Histopathology 8: Liver pathology Flashcards
Aspergillus produces …………. which causes hepatocellular carcinoma
Aflatoxin
Which tumour marker indicates hepatocellular carcinoma ?
AFP
List 4 causes of hepatocellular carcinoma ?
- Hepatitis B or C
- Alcoholic cirrhosis
- Haemochromatosis
- Aflatoxin
- NAFLD
Which cancer is caused by liver flukes ?
Cholangiocarcinoma
Which syndrome is associated with cholangiocarcinoma ?
Lynch syndrome type II
What are the macrophages in the liver called ?
Kupffer cells
Where do stellate cells reside in the liver ?
Space of disse
Is alcoholic cirrhosis micronodular or macronodular ?
Micronodular
Is cirrhosis due to viral hepatitis micronodular or macronodular ?
Macronodular
List 3 histological features of alcoholic liver disease ?
- Ballooning
- Mallory denk bodies
- Fibrosis
What causes NAFLD ?
Insulin resistance e.g due to diabetes or obesity
What is the characteristic histological features of PBC ?
Granulomatous destruction of bile ducts secondary to chronic inflammation
Which auto antibody is associated with PBC ?
anti-mitochondrial antibodies
Describe the characteristic histological features of PSC ?
- Periductal bile duct cirrhosis leading to bile duct loss
- “Onion skinning”
Which disease is associated with PSC ?
Ulcerative colitis
Is cirrhosis due to biliary tract disease micronodular or macronodular ?
Micronodular
List 5 genetic causes of liver cirrhosis ?
haemochromatosis wilson's disease alpha 1 antitrypsin deficiency galactosaemia glycogen storage disease
What is the most common benign liver tumour ?
Haemangioma
Which zone in liver lobules is the first to be affected by alcoholic liver disease ?
Zone 3
Which HLA is associated with autoimmune hepatitis ?
HLA-DR3
List 3 auto antibodies seen in autoimmune hepatitis ?
ANA
Anti-SMA
Anti-LKM
ERPC shows beading of bile ducts.
Most likely diagnosis ?
PSC
What is Budd-Chiari syndrome ?
Compression/ Occlusion of the hepatic vein
Which stain is used to identify copper in Wilson’s disease “
Rhodanine stain
What happens to Caeruloplasmin levels in Wilson’s disease ?
They are reduced
Which genetic disease causes both Emphysema and liver cirrhosis ?
Alpha 1 antitrypsin deficiency
Which auto-immune disease is associated with PBC ?
Sjogrens
What is the triad for PBC ?
Jaundice
xanthelasma
pruritus
Give 2 causes of haemosiderosis ?
alcohol
blood transfusions
describe the dual blood supply of the liver
hepatic portal vein
hepatic artery
what are stellate cells
store vitamin A
when activated - become myofibroblasts and lay down collagen
responsible for most of the scarring in liver disease
which liver zone has the most metabolically active enzymes
3 (closest to central vein)
describe the process of stellate activation
normal hepatocytes have microvilli
endothelial cells have no BM and have spaces between
stellate cells sit in the space between endothelial cells (space of disse)
blood gets through the endothelial cells
liver injury - kupffer cells activate endothelial cells stick together blood struggles to get through hepatocytes lose their microvilli stellate cells secrete BM type collagen into space of disse
what is cirrhosis
whole liver involvement
fibrosis
intra- and extra-hepatic shunting of blood
intrahepatic shunting = blood comes through liver but not in contact with hepatocytes
extrahepatic = blood backlogs into porto-systemic anastamoses
2 complications of cirrhosis
portal hypertension
hepatic encephalopathy
liver cell cancer
features of acute hepatitis
hep A and E
drugs
spotty necrosis
features of chronic hepatitis
viral hepatitis
drugs
AI
features of alcoholic liver disease
fatty liver
alcoholic hepatitis
cirrhosis
list histological features of alcoholic hepatitis
ballooning Mallory denk bodies (pink deposits) apoptosis pericellular fibrosis mainly in zone 3
features of NASH
hepatitis resulting from NAFLD
caused by insulin resistance associated with raised BMI and diabetes
one of commonest causes of liver disease ww
features of PBC
F>M
bile duct loss associated with chronic inflammation (with granulomas)
diagnostic test = AMA
bile ducts surrounded by epithelioid macrophages
features of PSC
M>F periductal bile duct fibrosis leading to loss associated with UC increased risk of cholangiocarcinoma diagnostic = bile duct imaging
features of haemochromatosis
genetically determined increased gut iron ab
HFe gene on chr 6
iron deposition in parenchymal cells
‘bronzed diabetes’ - skin and pancreas
what is haemosiderosis
iron overload
accumulation of iron in macrophages
result of blood transfusions
what is wilsons disease
accumulation of copper due to failure of excretion of copper by hepatocytes into bile
chr 13
accumulates in liver and CNS and iris (KF rings)
antibodies in AI hepatitis
anti-smooth muscle antibodies (ASMA)
responds to steroids
what is alpha-1 antitrypsin deficiency
failure to secrete alpha- 1 antitrypsin
deficiency in the blood, excess in hepatocytes
chronic hepatitis
emphysema
causes of hepatic granulomas
specific - PBC, drugs
general - TB, sarcoidosis
list benign liver tumours
liver cell adenoma
bile duct adenoma
haemangioma
list malignant liver tumorus
secondary (most common) hepatocellular carcinoma hepatoblastoma cholangiocarcinoma (associated with PSC, worm infections, cirrhosis) hemangiosarcoma
