Liver Flashcards
what are kuppfer cells
resident macrophages in liver
4 changes in liver pathology when there is liver injury
- loss of microvilli
- collagen secretion by the stellate and endothelial cells - loss of space of Disse
- BM begining to form as the endothelial cells stick together, + loss of fenestra
- Kupffer cell activation
fibrotic state of the liver with nodules of regenerating hepatocytes and distortion of the hepatic vasculature.
cirrhosis
intrahepatic shunts
bypass the hepatocytes
extrahepatic shunts
bypass the liver
micronodular pattern of cirrhosis is associated with
alcoho
macronodular pattern associ with
infection (viral)
wilsons
a1-AT
causes of acute hepatitis
- viruses
2. drugs - such as abx
“spotty necrosis” on histology
acute hepatitis
3 complications of cirrhosis
portal htn
hepatic encephalopathy
liver cell cancer (cirrhosis is the number 1 risk factor)
three maun causes of chronic hepatitis
- viral - hep B C D
- drugs - ISONIAZID
- autoimmune
inflamma and apoptosis of cells across the limiting plate, with increased lymphocytic infiltration. “piecemeal necrosis”
interface hepatitis
Grade of chronic hepatitis =
how active/how much INFLAMMATION there is
Fibrosis of chronic hep =
STAGE - how far from normal the fibrosis is
pale, greasy liver with cells full of fat, enlarged liver
Fatty liver - common after a night on the b o o z e
fat and inflammation in the liver. increased infiltration with PMN. clumped ballooned hepatocytes ‘mallory denke bodies’
alcoholic hepatitis
‘mallory got denked’
micronodular fibrosis of the liver with fatty changes
alcoholic liver cirrhosis
fatty liver changes and cirrhosis not associated with alcohol use
NAFLD
cause of NAFLD
insulin resistance associated with increased BMI
fatty liver changes and hepatitis
NASH (also caused by increased BMI and insulin resistance)
damage and loss of bile ducts due to chronic inflammation with granulomas (increased infiltration with macrophages)
anti-mitochondrial abs
primary biliary cholangitis
periductal fibrosis leading to bile duct damage and loss. associated with ulcerative colitis
primary sclerosing cholangitis
‘wrap around and sclerose the life out of it’ - periductal fibrosis
disappearing bile duct syndrome, seen in middle aged women and often associated with AI disease
primary biliary cholangitis
onion skinning fibrosis with increased rosk of cholangiocarcinoma. diagnosed on ERCP
PSC
mutation in the HFE gene on chromosone 6 leading to ‘bronzed diabetes’
haemochromatosis
increased iron intake leading to accumulation of iron in macrophages. no scarring seen on liver.
haemosiderosis
genetic defect in chromosome 13 leading to defective excretory function of the hepatocytes. can present with parkinsonian movements and kayser fleischer rings
wilsons disease
often seen in patients with lots of blood transfusions such as in thalassaemia and sickle cell
haemosiderosis
chocolate brown liver
haemochromatosis
AR genetic defects leading to lack of copper transporter protein. low caeruloplasmin level
Wilsons
can present with multi-system disease, diabetes, pgimented skin and myocardial damage.
Haemochromatosis.
anti-smooth muscle antibodies leading to interface hepatitis with plasma cells
autoimmune hepatitis
Rx of AI hepatitis
steroids
failure of secretion if a1-antitrypsin leading to elevated levels in the hepatocytes and decreased levels in the blood.
a1-AT def
2 specific causes of hepatic granulomas
PBC
drugs
2 general causes of granulomatous disease which can affect the liver
TB
sarcoid
area of the hepatic lobule that will be damaged in paracetamol toxicity
zone 3 (closest to the hepatic vein)
hepatocytes are more mature the closer you get to the hepatic vein, therefore the metabolism of drugs occurs at these sites.
any metabolite damage (drugs, alcohol) will be worse in ZONE 3.
metabolite in paracetamol toxicity that causes liver damamge
NAPQI
histology showing intra-cytoplasmic inclusions
a1-antitrypsin def
the inclusions contain the built up a1 AT
chronic hepatitis and intersitial lung disease showing a restrictive pattern on spirometry
a1-AT
benign liver tumor that is common in females, has increased incidence in pregnancy and on high dose OCP
liver cell adenoma
common benign tumor of the liver endothelial cells
haemangioma
commonest malignant cancer in the liver
secondary metastases - portal vein means all tumours from all over the body will pass through liver. especially pancreas, bowel usually adenocarcinoma
primary liver tumor that is common in children and usually occurs with other tumours
hepatoblastoma
primary liver tumour associated with cirrhosis in the western world and hepatitis in LEDCs.
histology shows and increase in nuclear:cytoplasmic ration
HCC
primary liver tumour associated with PSC, worms and cirrhosis. may see papillary invaginations
cholangiocarcinoma
can arise from the intrahepatic or extrahepatic bile ducts (including gall bladder ca)
benign liver tumour that presents with abdo pain, intraperitoneal bleeding. can be associate with OCP
liver adenoma
most common benign lesion of the liver
haemangioma
top 3 causes of cirrhosis
- ALD
- NAFLD
- chronic viral hep - b c d
size of nodules in macronodular vs micronodular
<3cm = micro >3cm = macro
macroscopic: large pale yellow greasy liver
microscopic: accumulation of fat droplets in hepatocytes (steatosis)
can lead to cirrhosis
fatty liver
anti-LKM Ig
type 2 autoimmune hepatitis
ANA, anti-SMA, anti-actin, anti-soluble liver antigen (SLA)
type 1 autoimmune hepatitis
anti-mitochondrial abs
PBC
inflammation and obliterative fibrosis of extrahepatic and intrahepatic bile ducts leading to stricture formation and dilatation of the preserved segments. increased ALP.
PSC
ERCP shows beading of the bile ducts due to multifocal strictures
PSC
associated with UC and increased risk of cholangiocarcinoma
PSC
increased serum ALP, increased cholesterol, bile duct loss with granulomas. presents with fatigue, pruritis, abdo discomfort and xanthelasma. USS shows no bile duct dilatation.
PBC
intracytoplasmic inclusions which stain with periodic acid Schiff
a1-AT def
rhodanine stain positive
mallory bodies and fibrosis on microscopy
Wilsons disease
