Inflammatory Liver Disease Flashcards
What is the cellular response to nonlethal cell injury?
- abnormal storage 2. hypertrophy 3. hyperplasia 4. dysplasia 5. neoplasia
What is the tissue response to nonlethal cell injury?
- acute inflammation 2. thrombosis 3. chronic inflammation 4. fibrosis
What is the response to lethal cell injury?
- necrosis 2. apoptosis
What are the patterns of liver injury?
- intracellular accumulations/abnormal storage
- necrosis and apoptosis
- inflammation
- regeneration
- fibrosis with subsequent cirrhosis
Describe the intracellular accumulations/abnormal storage?
- steatosis - triglyceride fat droplets 2. accumulation of copper, iron, bile and water
Inflammatory liver disease is morphologically characterised by?
recruitment of inflammatory cells in addition to various cellular responses
Inflammatory liver disease is characterised into?
- acute and chronic - mostly chronic 2. infectious and non infectious - mostly infectious
How to diagnose inflammtory liver disease?
- 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
What viruses cause infectious liver disease?
- hepatitis A, B, C, D, E 2. cytomegalovirus - in immunocompromised hosts
What bacteria cause infectious liver disease?
tuberculosis - as part of a septicaemia
What fungi cause infectious liver disease?
- candida 2. aspergillus 3. mucormycosis
What parasites cause infectious liver disease?
- amoeba 2. E.granulosus (hydatid)
Name types of non-infectious liver diseases?
- drug + toxin induced liver disease
- metabolic liver disease
- autoimmune hepatitis
- neonatal hepatitis
Name types of metabolic liver diseases?
- non alcoholic fatty liver disease
- Wilsons disease - copper accumulation
- haemochromatosis - iron haemochromatosis
- alpha 1 anti-trypsin deficiency
Describe the pattern of the inflammatory changes?
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
What is alcoholic liver disease?
common cause of acute and chronic liver disease due to excessive alcohol consumption
What are the 3 forms of liver disease?
- steatosis (micro and macrovesicular)
- alcoholic hepatitis
- cirrhosis
What are the stages of alcoholic liver disease?
- steatosis 2. fibrosis 3. cirrhosis 4. HCC
What are the risk factors of alcoholic liver disease?
- female 2. obesity 3. dietary factors 4. polymorphisms 5. drinking pattern 5. smoking
What is the pathogenesis of alcoholic liver disease?
- Diversion of cellular energy from essential metabolic pathways (fat metabolism) to alcohol metabolism leading to fat accumulation
- Acetaldehyde directly injures hepatocyte leading to an inflammatory reaction
- Alcohol stimulates collagen synthesis leading to fibrosis and cirrhosis
What is steatosis?
build up of fat in the liver
Describe steatosis?
- micro and macrovesicular
- Predominantly centrilobular/acinar
- hepatomegaly
- completely reversible if one stops taking alcohol
What is alcoholic hepatitis?
hepatocyte swelling and necrosis caused by drinking too much alcohol
Describe the micro morphology of alcoholic hepatitis?
- mallory bodies - cytokeratin intermediate filaments and proteins in the cytoplasm
- neutrophilic reaction
- fibrosis
What is cirrhosis?
end stage of disease causes by excessive alcohol consuption and hepatitis casudimg scarring and liver failure
Describe the micro morphology of cirrhosis?
- Bridging fibrous septae
- Regenerative parenchymal nodules with proliferating hepatocytes encircled by fibrosis
- Disruption of the entire liver architecture
What reasons do liver tumours com to the attention of patients and doctors?
- epigastric fullnes or discomfort 2. palpable abdominal mass 3. incidental findings
What are the types of liver tumours?
- benign 2. malignant
What are the types of malignant tumours?
- primary 2. metastatic: spread from other organs
Describe 2 types of benign liver tumours?
- haemongioma - blood vessel tumour
2. liver cell adenomas - commonly seen in young women on oral contraceptives
What are primary malignant tumours?
most arise from hepatocytes: Hepatocellular carcinoma(HCC).
Describe types of malignant tumours?
- cholangiocarcinoma - bile duct origin
- hepatoblastomas - Liver tumour of childhood (<2yrs of age)
- angiosarcoma - blood vessel tumours
What is the epidemiology of hepatocellular carcinoma?
- Documented prevalence for Malawi:
- 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)
What are the 3 major aetiological associations of neoplastic liver disease?
- Viral infection: HBV, HCV
- Chronic alcoholism
- Food contaminants (Aflatoxins)
What are the minor conditions associated with neoplastic liver disease?
- tyrosinaemia 2. hereditary haemochromatosis
Describe viral carcinogenesis?
- 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
Describe the macroscopic morphology?
- unifocal - one large mass 2. multifocal - several separate nodules 3. diffusely infiltrative - involving whole live
Describe the microscopic morphology?
- 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
Describe the course of the disease?
progressive enlargement of primary mass - 1. mestastases 2. derangement of liver function
Death occurs from?
- cachexia 2. eosophageal variceal bleed 3. liver failure with hepatic coma 4. rupture of tumour with fatal haemorrhage
