Histopath - Liver Flashcards
What is the portal triad formed of?
Hepatic artery, portal vein, bile duct
Which direction does blood and bile flow in liver lobule?
Blood flows from portal triad to central vein
Bile flows from central vein to portal triad
What are the zones of the the liver lobule hepatocytes?
Zone 1: Periportal - closest to portal triad/fresh blood (on the edge)
Affected first in viral hep and toxic substance ingestion - most oxygenated
Zone 2: mid zone
Zone 3: Periventricular - most mature hepatocytes (most central)
Most liver enzymes - most sensitive to metabolic toxins & least oxygenated (most sensitive to ischaemia)
*What is the best indicator for portal hypertension?
Splenomegaly
(+ascites, enlarges veins/varices)
Acute hepatitis histology
Spotty necrosis
Chronic hepatitis histology
- Piecemeal necrosis/interface hepatitis
- Bidging fibrosis
- Signals evolution to cirrhosis
What is cirrhosis
Diffuse abnormality of liver architecture - interferes with liver function and blood flow
4 feautres of cirrhosis
- Hepatocyte necrosis
- Fibrosis
- Nodules of regenerating hepatocytes
- Distortion of vascular architecture
What are the 2 types of nodules of regenerating hepatocytes in cirrhosis?
Micronodular - alcoholic hepatitis
Macronodular - alpha-1, Wilson’s, Viral hepatitis
What are the 2 types of shunting involved in liver cirrhosis?
Extrahepatic (blood backlogs into sites of porto-systemic anastomosis)
Intrahepatic (blood goes through liver but does not contact hepatocytes/not filtered)
What are (3) complications of cirrhosis?
- Portal HTN
- Hepatic encephalopathy
- Hepatocellular carcinoma
What are the 3 subtypes of alcoholic liver disease?
- Hepatic steatosis (fatty liver)
- Alcoholic hepatitis
- Alcoholic cirrhosis
(can co-exist at the same time)
Hepatic steatosis histology
Fat droplets in hepatocytes
(Fully reversible if EtOH avoided + large pale, yellow greasy liver)
*Alcoholic hepatitis histology
- Hepatocyte balooning
- Lit swell up and die
- Mallory denk bodies
(Large, fibrotic liver + mainly zone 3 damage)
Alcoholic cirrhosis histology
Micronodular cirrhosis
(Shrunken brown organ)
*Non-alcoholic fatty liver disease histology
Similar to alcoholic liver disease
(Distinguish based on hx - often associated w insulin resistance - raised BMI and *diabetes)
Primary sclerosing cholangitis v primary biliary cholangitis
1) M v F prevelance
*2) Type of disease process
1) PSC - more common males; PBC more common females
2) PSC - periductal bile duct fibrosis; PBC - loss of bile duct w granulomas present
Primary sclerosing cholangitis associated antibody
pANCA
Primary biliary cholangitis associated antibody
Anti-mitochondrial antibodies
Autoimmunte hepatitis typical patient group
Young/post-menopausal females w other autoimmune conditions
Autoimmune hepatitis associated antibodies (2)
Anti-smooth muscle antibodies and anti-liver-kidney-microsomal Ig
What are 3 genetic conditions of the liver?
Haemochromatosis
Wilson’s disease
Alpha-1 antitrypsin deficiency
What is haemochromatosis?
Increased gut iron absorption
(Iron deposits in hepatocytes –> liver damage + pt often has tanned skin)
Histology for haemochromatosis
Prussian blue stain
What is the genetic trait of haemochromatosis?
AR
What is Wilson’s disease?
Copper accumulation
due to failure of excretion by hepatocytes to bile
(in liver, CNS, iris [Kaiser-Fleischer rings])
Histology for Wilson’s disease
Rhodamine stain
What is the genetic trait of Wilson’s disease?
AR
What is alpha-1 antitrypsin deficiency?
Gross excess of alpah-1 antitrypsin in hepatocyes
-> globules form in hepatocytes ->chronic hepatitis
due to failure to secrete in blood
Histology for alpha-1 antitrypsin deficiency
Periportal red hyaline globules using PAS stain
What is the genetic trait of alpha-1 antitrypsin deficiency?
AD
What is the most common benign liver malignancy?
Hemangioma
What liver malignancy is associated with the OCP?
Liver cell adenoma
What is the most common malignant liver malignancy?
Secondary metastases
What malignant liver malignancy is associated with primary sclerosing cholangitis?
Cholangiocarcinoma
*Which liver malignancy is associated with aflatoxin?
Aflatoxins are produced by Aspergillus molds!
Hepatocellular carcinoma
*What is itchy skin a feature of?
Hepatitis
*PSC is also associated with which GI conditions
IBD
*PSC increased risk progressing to which ca?
Cholangiocarcinoma
Which microbe can cause HCC?
Aflatoxin/aspergillus mould
*Chronic stable liver presentation
palmar erythema, dupuytrens contracture, spider naevi and gynaecomastia.
*Most common cause portal vein thrombosis
malignancy
