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MBBS 2: GIT Pathology > Inflammatory Liver Disease > Flashcards

Inflammatory Liver Disease Flashcards

1
Q

What is the cellular response to nonlethal cell injury?

A
  1. abnormal storage 2. hypertrophy 3. hyperplasia 4. dysplasia 5. neoplasia
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2
Q

What is the tissue response to nonlethal cell injury?

A
  1. acute inflammation 2. thrombosis 3. chronic inflammation 4. fibrosis
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3
Q

What is the response to lethal cell injury?

A
  1. necrosis 2. apoptosis
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4
Q

What are the patterns of liver injury?

A
  1. intracellular accumulations/abnormal storage
  2. necrosis and apoptosis
  3. inflammation
  4. regeneration
  5. fibrosis with subsequent cirrhosis
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5
Q

Describe the intracellular accumulations/abnormal storage?

A
  1. steatosis - triglyceride fat droplets 2. accumulation of copper, iron, bile and water
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6
Q

Inflammatory liver disease is morphologically characterised by?

A

recruitment of inflammatory cells in addition to various cellular responses

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7
Q

Inflammatory liver disease is characterised into?

A
  1. acute and chronic - mostly chronic 2. infectious and non infectious - mostly infectious
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8
Q

How to diagnose inflammtory liver disease?

A
  1. patients clinical history 2. habits and lifestyle 3. physical examination findings 4. laboratory investigations 5. drug history 6. imaging/radiology 7. biopsy and tissue diagnosis
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9
Q

What viruses cause infectious liver disease?

A
  1. hepatitis A, B, C, D, E 2. cytomegalovirus - in immunocompromised hosts
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10
Q

What bacteria cause infectious liver disease?

A

tuberculosis - as part of a septicaemia

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11
Q

What fungi cause infectious liver disease?

A
  1. candida 2. aspergillus 3. mucormycosis
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12
Q

What parasites cause infectious liver disease?

A
  1. amoeba 2. E.granulosus (hydatid)
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13
Q

Name types of non-infectious liver diseases?

A
  1. drug + toxin induced liver disease
  2. metabolic liver disease
  3. autoimmune hepatitis
  4. neonatal hepatitis
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14
Q

Name types of metabolic liver diseases?

A
  1. non alcoholic fatty liver disease
  2. Wilsons disease - copper accumulation
  3. haemochromatosis - iron haemochromatosis
  4. alpha 1 anti-trypsin deficiency
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15
Q

Describe the pattern of the inflammatory changes?

A

can primarily affect 1. portal tracts and its constituents 2. hepatic lobular parenchyma - zonal: zone 1, 2, 3 3. both portal tracts and lobular parenchyma

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16
Q

What is alcoholic liver disease?

A

common cause of acute and chronic liver disease due to excessive alcohol consumption

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17
Q

What are the 3 forms of liver disease?

A
  1. steatosis (micro and macrovesicular)
  2. alcoholic hepatitis
  3. cirrhosis
18
Q

What are the stages of alcoholic liver disease?

A
  1. steatosis 2. fibrosis 3. cirrhosis 4. HCC
19
Q

What are the risk factors of alcoholic liver disease?

A
  1. female 2. obesity 3. dietary factors 4. polymorphisms 5. drinking pattern 5. smoking
20
Q

What is the pathogenesis of alcoholic liver disease?

A
  1. Diversion of cellular energy from essential metabolic pathways (fat metabolism) to alcohol metabolism leading to fat accumulation
  2. Acetaldehyde directly injures hepatocyte leading to an inflammatory reaction
  3. Alcohol stimulates collagen synthesis leading to fibrosis and cirrhosis
21
Q

What is steatosis?

A

build up of fat in the liver

22
Q

Describe steatosis?

A
  • micro and macrovesicular
  • Predominantly centrilobular/acinar
  • hepatomegaly
  • completely reversible if one stops taking alcohol
23
Q

What is alcoholic hepatitis?

A

hepatocyte swelling and necrosis caused by drinking too much alcohol

24
Q

Describe the micro morphology of alcoholic hepatitis?

A
  1. mallory bodies - cytokeratin intermediate filaments and proteins in the cytoplasm
  2. neutrophilic reaction
  3. fibrosis
25
Q

What is cirrhosis?

A

end stage of disease causes by excessive alcohol consuption and hepatitis casudimg scarring and liver failure

26
Q

Describe the micro morphology of cirrhosis?

A
  1. Bridging fibrous septae
  2. Regenerative parenchymal nodules with proliferating hepatocytes encircled by fibrosis
  3. Disruption of the entire liver architecture
27
Q

What reasons do liver tumours com to the attention of patients and doctors?

A
  1. epigastric fullnes or discomfort 2. palpable abdominal mass 3. incidental findings
28
Q

What are the types of liver tumours?

A
  1. benign 2. malignant
29
Q

What are the types of malignant tumours?

A
  1. primary 2. metastatic: spread from other organs
30
Q

Describe 2 types of benign liver tumours?

A
  1. haemongioma - blood vessel tumour

2. liver cell adenomas - commonly seen in young women on oral contraceptives

31
Q

What are primary malignant tumours?

A

most arise from hepatocytes: Hepatocellular carcinoma(HCC).

32
Q

Describe types of malignant tumours?

A
  1. cholangiocarcinoma - bile duct origin
  2. hepatoblastomas - Liver tumour of childhood (<2yrs of age)
  3. angiosarcoma - blood vessel tumours
33
Q

What is the epidemiology of hepatocellular carcinoma?

A
  1. Documented prevalence for Malawi:
  2. 8/100,000 in males, 0.4/100,000 in females 2. Globally 5.4% of all cancers 3. common in Asia followed by Africa 4. >85% in countries with high rates of chronic Hepatits B virus infection (HBV)
34
Q

What are the 3 major aetiological associations of neoplastic liver disease?

A
  1. Viral infection: HBV, HCV
  2. Chronic alcoholism
  3. Food contaminants (Aflatoxins)
35
Q

What are the minor conditions associated with neoplastic liver disease?

A
  1. tyrosinaemia 2. hereditary haemochromatosis
36
Q

Describe viral carcinogenesis?

A
  1. Chronic liver injury with regeneration: increase in pool of cycling cells at risk of genetic changes - Mutations arise spontaneously or by environmental agents eg aflatoxins 2. HBV encodes HBx protein: regulatory protein that disrupts normal growth control of infected liver cells
37
Q

Describe the macroscopic morphology?

A
  1. unifocal - one large mass 2. multifocal - several separate nodules 3. diffusely infiltrative - involving whole live
38
Q

Describe the microscopic morphology?

A
  1. HCC - Poorly differentiated to well differentiated 2. fibrolamellar - distinctive variant that occurs in young males and has no association with HBC but has thick fibrous bands
39
Q

Describe the course of the disease?

A

progressive enlargement of primary mass - 1. mestastases 2. derangement of liver function

40
Q

Death occurs from?

A
  1. cachexia 2. eosophageal variceal bleed 3. liver failure with hepatic coma 4. rupture of tumour with fatal haemorrhage

MBBS 2: GIT Pathology (7 decks)

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