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Pathology > Liver > Flashcards

Liver Flashcards

1
Q

Blood supply to liver

A

Portal circulation (70-80%)
Hepatic artery (30-20%)

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2
Q

Classic lobule

A

Centrilobular region: at center of hexagon (central vein - blood out of liver, bile in)
Midzonal region: middle region
Periportial region: (portal triad, blood into liver, bile out)

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3
Q

Hepatic acinus

A

Zonal model
Zone 1 ~ periportal
Zone 2 ~ midzonal
Zone 3 ~ centrilobular

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4
Q

Portal triad

A

Portal venule
Hepatic arteriole
Bile ductule

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5
Q

Indicators of liver injury

A

Leakage enzymes (cytosolic) - ALT (dogs/cats), AST (liver and muscle), SDH (large animals)

Inducible enzymes (membrane bound) - ALP (dogs/cats), GGT- liver and biliary (all species)

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6
Q

Kupffer cells

A

Macrophages living in space of Disse
Phagocytize RBCs, accumulate iron
Also phagocytize bacteria, endotoxin, apoptosis cells, etc.
Can accumulate ceroid/lipofusin (wear and tear pigment)/lipid

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7
Q

Lipogranuloma

A

Fatty cyst
Accumulate in macrophage??

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8
Q

Stellate cells

A

Vitamin A metabolism
May —> myfibroblasts —> fibrosis
Between sinusoids and hepatocytes in space of Disse

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9
Q

Liver function

A

Protein synthesis (albumin, fibrinogen, clotting factors, globulins)
Bile metabolism/transport
Bilirubin metabolism
Drug metabolism
Conversion of toxic compounds of GI origin (i.e. NH3)
Lipid/CHO

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10
Q

Sequelae of hypoalbuminemia

A

Ascites

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11
Q

Sequelae due to coagulopathy

A

Hemorrhage

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12
Q

Primary photosensitization

A

Photodynamic compound that can’t be excreted goes to skin (e.g. St John’s wort)

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13
Q

Secondary (hepatogenous) photosensitization

A

Follows colestasis in herbivores
Phylloerythrin (catabolism of chlorophyll) or other photodynamic compound accumulates

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14
Q

Congenital porphyria

A

Hereditary defect in heme metabolism —> photosensitization

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15
Q

Hyperbilirubinemia

A

Leads to icterus/jaundice

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16
Q

Types of icterus

A

Prehepatic
Hepatic
Post hepatic

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17
Q

Prehepatic icterus

A

Caused by hemolysis
Causes vary (immune-mediated, infectious, trauma, metabolic, toxin, etc)
Increased unconjugated bilirubin

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18
Q

Hepatic icterus

A

Liver disease comprises ability to uptake/excrete bilirubin
Increased conjugated and unconjugated bilirubin

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19
Q

Posthepatic icterus

A

Bile duct obstruction —> increased conjugated bilirubin

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20
Q

Hepatoencephalopathy

A

Inability to detox NH3 —> travels to brain and produces neurological signs

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21
Q

Reaction to liver injury

A

Hydropic or vacuolar degeneration
Glycogen accumulation
Fatty change/lipidosis
Storage disorders
Necrosis
Inflammation
Bile stasis

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22
Q

Vacuolar hepatopathy

A

Reversible injury
- hepatocellular swelling
- glycogen accumulation
- hepatic lipidosis

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23
Q

Hepatocellular swelling

A

Cells accumulate water due to inability to maintain fluid/ionic homeostasis
First sign of must injury

Swelling with pale staining cytoplasm

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24
Q

Glycogen accumulation

A

Hepatocytes swelling with clear cytoplasm, WITHOUT displacement of nucleus from cell center

Usually midzonal

Orangey hue to liver

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25
Q

Steroid hepatopathy

A

ONLY in dogs
Associated with glucocorticoids —> accumulation of glycogen in hepatocytes

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26
Q

Hepatic lipidosis

A

Vacuoles of lipid in cytoplasm of hepatocytes

Yellowy liver

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27
Q

Mechanisms of fatty Change in liver

A

Over-ingestion of fats or carbs (leading to FA synthesis)
Mobilization of fatty stores
Decreased oxidation of FAs
Decreased apoprotein in synthesis
Decreased export of lipoproteins

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28
Q

Tension lipidosis

A

Lipid accumulations at edges of liver due to anoxic environment created by tension

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29
Q

Feline fatty liver syndrome

A

Hepatic lipidosis in cats - usually a larger cat going off feed

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30
Q

Storage disorders

A

Accumulations in hepatocytes/Kupffer cells due to inherited metabolic disorders

Need to identify storage product and enzyme deficiency/defective gene for definitive diagnosis

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31
Q

Requirements for definitive diagnosis of storage disorder

A

Identification of storage product and enzyme deficiency / defective gene

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32
Q

Canine copper-associated hepatopathy

A

Accumulation of copper in hepatocytes, overlap with chronic hepatitis

Cu accumulates in centrolobular hepatocytes —> necrosis and inflammation —> chronic hepatitis/cirrhosis

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33
Q

Breeds with predilection for copper-associated hepatopathy

A

Bedlington terrier
West highland white terrier, Dalmatian (familial association)
Doberman pinschers, labs, cocker spaniels (breed predisposition)

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34
Q

Stain for detecting Cu

A

Rubeanic acid stain

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35
Q

Types of necrosis

A

Liquefactive
Coagulative

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36
Q

Patterns of necrosis

A

Focal
Multifocal
Confluent
Bridging
Massive
Piecemeal

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37
Q

Pattern of necrosis indicating infectious agents

A

Multifocal random

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38
Q

Pattern of necrosis indicating toxic or nutritional cause

A

Massive

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39
Q

Pattern of necrosis indicated toxic or hypoxic cause

A

Zonal

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40
Q

Hepatitis

A

Inflammation of liver parenchyma

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41
Q

Cholangitis

A

Inflammation of bile ducts

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42
Q

Cholangiohepaitits

A

Inflammation of bile ducts with extension into liver parenchyma

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43
Q

Cholecystitis

A

Inflammation of the gall bladder

44
Q

Choledochitis

A

Inflammation of the larger/common bile ducts

45
Q

Bile stasis / colestasis

A

Bile in canaliculi or bile ducts
Intracellular or extra/post-hepatic
Due to toxins, inflammation, duct obstruction
Often with Hyperbilirubinemia
Inc in inducible enzymes in circulation

46
Q

Pyrollizidine alkaloid toxicosis

A

Specific toxic insult in horses —> bile stasis

47
Q

Sequelae of necrosis and inflammation

A

Regeneration > fibrosis > bile duct hyperplasia

Cirrhosis

48
Q

Cirrhosis

A

severe diffuse (bridging) hepatic fibrosis with nodular regeneration and bile duct hyperplasia

49
Q

Fibrosis and nodular regeneration

A

Bands of fibrosis between nodules of normal (restored) hepatic tissue

Often seen with chronic hepatitis

Visualization of fibrosis with Masson’s trichrome or Van Gieson’s stain

50
Q

Sequelae of cirrhosis

A

Portal hypertension —> multiple acquired portosystemic shunts —> Ascites

Loss of hepatic function —> insufficiency —> failure—> coagulopathy, Hyperbilirubinemia, hepatoencephalopathy, edema, Ascites, photosensitization

51
Q

Congenital liver disease

A

Hereditary Hyperbilirubinemia
Storage diseases
Peritoneal-pericardial diaphragmatic hernia
Vascular shunts (common)
Biliary abnormalities

52
Q

Biliary cysts

A

Nodules will be greenish or yellowish in color
Can be multifocal or focal

53
Q

Traumatic insult to liver

A

Displacement through hernia
Rupture
Hematoma from blunt trauma
Lobar torsion (may occur with trauma)

54
Q

Factors predisposing liver to rupture

A

Hepatitis
Neoplasia
Fatty liver
Amyloidosis

55
Q

Amyloidosis

A

Eosinophilic material in space of Disse
Atrophy of adjacent hepatocytes, dilation of sinusoids; Lugol’s iodine to see amyloid (black)

Increases friability of liver

Can be associated with inflammatory conditions (secondary/reactive amyloid), breed predisposition

Can hemorrhage with biopsy

56
Q

Vascular causes of liver injury

A

Congestion
Infarction
Portal thrombi
Portosystemic shunts/vascular anomalies

57
Q

Passive congestion in liver

A

Secondary to CHF
Can form fibrosis
“Nutmeg” liver - blood pooling and loose

58
Q

Congenital portosystemic shunt

A

Often leads to hepatic hypoplasia/microhepatica

Typically a single, less tortuous shunt

Small stature, anesthetic intolerance, behavior abnormalities, head pressing, seizures, GI signs, …

59
Q

Acquired portosystemic shunt

A

Tend to be multiple, extra-hepatic, tortuous

Ascites may develop

Associated with cirrhosis, portal hypertension

60
Q

Intrahepatic portosystemic shunt more frequently found in

A

Large breed dogs (patent ductus venosus)

61
Q

Extrahepatic portosystemic shunt more frequently found in

A

Small breed dogs, cats, ferrets

62
Q

Primary portal vein hypoplasia

A

Microvascular dysplasia
Non-cirrhosis portal hypertension
Congenital

63
Q

Peliosis hepatis (telangiectasia)

A

Dilation of small groups of sinusoids
Generally incident finding
Primarily in cattle/cats

64
Q

Causes of inflammatory liver disease

A

Viral
Bacterial
Fungal
Parasitic
Idiopathic (serum hepatitis in horse, chronic hepatitis in dogs, lobular dissecting hepatitis)
Cholangitis

65
Q

Infectious canine hepatitis

A

Canine adenovirus 1
Rare due to vaccination
Edema blue eyes
Necrosis/inflammation of liver
(Also caused turkey spotted kidney)

66
Q

Viral causes of hepatitis

A

CAV-1 (dogs)
Herpesviruses (mammals, birds)
Coronaviruses (FIP virus, murine coronavirus)
Rift Valley fever (ruminants)

67
Q

Bacterial causes of hepatitis

A

Clostridium spp
Salmonella spp
Leptospirosis
Mycobacteria spp

68
Q

Parasitic causes of hepatitis

A

Protozoa (T. Gondii, N. Caninum, Eimeria stiedae)
Nematodes (larval migrans, Ascaris suum)
Cestodes (cysts in liver)
Trematodes (Fasciola spp, Fascioloides spp)

69
Q

Tyzzer’s disease

A

C. Piliforme (Gram NEGATIVE clostridium)
Obligate intracellular

K9, Equine

70
Q

Fibrinous cholecystitis

A

Caused by Salmonella
Inflammation of gall bladder

71
Q

Clostridium hemolyticum

A

Bacterial cause of hepatitis
Focally extensive, bacillary haemoglobinuria

72
Q

Clostridium novyi

A

Infectious necrotic hepatitis / black disease
In cattle / sheep
Proliferate in area of ischemia often associated with a liver fluke

73
Q

Liver abscesses

A

Common in cattle
Associated with omphalitis
Often Fusobacterium necrophorum in large animals
Also Salmonella, Lepto, Mycobacteria

Multifocal necrosis

74
Q

Granulomatous hepatitis can be caused by

A

Mycobacterium spp
Histoplasma capsulatum (fungi)

75
Q

Eimeria stediae

A

Causes severe proliferative hepatitis in rabbits
Proliferative colangitis

76
Q

Milk spot liver caused by

A

Ascarid migration in pigs (A. suum)

77
Q

Hepatic tremadoiasis

A

Fasciola hepatica - bovine
Opisthorchis felineus - felin

78
Q

Serum hepatitis / Theiler’s disease

A

(Small friable) Dish rag liver in horses with severe diffuse centrilobular necrosis

Historically associated with administration of xenobiotics, vaccines, idiopathic

Most recently suggests Equine parvovirus hepatitis

Acute massive necrotizing hepatitis

79
Q

Chronic Canine Hepatitis

A

Chronic inflammation of liver (often periportal)
Lymphocytes, plasma cells, few neutrophils

Most canine hepatitis is idiopathic
Approximately 1/3 associated with excess Cu

80
Q

Chronic (lymphocytic) Cholangitis in cats

A

Chronic inflammation of bile duct/ductules
Often associated with IBD/pancreatitis (triaditis)
Idiopathic

Histologically may overlap with small cell lymphoma —> immunohistochemistry may be needed

81
Q

Lobular dissecting hepatitis

A

Rare idiopathic inflammatory disease
Young to middle aged large breed dogs
Mixed inflammation with fibroplasia throughout sinusoids (separates hepatocytes)

Poor prognosis

82
Q

Acute neutrophilic (Suppurative) Cholangitis

A

Believed to involve ascending bacterial infection, in rare occasions, obstruction of extrahepatic bile ducts

Cats > dogs

Histo: onion skin like lesions, looser/more clear space than lymphocytic Cholangitis

83
Q

Predictable (e.g. toxin)

A

Dose-dependent

84
Q

Idiosyncratic

A

Individual response (i.e. dose independent toxin)

85
Q

Direct toxin

A

Toxic as ingested

86
Q

Indirect toxin

A

Toxic as metabolized

87
Q

Mechanisms of hepatoxicity

A

DNA damage (alkylation, intercalating)
RNA damage (binding RNA polymerase, impair RNA transcription)
Inhibition of lysosomal enzymes
Production of free radicals - membrane damage
Canalicular damage —> bile stasis/icterus
Stimulation of apoptosis
Idiopathic

88
Q

Manifestation of liver toxicity

A

No morphological abnormalities (biochem only)
Fatty change / lipidosis
Cell swelling
Bile stasis
Necrosis

89
Q

Examples of toxins

A

Pharmaceuticals (NSAIDs, phenobarbital)
Plants
Mushrooms
Algae

90
Q

Acute copper toxicity results in liver disease in … grazing on pasture high in … and low in …

Often associated with a stressful event

A

Sheep
Cu
Mo

91
Q

Hepatosis dietetica

A

Liver disease in swine attributed to Vit E / Se deficiency

92
Q

Pathogenesis of Hepatosis dietetica

A

Lack of antioxidants —> massive centrilobular necrosis by ROS damage

93
Q

Hepatosis dietetica is seen in combination with what cardiovascular disease?

A

Mulberry heart disease

94
Q

Hepatocutaneous syndrome is associated with what other disease condition

A

Superficial necrolytic dermatitis (severe keratosis of paws/nose)

95
Q

Cystic mucosal hyperplasia of the gall bladder

A

Incidental finding

96
Q

Nodular hyperplasia

A

Incidental finding
Most dogs >10 will develop 0.5 to 10 cm nodules

97
Q

Hepatocellular adenoma

A

Single large mass
Uncommon, but present in dogs; rare in other species

98
Q

Cholangiocellular (biliary) cystadenoma

A

Green or yellow tumor in liver
Singular or multifocal

99
Q

Gall bladder adenoma

A

Occurs uncommonly in dogs

100
Q

Hepatocellular carcinoma

A

Uncommon in dogs (rarely metastatic)
Rare in other species

101
Q

Cholangiocellular (bile duct) carcinoma

A

Biliary duct tumor
Umbilicated lesions
Highly infiltrative and metastatic
Uncommon, but both dogs and cats

102
Q

Metastatic tumors affecting the liver

A

Lymphosarcoma
Metastatic (pancreatic) carcinoma
Diffuse mast cell tumor
Histiocytic sarcoma
Hemangiosarcoma

103
Q

Gall bladder lesions

A

Cystic mucosal hyperplasia
Mucocele
Infarction / cholecystitis
Choleliths (stones)

104
Q

Mucocele

A

Kiwi fruit ultrasound
Accumulation of inspissated bile and/or mucin in gall bladder
Idiopathic
May lead to obstruction / rupture

105
Q

Cholelithiasis

A

Infrequent
May lead to obstruction

106
Q

Cholecystitis

A

Secondary to pressure necrosis/inflammation with obstruction or ascending bacterial infection

Pathology (21 decks)

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