Histopathology Liver damage acute

Question 1

Understand the concept of injury patterns in liver disease

What is the most vulnerable zone and why?

Answer 1

Zone 3, furthest from portal tract and thus blood supply.
Because many of the toxins don’t cause direct injury, it’s their metabolites that do, and often the machinery to break them down is in zone 3. Also relative hypoxia.
Get apoptosis, progressing to zone 3 necrosis, progressing to bridging necrosis to multiacinar necrosis.

Question 2

Explain the basic microanatomy, with reference to the lobular and acinar models

Answer 2

Liver classic lobules, made up of plates of hepatocytes 1-2 cells thick
Supported by reticulin fibres.

Question 3

Describe the normal function of the hepatocyte, and the clinical problem that correlates with hepatocellular dysfunction

Answer 3

m

Question 4

Define the terms acute liver disease and acute hepatitis

Answer 4

y

Question 5

Understand the difference the apoptosis and necrosis, and the central of apoptosis in viral hepatitis-like injury

Answer 5

y

Question 6

List the causes of acute liver disease/acute hepatitis

Answer 6

• Acute viral hepatitis (A,B,E).
• Drug induced liver injury (DILI).
• “Natural” remedies.
• Autoimmune hepatitis.
• Idiopathic (seronegative, acute non A non B hepatitis).

Question 7

Describe the key histology features of three patterns of acute hepatitis - viral hepatitis-like, toxic/ischaemic-like, fulminant acute hepatitis

Answer 7

• Pan -lobular disarray: swollen liver cells, gaps on liver cell plates.
• Apoptosis.
• Necrosis of variable extent depending on
severity.
• Aggregates of enlarged macrophages.
• Cholestasis.

Question 8

What are the histopathological differences between paracetamol toxicity and traditional acute hepatitis?

Answer 8

Paracetamol predominantly causes liver necrosis (coagulative) in zone 3 (can extend to others if more severe). Absence of inflammation