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a path 3 > HISTO: Liver pathology > Flashcards

HISTO: Liver pathology Flashcards

1
Q

How much does the liver weigh? What is the dual blood supply of the liver?

A

1.5kg

Prortal vein and hepatic artery

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2
Q

What are the cells of the liver?(6)

A
  1. Hepatocytes
  2. Bile ducts
  3. Blood vessels
  4. Endothelial cells
  5. Kupffer cells
  6. Stellate cells
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3
Q

Where are stellate cells located? What is the function of stellate cells in the liver?

A

Stellate cells sit in the space of Disse between the endothelial cells and hepatocytes.

They become myofibroblasts if there is damage and inflammation

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4
Q

What are the defining signs of liver cirrhosis?

A
  1. whole liver involved
  2. fibrosis
  3. nodules of regenerating hepatocytes
  4. distortion of liver vascular architecture: intra- and extra- hepatic (e.g. gastro-oesophageal) shunting of blood
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5
Q

Given picture one, what does picture two show?

A

1) whole liver involved in fibrosis in cirrhosis
s) nodules of regenerating hepatocytes in cirrhosis

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6
Q

What are the two classifications of cirrhosis?

A

a) according to nodule size: micronodular or macronodular
b) according to aetiology:
1) alcohol / insulin resistance
2) viral hepatitis etc.

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7
Q

What kind of shunting is found in liver cirrhosis?

A

Both intra- and extra-hepatic shunting

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8
Q

List 3 complications of cirrhosis.

A
  1. Portal hypertension
  2. Hepatic encephalopathy – lack of filtration
  3. Liver cell cancer – most important factor for this is cirrhosis
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9
Q

What is this complication of liver cirrhosis?

A

Streaky vessels = varices which can easily rupture

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10
Q

What is this complication of liver cirrhosis?

A

Spleen 3x normal size

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11
Q

What is this complication of liver cirrhosis?

A

Liver cancer

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12
Q

Can liver cirrhosis be reversible?

A

Yes it may be, if you aggressively treat the aetiology of the cirrhosis

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13
Q

What are the durations defining acute and chronic hepatitis?

A

Acute hepatitis <6 months duration (Hep AE, drugs)

Chronic >6 months

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14
Q

Name 2 causes of acute hepatitis.

A

Viruses

Drugs

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15
Q

What is spotty necrosis?

A

Spotty necrosis – inflammation between where the blood is coming in and going out. Can be seen in both drug and virus induced acute hepatitis.

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16
Q

What are 3 causes of chronic hepatitis?

A
  1. viral hepatitis (BCD hep)
  2. drugs
  3. auto-immune
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17
Q

How do you characterise severity of chronic hepatitis?

A

Stage is more important than grade in cancer, in chronic hepatitis it is the opposite

severity of inflammation = grade

severity of fibrosis = stage

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18
Q

What are the 3 types of alcoholic liver disease (ALD)?

A

1) fatty liver
2) alcoholic hepatitis
3) cirrhosis

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19
Q

What is this type of ALD? Describe where you would also see this other than ALD.

A

Fatty liver - can also be seen in marasmus so not specific for ALD

This is a reversible metabolic process

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20
Q

What are the main features of alcoholic hepatitis?

A

KEY: Ballooning ( +/- Mallory Denk Bodies – collapsed cytoskeleton of hepatocytes )

  • Fat
  • Apoptosis
  • Pericellular fibrosis
  • Mainly seen in Zone 3
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21
Q

What is shown here in ALD?

A

Balloon hepatocytes shown with surrounding fibrosis - seen in alcoholic hepatitis.

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22
Q

What type of ALD is seen here?

A

Cirrhosis

23
Q

What is NAFLD and NASH caused by? What is the epidemiology worldwide?

A

Non-alcoholic fatty liver disease (NAFLD) including non-alcoholic steatohepatitis (NASH)

  • Histologically looks like alcoholic liver disease
  • Due to insulin resistance associated with raised BMI and diabetes
  • Becoming recognised as one of the commonest causes of liver disease, world-wide
24
Q

What is the epidemiology of primary biliary cholangitis? (PBC)

A
  • Previously primary biliary cirrhosis – not as many patients have cirrhosis as previously thought
  • F> M - ~10:1
25
Q

What happens to bile ducts in PBC?

A

Bile duct loss associated with chronic inflammation (with granulomatous destruction of these ducts – HALLMARK)

26
Q

What antibodies are detected in PBC?

A
  • Diagnostic test is detection of anti-mitochondrial antibodies (anti-M2 antibodies)
27
Q

What disease is PSC (primary sclerosing cholangitis) associated with?

A

Ulcerative colitis

Associated with increased risk of cholangiocarcinoma.

28
Q

What is the pathophysiology of PSC? What is the epidemiology of PSC? What is seen in the picture below in PSC?

A
  • M > F
  • Periductal bile duct fibrosis leading to loss
  • Diagnostic test is bile duct imaging

Picture: Onion skin fibrosis (not granulomatous destruction like in PBC)

29
Q

What is the aetiology of haemochromatosis?

A
  • Genetically determined increased gut iron absorption
  • Gene on chromosome 6 (HFe)
  • Parenchymal damage to organs secondary to iron deposition (bronzed diabetes)
30
Q

What is show below and what condition is this?

A

Iron is INSIDE hepatocytes – seen as brown on this slide. This is haemochromatosis.

31
Q

What is the difference between this and haemochromatosis? What can cause this?

A

Haemosiderosis

  • Compared to previous, iron is INSIDE MACROPHAGES not hepatocytes like in haemochromatosis.
  • Blood transfusion causes haemosiderosis
  • Kupffer cells
32
Q

What is the aetiology of Wilson’s disease?

A
  • Accumulation of copper due to failure of excretion by hepatocytes into the bile – normally bile ducts excrete copper
  • Assessed by biopsy or biochemistry
33
Q

What are the genetics of Wilson’s disease?

A
  • Genes on chromosome 13
34
Q

What clinical features would you see in Wilson’s disease in the liver and eyes?

A

Accumulates in the liver and CNS (hepato-lenticular degeneration) including Kayser-Fleishcer rings

35
Q

What is shown below?

A

Rhodanine stain for copper – copper becomes golden brown against blue counterstain. This is Wilson’s disease.

36
Q

What sex is more affected by autoimmunse hepatitis?

A

Females > males

37
Q

What is the pathophysiology of autoimmune hepatitis? What antibodies are found in the serum? Does it respond to steroids?

A
  • Active chronic hepatitis with plasma cells
  • Anti-smooth muscle actin antibodies in the serum
  • Responds to steroids
38
Q

What is the pathophysiology of alpha-1 antitrypsin deficiency? What is seen histologically?

A
  • Failure to secrete alpha-one antitrypsin – they make it but it cannot be secreted into the blood. In respiratory medicine, this antielastase would usually stop inflammation so without it you get emphysema and inflammation.
  • Intra-cytoplasmic inclusions due to misfolded protein
  • Hepatitis and cirrhosis
39
Q

How can alpha-1 antitrypsin present in the neonatal period?

A

Giant cell hepatitis

40
Q

What is liver disease caused by drugs called?

A

Drug related liver injury - any kind of liver disease can be caused by drugs

May be overdose related of idiosyncratic

41
Q

What % of drug reactions involve the liver?

A

10%

42
Q

What zone of the liver does paracetamol toxicity affect?

A

Paracetamol is converted to a toxic metabolite in the liver.

Causes zone 3 damage because this is where most cells involved in drug metabolism are located.

43
Q

What are 4 causes of hepatic granulomas?

A

Specific causes:

  • PBC
  • drugs

General causes

  • TB
  • Sarcoid etc
44
Q

What does this picture show in the liver?

A

Granuloma = organised collection of activated macrophages. Can be caused by sarcoid, TB, PBC or drugs.

45
Q

Name 3 benign liver tumours.

A

1) liver cell adenoma
2) bile duct adenoma
3) haemangioma

46
Q

When are benign liver tumours common?

A

Common in women (menopause/reproductive years). Sharp demarcated edges seen on histology.

47
Q

What are the most common malignant tumours of the liver?

A
  1. secondary tumours e.g. pancreatic will spread here quietly
  2. primary tumours
48
Q

Describe the portal venous system of the liver.

A

E.g. pancreatic cancer can spread; usually adenocarcinomas make glands and secrete mucin.

49
Q

What are the malignant primary tumours of the liver?

A
  1. hepatocellular carcinoma
  2. hepatoblastoma
  3. cholangiocarcinoma
  4. haemangiosarcoma
50
Q

What precursor liver pathology is liver cell cancer associated with?

A

Cirrhosis; seen especially in the West

51
Q

What are cholangiocarcinomas associated with?

A

Associated with:

  • PSC
  • Worm infections
  • Cirrhosis
52
Q

Where can cholangiocarcinomas arise from?

A
  • intrahepatic ducts
  • extrahepatic ducts (including gall bladder)

Can cause potential obstruction.

53
Q

Which of these is not associated with fatty change in the liver?

  1. Diabetes
  2. Hepatitis B
  3. Hepatitis C
  4. Alcohol
A

Hep B or C

Diabetes and alcohol are almost ALWAYS associated with fatty liver change

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