Histopathology - Liver tutorial

Question 1

Why does the liver rarely undergo ischaemia?

Answer 1

It has a dual blood supply (hepatic artery and portal vein)

Question 2

Which zone of the liver is the portal tract in?

Answer 2

In zone 1 (has the best blood supply)

Question 3

What is the importance of zone 3?

Answer 3

Contains the most metabolically active hepatocytes but most prone to ischaemia

Question 4

What is special about the endothelial cels in the liver?

Answer 4

They do not sit on a basement membrane and are discontinuous (fenestrated)

Question 5

Resident macrophages in liver?

Answer 5

Kuppfer cells

Question 6

Function of stellate cells when normal and in liver damage

Answer 6

Normal: produce vitamin A

Liver damage: stellate cells become activated to myofibroblasts and lay down collagen

Question 7

Which cells in the liver are responsible for liver scarring

Answer 7

Stellatecells

Question 8

Liver injury changes

Answer 8

Hepatocytes lose microvilli
Kuppfer cells become activated
Stellate cells become activated to myofibroblasts
Deposition of scar tissue in space of disse by stellate cells
Loss of fernestration in endothelium

Question 9

Definition of cirrhosis

Answer 9

Whole liver involved
Fibrosis
Nodules of regenerating hepatocytes
Distortion of liver vasculature: both intra and extrahepatic shunting of blood (due to bridging fibrosis)

Question 10

What is cirrhosis classification based on?

Answer 10

Aetiological cause of cirrhosis

Question 11

The patterns of nodular regeneration in alcoholic/ NAFLD hepatitis causing cirrhosis

Answer 11

MICRONODULAR reorganisation

Question 12

The patterns of nodular regeneration in viral hepatitis causing cirrhosis?

Answer 12

MACRONODULAR reorganisation

Question 13

Pathological finding in acute hepatitis

Answer 13

Spotty necrosis

Question 14

Pathoological finding in chronic hepatitis

Answer 14

Interface hepatitis/piecemeal necrosis

Question 15

Is cirrhosis reversible?

Answer 15

YES

Question 16

Which hepatitis viruses can casue acute hepatiits?

Answer 16

A and E

Question 17

3 main causes of chronic hepatitis

Answer 17

Viruses, drugs and autoimmune

Question 18

Grade and stage of chronic hepatitis

Answer 18

Grade = degree of inflammation
Stage = severity of fibrosis/scarring

Question 19

How is alcohol toxic to the liver?

Answer 19

Alcohol itself is not toxic but the metabolic product of acetaldehyde is

Question 20

Three histological patterns of alcoholic liver disease

Answer 20

Fatty change, alcoholic hepatitis and cirrhosis

Question 21

Features of alcoholic hepatitis

Answer 21

Ballooning (+/- mallory denk bodies), apoptosis, pericellular fibrosis

Question 22

Which zone is affected most in alcoholic hepatiits

Answer 22

Zone 3 as it has the highest concentration of aldehyde dehydrogenase as cells most metabolically active

Question 23

Histology of NAFLD

Answer 23

Identical to alcoholic liver disease

Question 24

Pathophysiology of PBC

Answer 24

Bile duct loss due to CHRONIC inflammation with GRANULOMAS

Question 25

Histology of PBC

Answer 25

Bile ducts surrounded by epithelioid macrophages
NO bile duct dilatation
INTRAHEPATIC

Question 26

Antibody in PBC

Answer 26

AMA

Question 27

PSC

Answer 27

Periductal bile duct fibrosis WITHOUT inflammation

Question 28

PSC associations

Answer 28

UC, Cholangiocarcinoma, pANCA

Question 29

PSC histology

Answer 29

Intra AND extrahepatic

Question 30

How is PSC diagnoised? Common findings?

Answer 30

Radiology
On USS –> onion skinning, duct dilatation
ERCP: Beads on a string

Question 31

Haemochromatosis: which gene and which chromosome?

Answer 31

HFe, Chr6

Question 32

What is haemosiderosis?

Answer 32

Iron deposition in MACROPHAGES

Question 33

When do people get haemosiderosis?

Answer 33

Transfusion haemosiderosis

Question 34

Wilson’s disease mutation on which Chr?

Answer 34

Chr13

Question 35

Stain for Wilson’s

Answer 35

Rhodanine

Question 36

Autoimmune hepatitis antibody

Answer 36

ASMA

Question 37

Management of autoimmune hepatitis

Answer 37

Steroid responsive

Question 38

Causes of hepatic granulomas

Answer 38

PBC, drugs, TB, sarcoid

Question 39

Most common benign tumours of liver

Answer 39

Haemangiomas

Question 40

Most common malignant liver tumour?

Answer 40

Secondary tumours

Question 41

Other types of malignant liver cancers

Answer 41

HCC, cholangiocarcinoma, hepatoblastoma (children)