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Pathology > Hi - Liver > Flashcards

Hi - Liver Flashcards

1
Q

Mallory Denk bodies

A

Alcoholic hepatitis

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2
Q

Defining histological features of alcoholic hepatitis

A

Fibrosis
Inflammation
Ballooning
Mallory Denk bodies

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3
Q

Treatment for alcoholic hepatitis

A

Supportive
Stop EtOH
Nutrition + vitamins
Occasionally steroids

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4
Q

What can B1 deficiency lead to?

A

Beri Beri

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5
Q

What can niacin deficiency lead to?

A

Pellagra

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6
Q

Spider nave
Dupuytren’s contracture
Palmar erythema
Gynaecomastia

What does this suggest?

A

Chronic stable liver disease

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7
Q

If you see an alcoholic with a visible vein on the abdominal wall, which other finding are you most likely to see:

A: hepatomegaly, B: splenomegaly, C: bilateral palpable kidneys, D: palpable bladder, E: enlarged prostate on PR

A

B: splenomegaly

EtOH –> nodules form –> cirrhosis. this cause portal Hypertension.

This blood backs up into the splenic vein –> splenomegaly

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8
Q

Patient with chronic stable liver disease recently noticed visible veins, splenomegaly AND ascites. what does this suggest?

A

Portal hypertension

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9
Q

Hepatic flap is seen in a patient with previously chronic stable liver disease. What does this indicate?

A

Liver failure

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10
Q

4 possible portosystemic anastomoses?

A
  1. Oesophageal varices
  2. Rectal varices
  3. Umbilical vein reanalysing
  4. Spleno-renal shunt
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11
Q

What causes bile salts/acids to rise?

A

Obstruction of bile ducts

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12
Q

Life cycle of the hepatocyte - how does it move over time?

A

Hepatocytes are ‘born’ in zone 1, closest to the portal triad,

The move towards zone 3 as they mature

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13
Q

4 defining features of liver cirrhosis

A
  1. Whole liver involvement
  2. Fibrosis
  3. Nodules of regenerating hepatocytes
  4. Disrupted vascular architecture - shunting of blood
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14
Q

how to define chronic hepatitis from acute hepatitis

A

Chronic = abnormal LFTs for >6 months

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15
Q

what is ‘piecemeal necrosis’

A

Interface hepatitis i.e. inflammation is at the area between lobules + portal triad, resulting in loss of limiting plate between portal triad/hepatocytes

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16
Q

3 types of alcoholic liver disease

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
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17
Q

Histological features of alcoholic hepatitis

A

Ballooning of hepatocytes
Mallory Denk bodies (chunks of pink cytoplasm)
Apoptosis
Pericellular fibrosis with fat in middle
Mainly seen in zone 3

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18
Q

anti-mitochondrial antibodies are seen in…?

A

Primary biliary cholangitis = AMA +ve

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19
Q

which liver disease is associated with UC?

A

Primary sclerosing cholangitis

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20
Q

Which chromosome is mutated in haemochromatosis

A

6

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21
Q

Name the disease in which iron accumulates in macrophages? what is the cause?

A

haemosiderosis
- caused by repeated blood transfusions

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22
Q

Wilson’s disease - what is the pathophysiology?

A

Mutation of copper ATPase gene (Chr13) leading to copper overload due to failure of secretion in bile

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23
Q

what is the responsible antibody in autoimmune hepatitis?

A

Anti-smooth muscle

24
Q

the effect of a1-antitrypsin deficiency on the liver?

A

the enzyme is synthesised but cant be secreted

  • TONS of enzymes in hepatocytes, but NONE in blood
  • Intracytoplasmic inclusions –> fibrosis + cirrhosis
25
Q

Useful lab investigation of suspected hepatocellular carcinoma

A

alpha-fetoprotein

26
Q

Anti-mitochondrial antibodies

A

PBC - primary biliary cirrhosis

27
Q

Anti-smooth muscle antibodies

A

autoimmune hepatitis

28
Q

Perl’s prussian blue stain

A

Stains for iron in the liver

29
Q

haemochromatosis vs haemosiderosis causes

A

Haemochromatosis is genetic
Haemosiderosis is due to acquired cause (transfusions, EtOH)

30
Q

List cells of the liver

A

Hepatocytes
Bile ducts
BVs
Endothelial cells
Kuppfer cells - macrophages
Stellate cells - Vit A store / activated to myofibroblasts

31
Q

What is the portal triad

A

portal vein artery and bile duct

32
Q

Which liver zone is the most mitotically active?

A

zone 3 closest to portal triad

33
Q

Describe stellate cell activation

A

Reduced hepatocyte microvilli
Deposition of scar matrix
Collagen deposition in space of Dyss, reducing blood flow to hepatocytes
Loss of fenestrate between endothelial cells
Kuppfer cells activated

34
Q

What is the point of stellate cell activation?

A

Causes cirrhosis

35
Q

complications of cirrhosis

A

portal HTN eg varices
hepatic encephaopathy - increased toxicity of blood due to reduced filtering
liver cell cancer

36
Q

is cirrhosis reversible?

A

Can be in viral hepatitis if treated aggressively ith antivirals

37
Q

causes of acute hepatitis

A

Viruses - A and E
drugs

38
Q

histology of acute hepatitis

A

spotty necrosis

39
Q

causes of chronic hepatitis

A

viruses - B,C,D
drugs
AI

40
Q

what do grade and stage mean in cirrhosis?

A

grade = severity of inflamm
stage = severity of cirrhosis

41
Q

cause of NAFLD

A

insulin resistance associated with high BMI or DM

42
Q

Histology of PBC

A

bile duct loss, chronic inflammation and granulomas

43
Q

who gets PBC

A

Middle aged females

44
Q

complication of PBC

A

50% cirrhosis

45
Q

histology of PSC

A

dense fibrosis - onion skinning - around bile duct, leading to bile duct loss

46
Q

what cancer are PSC patients at risk of getting?

A

Cholangiocarcinoma

47
Q

where is the iron accumulation in haemochromotosis

A

INTRAcellular - hepatocytes
also in pancreas / skin –> “bronzed diabetes”

48
Q

what conditions is alpha 1 antitrypsin deficiency associated with?

A

Emphysema, hepatitis and cirrhosis

49
Q

Specific and general causes of hepatic granulomas

A

Specific = PBC, drugs
General = TB, sarcoid

50
Q

What is a granuloma?

A

Giant cell with activated macrophages around

51
Q

Which liver cancers are benign?

A

Liver / bile duct adenoma
Haemangioma

52
Q

Which liver cancers are malignant?

A

Secondary mets
Hepatocellular
Hepatoblastoma
Cholangiocarcinoma
Haemgiosarcoma

53
Q

Who gets hepatocellular carcinoma?

A

Old, Western men with cirrhosis

54
Q

Who gets hepatoblastoma?

A

Kids

55
Q

Associations of cholangiocarcinoma?

A

PSC, worms, cirrhosis

56
Q

Multiple lesions seen throughout liver. What type of cancer? Why?

A

Mets - portal circulation comes from many organs and passes through liver so easy route of transmission

Pathology (87 decks)

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