Histopath - Liver Flashcards

1
Q

What is the portal triad formed of?

A

Hepatic artery, portal vein, bile duct

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2
Q

Which direction does blood and bile flow in liver lobule?

A

Blood flows from portal triad to central vein

Bile flows from central vein to portal triad

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3
Q

What are the zones of the the liver lobule hepatocytes?

A

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)

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4
Q

*What is the best indicator for portal hypertension?

A

Splenomegaly

(+ascites, enlarges veins/varices)

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5
Q

Acute hepatitis histology

A

Spotty necrosis

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6
Q

Chronic hepatitis histology

A
  • Piecemeal necrosis/interface hepatitis
  • Bidging fibrosis
    • Signals evolution to cirrhosis
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7
Q

What is cirrhosis

A

Diffuse abnormality of liver architecture - interferes with liver function and blood flow

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8
Q

4 feautres of cirrhosis

A
  1. Hepatocyte necrosis
  2. Fibrosis
  3. Nodules of regenerating hepatocytes
  4. Distortion of vascular architecture
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9
Q

What are the 2 types of nodules of regenerating hepatocytes in cirrhosis?

A

Micronodular - alcoholic hepatitis

Macronodular - alpha-1, Wilson’s, Viral hepatitis

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10
Q

What are the 2 types of shunting involved in liver cirrhosis?

A

Extrahepatic (blood backlogs into sites of porto-systemic anastomosis)

Intrahepatic (blood goes through liver but does not contact hepatocytes/not filtered)

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11
Q

What are (3) complications of cirrhosis?

A
  • Portal HTN
  • Hepatic encephalopathy
  • Hepatocellular carcinoma
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12
Q

What are the 3 subtypes of alcoholic liver disease?

A
  • Hepatic steatosis (fatty liver)
  • Alcoholic hepatitis
  • Alcoholic cirrhosis

(can co-exist at the same time)

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13
Q

Hepatic steatosis histology

A

Fat droplets in hepatocytes

(Fully reversible if EtOH avoided + large pale, yellow greasy liver)

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14
Q

*Alcoholic hepatitis histology

A
  • Hepatocyte balooning
    • Lit swell up and die
  • Mallory denk bodies

(Large, fibrotic liver + mainly zone 3 damage)

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15
Q

Alcoholic cirrhosis histology

A

Micronodular cirrhosis

(Shrunken brown organ)

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16
Q

*Non-alcoholic fatty liver disease histology

A

Similar to alcoholic liver disease

(Distinguish based on hx - often associated w insulin resistance - raised BMI and *diabetes)

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17
Q

Primary sclerosing cholangitis v primary biliary cholangitis

1) M v F prevelance

*2) Type of disease process

A

1) PSC - more common males; PBC more common females
2) PSC - periductal bile duct fibrosis; PBC - loss of bile duct w granulomas present

18
Q

Primary sclerosing cholangitis associated antibody

19
Q

Primary biliary cholangitis associated antibody

A

Anti-mitochondrial antibodies

20
Q

Autoimmunte hepatitis typical patient group

A

Young/post-menopausal females w other autoimmune conditions

21
Q

Autoimmune hepatitis associated antibodies (2)

A

Anti-smooth muscle antibodies and anti-liver-kidney-microsomal Ig

22
Q

What are 3 genetic conditions of the liver?

A

Haemochromatosis

Wilson’s disease

Alpha-1 antitrypsin deficiency

23
Q

What is haemochromatosis?

A

Increased gut iron absorption

(Iron deposits in hepatocytes –> liver damage + pt often has tanned skin)

24
Q

Histology for haemochromatosis

A

Prussian blue stain

25
What is the genetic trait of haemochromatosis?
AR
26
What is Wilson's disease?
Copper accumulation due to failure of excretion by hepatocytes to bile (in liver, CNS, iris [Kaiser-Fleischer rings])
27
Histology for Wilson's disease
Rhodamine stain
28
What is the genetic trait of Wilson's disease?
AR
29
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
30
Histology for alpha-1 antitrypsin deficiency
Periportal red hyaline globules using PAS stain
31
What is the genetic trait of alpha-1 antitrypsin deficiency?
AD
32
What is the most common benign liver malignancy?
Hemangioma
33
What liver malignancy is associated with the OCP?
Liver cell adenoma
34
What is the most common malignant liver malignancy?
Secondary metastases
35
What malignant liver malignancy is associated with primary sclerosing cholangitis?
Cholangiocarcinoma
36
\*Which liver malignancy is associated with aflatoxin? Aflatoxins are produced by Aspergillus molds!
Hepatocellular carcinoma
37
\*What is itchy skin a feature of?
Hepatitis
38
\*PSC is also associated with which GI conditions
IBD
39
\*PSC increased risk progressing to which ca?
Cholangiocarcinoma
40
Which microbe can cause HCC?
Aflatoxin/aspergillus mould
41
\*Chronic stable liver presentation
palmar erythema, dupuytrens contracture, spider naevi and gynaecomastia.
42
\*Most common cause portal vein thrombosis
malignancy