Hi - Liver Flashcards
Mallory Denk bodies
Alcoholic hepatitis
Defining histological features of alcoholic hepatitis
Fibrosis
Inflammation
Ballooning
Mallory Denk bodies
Treatment for alcoholic hepatitis
Supportive
Stop EtOH
Nutrition + vitamins
Occasionally steroids
What can B1 deficiency lead to?
Beri Beri
What can niacin deficiency lead to?
Pellagra
Spider nave
Dupuytren’s contracture
Palmar erythema
Gynaecomastia
What does this suggest?
Chronic stable liver disease
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
B: splenomegaly
EtOH –> nodules form –> cirrhosis. this cause portal Hypertension.
This blood backs up into the splenic vein –> splenomegaly
Patient with chronic stable liver disease recently noticed visible veins, splenomegaly AND ascites. what does this suggest?
Portal hypertension
Hepatic flap is seen in a patient with previously chronic stable liver disease. What does this indicate?
Liver failure
4 possible portosystemic anastomoses?
- Oesophageal varices
- Rectal varices
- Umbilical vein reanalysing
- Spleno-renal shunt
What causes bile salts/acids to rise?
Obstruction of bile ducts
Life cycle of the hepatocyte - how does it move over time?
Hepatocytes are ‘born’ in zone 1, closest to the portal triad,
The move towards zone 3 as they mature
4 defining features of liver cirrhosis
- Whole liver involvement
- Fibrosis
- Nodules of regenerating hepatocytes
- Disrupted vascular architecture - shunting of blood
how to define chronic hepatitis from acute hepatitis
Chronic = abnormal LFTs for >6 months
what is ‘piecemeal necrosis’
Interface hepatitis i.e. inflammation is at the area between lobules + portal triad, resulting in loss of limiting plate between portal triad/hepatocytes
3 types of alcoholic liver disease
- Fatty liver
- Alcoholic hepatitis
- Cirrhosis
Histological features of alcoholic hepatitis
Ballooning of hepatocytes
Mallory Denk bodies (chunks of pink cytoplasm)
Apoptosis
Pericellular fibrosis with fat in middle
Mainly seen in zone 3
anti-mitochondrial antibodies are seen in…?
Primary biliary cholangitis = AMA +ve
which liver disease is associated with UC?
Primary sclerosing cholangitis
Which chromosome is mutated in haemochromatosis
6
Name the disease in which iron accumulates in macrophages? what is the cause?
haemosiderosis
- caused by repeated blood transfusions
Wilson’s disease - what is the pathophysiology?
Mutation of copper ATPase gene (Chr13) leading to copper overload due to failure of secretion in bile
what is the responsible antibody in autoimmune hepatitis?
Anti-smooth muscle
the effect of a1-antitrypsin deficiency on the liver?
the enzyme is synthesised but cant be secreted
- TONS of enzymes in hepatocytes, but NONE in blood
- Intracytoplasmic inclusions –> fibrosis + cirrhosis
Useful lab investigation of suspected hepatocellular carcinoma
alpha-fetoprotein
Anti-mitochondrial antibodies
PBC - primary biliary cirrhosis
Anti-smooth muscle antibodies
autoimmune hepatitis
Perl’s prussian blue stain
Stains for iron in the liver
haemochromatosis vs haemosiderosis causes
Haemochromatosis is genetic
Haemosiderosis is due to acquired cause (transfusions, EtOH)
List cells of the liver
Hepatocytes
Bile ducts
BVs
Endothelial cells
Kuppfer cells - macrophages
Stellate cells - Vit A store / activated to myofibroblasts
What is the portal triad
portal vein artery and bile duct
Which liver zone is the most mitotically active?
zone 3 closest to portal triad
Describe stellate cell activation
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
What is the point of stellate cell activation?
Causes cirrhosis
complications of cirrhosis
portal HTN eg varices
hepatic encephaopathy - increased toxicity of blood due to reduced filtering
liver cell cancer
is cirrhosis reversible?
Can be in viral hepatitis if treated aggressively ith antivirals
causes of acute hepatitis
Viruses - A and E
drugs
histology of acute hepatitis
spotty necrosis
causes of chronic hepatitis
viruses - B,C,D
drugs
AI
what do grade and stage mean in cirrhosis?
grade = severity of inflamm
stage = severity of cirrhosis
cause of NAFLD
insulin resistance associated with high BMI or DM
Histology of PBC
bile duct loss, chronic inflammation and granulomas
who gets PBC
Middle aged females
complication of PBC
50% cirrhosis
histology of PSC
dense fibrosis - onion skinning - around bile duct, leading to bile duct loss
what cancer are PSC patients at risk of getting?
Cholangiocarcinoma
where is the iron accumulation in haemochromotosis
INTRAcellular - hepatocytes
also in pancreas / skin –> “bronzed diabetes”
what conditions is alpha 1 antitrypsin deficiency associated with?
Emphysema, hepatitis and cirrhosis
Specific and general causes of hepatic granulomas
Specific = PBC, drugs
General = TB, sarcoid
What is a granuloma?
Giant cell with activated macrophages around
Which liver cancers are benign?
Liver / bile duct adenoma
Haemangioma
Which liver cancers are malignant?
Secondary mets
Hepatocellular
Hepatoblastoma
Cholangiocarcinoma
Haemgiosarcoma
Who gets hepatocellular carcinoma?
Old, Western men with cirrhosis
Who gets hepatoblastoma?
Kids
Associations of cholangiocarcinoma?
PSC, worms, cirrhosis
Multiple lesions seen throughout liver. What type of cancer? Why?
Mets - portal circulation comes from many organs and passes through liver so easy route of transmission
