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Systemic Pathology > Liver! > Flashcards

Liver! Flashcards

1
Q

Major Components of the liver:

Structural framework

A

connective tissue capsule, trabeculae and reticular network forms the framework for hepatic architecture

Sinusoids and hepatic cords

biliary tree

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2
Q

Major components of the liver

Cells of the liver

A

hepatocytes

Kupffer cells

Stellate cells

Endothelial cells

Biliary epithelium

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3
Q
A

liver architecture

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4
Q

Hepatic Architecture

A
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5
Q

Hepatic Lobule

A

an anatomic unit with the central vein at the center of the lobule and portal triads at the periphery

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6
Q

Hepatic Acinus

A

a functional unit with the central axis bridging between portal areas, with the outer part of the acinus around the central vein

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7
Q

Hepatocytes

A
  • Account for approximately 80% of total liver mass
  • Arranged in branching, single-cell plates between sinusoids
  • Numerous microvilli on the surface facing the sinusoid
  • Responsible for most of the synthetic, secretory, storage, detoxification and metabolic functions of the liver
  • Contain numerous intracellular organelles
  • Produce and secrete bile into bile canaliculi
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8
Q

Kupffer cells

A
  • member fo the mononuclear phagocyte system
  • mobile macrophages located within the sinusoids
  • Phagocytose immune complexes and particulate matter in the sinusoids
  • produce pro-inflammatory and anti-inflammatory cytokines to contribute to innate immunity
  • Pro-inflammatory products can activate hepatic stellate cells to create collagen
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9
Q

Hepatic Stellate Cells

A

Located in the space of disse

normal function is storage of Vitamin A

During hepatic injury they convert to a myofibroblast phenotype and produce collagen and other ECM components to promote hepatic fibrosis

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10
Q

Sinusoidal Endothelium

A
  • Second most common cell in the liver
    • 15-20% of all cells
    • 3% of liver mass
  • Contain numerous fenestrae
  • They lack a well organized basement membrane
  • Discontinuous capillary allows intimate contact with blood components and hepatocytes
  • Facilitate exchanges between plasma and hepatocytes
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11
Q

Blood Vessels

A

liver has dual blood supply

Hepatic artery

Protal vein

Blood flow is from portal triad to central vein

Discontinuous capillary with fenestrated endothelium allows intimate contact with blood components and hepatocytes

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12
Q

Lymphatic Vessels

A
  • Fluid from the hepatic interstitium flows into the space of disse then to the portal interstitum to the portal lymphatics
    • fluid is derived form the blood as well as products of hepatocytes, hepatic stellate cells and kupffer cells
  • Liver accounts for 50% of the lymph that enters the thoracic duct
  • Role of lymphatics in disease is poorly understood
    • obesity, lipidosis, hypercholesterolemia, lipoprotien associated disease
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13
Q

Biliary System

A
  • Bile is transported form the hepatocyte through a progressively enlarging duct system for secretion into the small intestine
    • bile canaliculi
    • Intrahepatic bile ductules
    • Interlobular bile ducts
    • interlobar ducts
    • Lobar ducts
    • Extrahepatic bile duct
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14
Q

Comparative Hepatic Anatomy:

How many lobes?

Dogs and Cats

A

6

left lateral, left medial, quadrate, right medial, right lateral, cuadate

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15
Q

Comparative Hepatic Anatomy:

How many lobes?

Mice and Rats

A

4

right, caudate, left, middle

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16
Q

Comparative Hepatic Anatomy:

How many lobes?

Horse

A

5

Right, Quadrate, left medial, left lateral, caudate

17
Q

Comparative Hepatic Anatomy:

How many lobes?

Bovine

A

4

right, caudate, left, quadrate

18
Q

Comparative Hepatic Anatomy:

How many lobes?

Elephant and Chicken / Avian

A

2

Left, right

19
Q

Comparative Hepatic Anatomy:

How many lobes?

Pig

A

5

left medial, left lateral, right medial, right lateral, cuadate

20
Q

Comparative Hepatic Anatomy:

How many lobes?

Humans

A

4

left, right, quadrate, cuadate

21
Q

Who doesn’t have a gallbladder?

A
  • Equines
    • horses, mules, etc.
  • Cervids
    • white-tailed deer, elk, moose, etc
  • Camels
  • Rats
  • Elephants
  • Giraffes
    • but often present in neonates, involuting with age
  • Rhinoceroses
  • Doves, pigeons, ostriches, and some psittacines
    • but most avian species have gall bladder
  • Among others
22
Q

Liver Function

A
  • The liver plays a central role in metabolism
    • synthesis and metabolism of proteins, lipids, and carbohydrates
    • Storage of nutrients
    • conjugation and detoxification reactions
    • Immune functions
    • Waste product excretion
    • Bile synthesis and secretion
23
Q

Nutrient synthesis, storage, and metabolism

A

Glucose metabolism

Degradation of plasma lipids and synthesis / storage / oxidation of fatty acids

Production of most plasma proteins

Production of cholesterol and lipoproteins

Nutrient storage

24
Q

Conjugation and Detoxification

A

Xenobiotic biotransformation and excretion

  • Phase 1 reactions:
    • Convert toxins into less (sometimes more) harmful intermediate compounds
      • Cytochrome P-450
  • Phase 2 reactions
    • convert phase 1 products into water soluble products for excretion
      • conjugation reactions
        • glucuronidation
        • Sulfation
        • Glutathione and amino acids conjugations
25
Q

Immune Functions

A

Removal of foreign material from blood

Kupffer cells

Hepatocytes protein synthesis

Inflammation and innate immunity are signaling pathways

26
Q

Bile Synthesis and Secretion

A
  • Bile
    • bile = water + bile salts + bilirubin + cholesterol + fatty acids + lecinthin
  • Bilirubin is derived form hemoglobin and other heme proteins
    • is taken up by hepatocytes, conjugated to glucuronic acid to become water soluble and less toxic, and excreted through the biliary system
  • Bile acids are produced by hepatocytes and efficiently recycled by the enterohepatic circulation
    • bile acids are essential for digestion and absorption of lipids and fat-soluble vitamins
  • Excretion of wast products and metabolites
27
Q

Liver - Dysfunction

A

liver has a large functional reserve capacity

Clinical evidence of disease may initially be absent

There are a wide variety of clinical assays to use to evaluate liver function

  • Liver enzymes
    • gamma-glutamyl transpeptidase (GGT)
    • Alkaline phosphatase (ALP)
    • Alanine transaminase (ALT)
    • Aspartate transaminase (AST)
  • Bilirubin, bile products, albumin, total protein
  • Prothrombin TIme
28
Q

Liver - Dysfunction

Clinical Signs

A

icterus

photosensitization

Encephalopathy

Hemorrhage

Edema

Gastrointestinal distrubances

Unthriftiness

29
Q

Icterus

A
  • Excess bilirubin results in yellow discoloration of tissue
    • causes of hyperbilirubinemia
      • over productions
        • hemolysis or excessive RBC degradation
      • Hepatocyte injury
        • decreased uptake, conjugation or secretion of bilirubin
      • Decreased bile flow
        • intrahepatic (bile canaliculi)
        • Extrahepatic (Bile ducts / gallbladder)
30
Q

Photosensitization

A
  • Activation of pigments by UV light causes erythema, hair loss, and dermal necrosis
    • Type 1:
      • increased ingestion of photodynamic pigments
    • Type 2
      • abnormal metabolism of photodynamic pigments
    • Type 3
      • decreased secretion of photodynamic pigments
31
Q

Encephalopathy

A

Accumulation of ammonia, toxic products and neurotransmitter-like substances cause neurologic dysfunction

These substances are normally excreted by the liver

Accumulation can be due to decreased metabolism by the liver or vascular shunting past the liver

Sings ranged form depression to convulsions

32
Q

Hemorrhage

A

all clotting factors are produced by the liver

Factor V!!! is one possibele exception

With severe hepatic injury, decreased production can result in defective secondary hemostasis

33
Q

Edema

A

albumin, produced mainly by the liver, regulates plasma osmotic pressure

Hypoalbuminemia results in fluid imbalance and edema

34
Q

Gastrointestinal Disturbances

A

decreased bile excretion will disrupt digestion

decreased bile acids decrease fate and fat-soluble vitamin absorption

35
Q

Unthriftiness

A

chronic liver dysfunction resutls in weight oss and poor conditions

Hypoabluminemia

Altered fat and protein metabolism

Altered digestion

36
Q

Liver - Dysfunciton

Acute Hepatic Disease

A

icterus and Gastrointestinal abnormalities

37
Q

Liver dysfunction:

Chronic Hepatic Disease

A

weight loss and unthriftiness

Systemic Pathology (4 decks)

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