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Year 5 Path Charis > Histopathology - Liver > Flashcards

Histopathology - Liver Flashcards

1
Q

Portal triad

A

branches of the bile ducts, hepatic artery, portal vein

zone 1 closest to the portal triad

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2
Q

which zone has the most liver enzymes?

A

Zone 3

zone that gets less oxygen (further away from portal triad)
has the most metabolically active cells of the liver
that is also where the drug metabolising hepatocytes are

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3
Q

Flow of blood in the liver

A

reaches liver via hepatic portal vein (blood from gut) + hepatic artery (blood from heart)

blood travels in sinusoids –> drains in central vein –> goes to hepatic vein –> hepatic vein joins vena cava

https: //www.google.com/search?q=hepatic+vein+vena+cava&tbm=isch&ved=2ahUKEwirzJW3p4f3AhVO3RoKHcVPAqsQ2-cCegQIABAA&oq=hepatic+vein+vena+cava&gs_lcp=CgNpbWcQAzIGCAAQCBAeMgYIABAIEB4yBAgAEBg6BwgjEO8DECc6BAgAEEM6BwgAELEDEEM6CAgAEIAEELEDOgsIABCABBCxAxCDAToFCAAQgARQkhBYiUBg70BoAHAAeACAAYwCiAHaFpIBBjAuMjEuMZgBAKABAaoBC2d3cy13aXotaW1nwAEB&sclient=img&ei=0KdRYqukH866a8WfidgK&bih=640&biw=711#imgrc=ACCrpSkAxRVGkM
https: //www.google.com/search?q=hepatic+vein+vena+cava&tbm=isch&ved=2ahUKEwirzJW3p4f3AhVO3RoKHcVPAqsQ2-cCegQIABAA&oq=hepatic+vein+vena+cava&gs_lcp=CgNpbWcQAzIGCAAQCBAeMgYIABAIEB4yBAgAEBg6BwgjEO8DECc6BAgAEEM6BwgAELEDEEM6CAgAEIAEELEDOgsIABCABBCxAxCDAToFCAAQgARQkhBYiUBg70BoAHAAeACAAYwCiAHaFpIBBjAuMjEuMZgBAKABAaoBC2d3cy13aXotaW1nwAEB&sclient=img&ei=0KdRYqukH866a8WfidgK&bih=640&biw=711#imgrc=ACCrpSkAxRVGkM

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4
Q

Liver marker that increases most in obstructive jaundice/ obstruction of bile duct/ damage to biliary epithelial cells

A

ALP

obstruction of the bile ducts also causes
also absence of urobilinogen in urine and presence of bile salts/acids in the blood

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5
Q

• Most representative of liver function 

A

prothrombin time

 PT affected by warfarin (extrinsic pathway)
 APTT/PTTK affected by heparin (intrinsic pathway)

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6
Q

What is the van den Bergh reaction

A

van den Bergh reaction measures serum bilirubin via fractionation

A direct reaction measures conjugated bilirubin

Addition of methanol causes a complete reaction, which measures total bilirubin (conjugated plus unconjugated);

the difference measures unconjugated bilirubin (an indirect reaction).

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7
Q

What is the function of phototherapy?

A

Converts bilirubin to

lumirubin
photobilirubin

these compounds dont need conjugation for excretion

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8
Q

How is Gilberts disease inherited + pathophysiology + mx

A

Recessive

reduced activity of UDP (uridine 5 diphospho) glucuronyl transferase to 30%–> higher unconjugated bilirubin levels –> Unconjugated bilirubin tightly albumin bound and does not enter urine –> not excretes

Worsened by fasting

Phenobarbitone reduces levels

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9
Q

o if pt Anti-HBs + no Anti-HBe

o If pt Anti-HBs + Anti-HBe

A

• We only vaccinate people with HBsAg and no HBeAg
o if pt Anti-HBs + no Anti-HBe vaccinated
o If pt Anti-HBs + Anti-HBe  infected

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10
Q

What are mallory denk bodies?

A

 Mallory denk bodies (clumped cytoskeleton of hepatocytes)  characteristic change in hepatocytes of alcoholic hepatitis

(2 step process: alcohol  acetaldehyde, acetaldehyde  acetic acid
acetaldehyde  toxic to hepatocytes  cross-links lysine residues  causes cytoskeleton to clump  Mallory denk bodies)

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11
Q

What kind of inflammation is present in alcoholic hepatitis?

A

Neutrophilic inflammation (acute)

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12
Q

ballooning of cells found in

A

steatohepatitis

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13
Q

commonest cause of fatty liver disease in the west

A

• NAFLD – associated with high BMI, diabetes etc

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14
Q 
Vitamin deficiencies
•	D – 
•	C – 
•	B12 – 
•	B1 – 
•	B3 - 
•	Folate –
A 
Vitamin deficiencies
•	D – rickets
•	C – scurvy
•	B12 – pernicious anaemia (missing the intrinsic factor, need injections of B12)
•	B1 – beri-beri
•	B3 - pellagra
•	Folate – neural tube defects
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15
Q

Portal HTN triad

A

Caput medusae
Splenomegaly
Ascites

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16
Q

What is the intrahepatic shunting of blood?

A

Fibrous scar joins the portal tracts + the central vein  blood flows through the fibrous scar, missing the hepatocytes and goes straight to the central vein  intrahepatic shunting of blood  this is the point at which the disease starts becoming non-reversible

Ischaemia of hepatocytes
Toxins + poisons in blood not cleared out  encephalopathy
17
Q

Micronodular cirrhosis

Macronodular cirrhosis

A

 Macronodular (nodules >3mm) – variable nodule size – viral hepatitis, Wilson’s disease, A1AT

 Micronodular (nodules <3mm)– alcoholic/non-alcoholic, biliary tract disease

18
Q

Portosystemic anastomoses

A

Oesophageal varices
Rectal varices
Umbilical vein recanalising
Spleno-renal shunt

19
Q

gall bladder is palpable in a jaundiced patient…

The cause is gallstones
The cause is pancreatic Ca

A

The cause is pancreatic Ca

o If obstruction caused by stone in CBD  gallbladder is likely to be thickened + fibrotic => not distended or palpable but rather shrivelled up
o If obstruction caused by tumour in CBD  gallbladder is likely to be normal => will dilate due to back-pressure

20
Q

Describe what happens during liver injury

A

Normally, endothelial cells are discontinuous + hepatocytes have microvilli

Liver injury
Hepatocytes lose microvilli
Stellate cells become activated to myofibroblasts – produce collagen

Changes in endothelial cells  become continuous

Blood in the sinusoid doesn’t interact with hepatocytes because of 3 reasons

1) endothelial cells are joined together
2) collagen is produced by the myofibroblasts in the space of Disse
3) hepatocytes lose their microvilli

21
Q

Acute vs chronic hepatitis + causes

A

Acute <6m
Drugs
Viruses - hep A+E

Chronic >6m
Drugs
VIruses - B, C ,D
Autoimmune

22
Q

Stage vs grade of chronic hepatitis

A 
stage = severity of fibrosis
grade = severity of inflammation

stage more important than grade

23
Q

Histology - portal inflammation vs interface hepatitis (piecemeal necrosis)

A

Portal inflammation
o All the lymphocytes are in the portal tract – Inflammation hasn’t crossed the limiting plate

Interface hepatitis
o Inflammation has crossed the limiting plate – hepatitis interfaces between portal tract + parenchyma

24
Q

Features of alcoholic hepatitis

A
  • Apoptosis
  • Fat
  • Pericellular fibrosis
  • Mainly seen in zone 3
  • (chronic hepatitis due to viruses – mostly seen around zone 1 – portal and periportal)
  • Ballooned cells = hepatitis
25
Q

Which scoring system is being used to assess the severity of liver cirrhosis

A

o Modified Child’s Pugh Score (ABCDE)

Albumin 
Bilirubin
Clotting PT
Ascites (Distension)
Encephalopathy
26
Q

PBC buzzwords

Epidemiology 
What is it
Ix
Association
Mx
A
  • Female
  • Autoimmune

• Chronic inflammation with granulomas of the INTRAHEPATIC bile ducts
–> Granulomatous inflammatory destruction + loss of INTRAHEPATIC bile ducts

  • Anti-mitochondrial antibodies = diagnostic test (anti-M2 antibodies)
  • US = NO bile duct dilation
  • Hx = bile duct loss with granulomas
  • Raised cholesterol, xanthelasma, steatorrhea
  • Chronic bile duct damage leading to fibrosis can eventually lead to cirrhosis if its treatment doesn’t stop its development

Mx - ursodeoxycholic acid

27
Q

PSC buzzwords

Epidemiology
What is it
Ix
Association

A
  • Males
  • Inflammation + fibrosis of EXTRAHEPATIC and INTRAHEPATIC bile ducts
  • Multifocal stricture formation with dilation of preserved segments
  • ERCP = beading of the bile ducts (diagnostic)
  • US = bile duct dilation
  • Hx = onion skin fibrosis

• Associated with UC + cholangiocarcinoma

28
Q

Haemochromatosis/ Bronzed diabetes

Inheritance
Chromosome
Pathophysiology
Cirrhosis 
Histology

Fe, Ferritin, Transferrin saturation, TIBC/transferrin

A

AR
Chr 6
Increased iron absorption form the gut

Hepatomegaly with micronodular cirrhosis

Histology
Iron deposit in hepatocytes
Prussian blue stain

High Fe, ferritin, transferrin saturation
Low TIBC/transferrin

29
Q

Haemosiderosis cause + complication

A

caused by blood transfusion - iron accumulation in macrophages (e.g. Kupffer cells of liver)

does NOT lead to cirrhosis

30
Q

Wilson’s disease

Chromosome 
inheritance
Protein affected
Buzzwords 
Biochemistry
Mx
A

Chr 13
AR

copper transporting ATPase

Kayser Fleischer rings
Mallory bodies
Rhodanine stain

low serum Cu, low serum ceruloplasmin
high urinary copper

Lifelong penicillamne

31
Q

Autoimmune hepatitis

HLA association
Antibodies
Dx

A

HLA-DR3

Type 1
Anti-smooth muscle antibodies 
Anti nuclear antibodies
Antti actin antibodies
Anti soluble liver antigen

Type 2
Anti liver kidney microsomal Ig

Dx
Anti-smooth muscle antibodies in serum

32
Q

Liver histology of A1AT

alpha 1 antitrypsin deficiency

A

intracytoplasmic inclusions of antitrypsin 1

stain with periodic acid schiff

33
Q

Benign liver tumours

A

Liver cell adenoma
F>M, related to oestrogen levels, increased risk with COCP

Bile duct adenoma

Haemangioma
Most common benign lesion

34
Q

Commonest liver tumours

A

Benign - haemangioma

Malignant - secondary metastases

35
Q

Haemochromatosis symptoms

A 
o	Skin bronzing (melanin deposition)
o	DM
o	Hepatomegaly with micronodular cirrhosis
o	Cardiomyopathy
o	Hypogonadism
o	Pseudogout

Year 5 Path Charis (44 decks)

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