacity

40
Q

What is the term for inflammation of the biliary tree?

A

Cholangitis

41
Q

What is the term for inflammation of the gall bladder?

A

Cholecystitis

42
Q

What is the term for inflammation of the biliary tree and hepatic parenchyma?

A

Cholangiohepatitis

43
Q

What are the gross features of acute hepatitis?

A

Multiple coalescing whiteish foci
Multiple areas of necrosis and acute inflammation

44
Q

What can cause acute hepatitis?

A

Infectious agents
Toxins/drugs

45
Q

What are some sequelae to acute bacterial hepatitis?

A

Healing and scarring - depressions in surface
Chronic inflammation
Abscess
Septic emboli in caudal vena cava

46
Q

What is the key difference in features between acute and chronic hepatitis?

A

Fibrosis
There is still inflammation and necrosis

47
Q

Where does fibrosis tend to be laid down in the liver?

A

Space of Disse - space between the hepatocytes and blood vessel endothelium
Interrupts blood flow to hepatocytes

48
Q

What are some specific causes of chronic hepatitis?

A

Ragwort toxicity
Copper toxicosis
Idiopathic
Pathogens - mycobacterium

49
Q

What are the key features of acute cholangitis on pathology?

A

Acute inflammation around bile ducts - neutrophils

50
Q

What are the key features of chronic cholangitis on pathology?

A

Chronic inflammation and fibrosis around bile ducts - lymphocytes and plasma cells
Thickened bile duct walls

51
Q

What are the main causes of cholangitis/cholangiohepatitis/cholecystitis?

A

Parasites - liver fluke
Bacteria - ascending infection up biliary tract
Idiopathic - lymphocytic cholangitis

52
Q

What is the word for end stage liver?

A

Cirrhosis

53
Q

What are the key features of end stage liver (cirrhosis)?

A

DIFFUSE chronic changes
Disturbed lobular architecture, fibrosis
Disturbed hepatic vasculature - bridging

54
Q

What are two hyperplastic changes that can occur in the liver in dogs?

A

Gall bladder mucocoele
Hepatic nodular hyperplasia

55
Q

What is a gall bladder mucocoele? What does it cause?

A

Hyperplastic gall bladder mucosa with extreme mucin production
Can be incidental but can cause biliary obstruction/thrombi/rupture

56
Q

What is hepatic nodular hyperplasia? What does it cause?

A

Common incidental finding in older dogs - well differentiated hepatocytes in modified lobules
No clinical significance

57
Q

What are the 3 potential cells of origin for primary neoplasms in the liver?

A

Hepatocellular origin
Bile duct epithelium origin
Mesenchymal origin

58
Q

What neoplasms are of hepatocellular origin?

A

Hepatocellular adenoma or carcinoma

59
Q

What neoplasms are of bile duct epithelium origin?

A

Cholangiocellular adenoma or carcinoma

60
Q

What neoplasms are of mesenchymal origin in the liver?

A

Haemangiosarcoma

61
Q

What do hepatocellular adenomas look like?

A

Single spherical tumour - grow by expansion

62
Q

What does hepatocellular carcinoma look like?

A

Multiple massive whitish nodules scattered through the liver

63
Q

What does a cholangiocellular carcinoma look like?

A

Single or multiple tumours where surface has a dip in it - from the bile ducts

64
Q

What are some secondary hepatic neoplasms?

A

Metastasis from:
Lymphoma
Pancreatic tumours
Mammary tumours
Haemangiosarcoma - splenic
Histiocytic sarcoma

65
Q

What does lymphoma look like?

A

Can be nodular - smooth raised whitish foci over whole liver
Or diffuse - mottled

CVSOH BVSc4 (86 decks)

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