Histopath - Liver

Question 1

What is the portal triad formed of?

Answer 1

Hepatic artery, portal vein, bile duct

Question 2

Which direction does blood and bile flow in liver lobule?

Answer 2

Blood flows from portal triad to central vein

Bile flows from central vein to portal triad

Question 3

What are the zones of the the liver lobule hepatocytes?

Answer 3

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)

Question 4

*What is the best indicator for portal hypertension?

Answer 4

Splenomegaly

(+ascites, enlarges veins/varices)

Question 5

Acute hepatitis histology

Answer 5

Spotty necrosis

Question 6

Chronic hepatitis histology

Answer 6

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

Question 7

What is cirrhosis

Answer 7

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

Question 8

4 feautres of cirrhosis

Answer 8

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

Question 9

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

Answer 9

Micronodular - alcoholic hepatitis

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

Question 10

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

Answer 10

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

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

Question 11

What are (3) complications of cirrhosis?

Answer 11

• Portal HTN
• Hepatic encephalopathy
• Hepatocellular carcinoma

Question 12

What are the 3 subtypes of alcoholic liver disease?

Answer 12

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

(can co-exist at the same time)

Question 13

Hepatic steatosis histology

Answer 13

Fat droplets in hepatocytes

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

Question 14

*Alcoholic hepatitis histology

Answer 14

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

(Large, fibrotic liver + mainly zone 3 damage)

Question 15

Alcoholic cirrhosis histology

Answer 15

Micronodular cirrhosis

(Shrunken brown organ)

Question 16

*Non-alcoholic fatty liver disease histology

Answer 16

Similar to alcoholic liver disease

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

Question 17

Primary sclerosing cholangitis v primary biliary cholangitis

1) M v F prevelance

*2) Type of disease process

Answer 17

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

Question 18

Primary sclerosing cholangitis associated antibody

Answer 18

pANCA

Question 19

Primary biliary cholangitis associated antibody

Answer 19

Anti-mitochondrial antibodies

Question 20

Autoimmunte hepatitis typical patient group

Answer 20

Young/post-menopausal females w other autoimmune conditions

Question 21

Autoimmune hepatitis associated antibodies (2)

Answer 21

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

Question 22

What are 3 genetic conditions of the liver?

Answer 22

Haemochromatosis

Wilson’s disease

Alpha-1 antitrypsin deficiency

Question 23

What is haemochromatosis?

Answer 23

Increased gut iron absorption

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

Question 24

Histology for haemochromatosis

Answer 24

Prussian blue stain

Question 25

What is the genetic trait of haemochromatosis?

Answer 25

AR

Question 26

What is Wilson’s disease?

Answer 26

Copper accumulation

due to failure of excretion by hepatocytes to bile

(in liver, CNS, iris [Kaiser-Fleischer rings])

Question 27

Histology for Wilson’s disease

Answer 27

Rhodamine stain

Question 28

What is the genetic trait of Wilson’s disease?

Answer 28

AR

Question 29

What is alpha-1 antitrypsin deficiency?

Answer 29

Gross excess of alpah-1 antitrypsin in hepatocyes

-> globules form in hepatocytes ->chronic hepatitis

due to failure to secrete in blood

Question 30

Histology for alpha-1 antitrypsin deficiency

Answer 30

Periportal red hyaline globules using PAS stain

Question 31

What is the genetic trait of alpha-1 antitrypsin deficiency?

Answer 31

AD

Question 32

What is the most common benign liver malignancy?

Answer 32

Hemangioma

Question 33

What liver malignancy is associated with the OCP?

Answer 33

Liver cell adenoma

Question 34

What is the most common malignant liver malignancy?

Answer 34

Secondary metastases

Question 35

What malignant liver malignancy is associated with primary sclerosing cholangitis?

Answer 35

Cholangiocarcinoma

Question 36

*Which liver malignancy is associated with aflatoxin?
Aflatoxins are produced by Aspergillus molds!

Answer 36

Hepatocellular carcinoma

Question 37

*What is itchy skin a feature of?

Answer 37

Hepatitis

Question 38

*PSC is also associated with which GI conditions

Answer 38

IBD

Question 39

*PSC increased risk progressing to which ca?

Answer 39

Cholangiocarcinoma

Question 40

Which microbe can cause HCC?

Answer 40

Aflatoxin/aspergillus mould

Question 41

*Chronic stable liver presentation

Answer 41

palmar erythema, dupuytrens contracture, spider naevi and gynaecomastia.

Question 42

*Most common cause portal vein thrombosis

Answer 42

malignancy