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Histopath > Liver > Flashcards

Liver Flashcards

1
Q

what are kuppfer cells

A

resident macrophages in liver

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2
Q

4 changes in liver pathology when there is liver injury

A
  1. loss of microvilli
  2. collagen secretion by the stellate and endothelial cells - loss of space of Disse
  3. BM begining to form as the endothelial cells stick together, + loss of fenestra
  4. Kupffer cell activation
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3
Q

fibrotic state of the liver with nodules of regenerating hepatocytes and distortion of the hepatic vasculature.

A

cirrhosis

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4
Q

intrahepatic shunts

A

bypass the hepatocytes

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5
Q

extrahepatic shunts

A

bypass the liver

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6
Q

micronodular pattern of cirrhosis is associated with

A

alcoho

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7
Q

macronodular pattern associ with

A

infection (viral)
wilsons
a1-AT

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8
Q

causes of acute hepatitis

A
  1. viruses

2. drugs - such as abx

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9
Q

“spotty necrosis” on histology

A

acute hepatitis

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10
Q

3 complications of cirrhosis

A

portal htn
hepatic encephalopathy
liver cell cancer (cirrhosis is the number 1 risk factor)

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11
Q

three maun causes of chronic hepatitis

A
  1. viral - hep B C D
  2. drugs - ISONIAZID
  3. autoimmune
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12
Q

inflamma and apoptosis of cells across the limiting plate, with increased lymphocytic infiltration. “piecemeal necrosis”

A

interface hepatitis

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13
Q

Grade of chronic hepatitis =

A

how active/how much INFLAMMATION there is

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14
Q

Fibrosis of chronic hep =

A

STAGE - how far from normal the fibrosis is

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15
Q

pale, greasy liver with cells full of fat, enlarged liver

A

Fatty liver - common after a night on the b o o z e

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16
Q

fat and inflammation in the liver. increased infiltration with PMN. clumped ballooned hepatocytes ‘mallory denke bodies’

A

alcoholic hepatitis

‘mallory got denked’

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17
Q

micronodular fibrosis of the liver with fatty changes

A

alcoholic liver cirrhosis

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18
Q

fatty liver changes and cirrhosis not associated with alcohol use

A

NAFLD

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19
Q

cause of NAFLD

A

insulin resistance associated with increased BMI

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20
Q

fatty liver changes and hepatitis

A

NASH (also caused by increased BMI and insulin resistance)

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21
Q

damage and loss of bile ducts due to chronic inflammation with granulomas (increased infiltration with macrophages)
anti-mitochondrial abs

A

primary biliary cholangitis

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22
Q

periductal fibrosis leading to bile duct damage and loss. associated with ulcerative colitis

A

primary sclerosing cholangitis

‘wrap around and sclerose the life out of it’ - periductal fibrosis

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23
Q

disappearing bile duct syndrome, seen in middle aged women and often associated with AI disease

A

primary biliary cholangitis

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24
Q

onion skinning fibrosis with increased rosk of cholangiocarcinoma. diagnosed on ERCP

A

PSC

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25
Q

mutation in the HFE gene on chromosone 6 leading to ‘bronzed diabetes’

A

haemochromatosis

26
Q

increased iron intake leading to accumulation of iron in macrophages. no scarring seen on liver.

A

haemosiderosis

27
Q

genetic defect in chromosome 13 leading to defective excretory function of the hepatocytes. can present with parkinsonian movements and kayser fleischer rings

A

wilsons disease

28
Q

often seen in patients with lots of blood transfusions such as in thalassaemia and sickle cell

A

haemosiderosis

29
Q

chocolate brown liver

A

haemochromatosis

30
Q

AR genetic defects leading to lack of copper transporter protein. low caeruloplasmin level

A

Wilsons

31
Q

can present with multi-system disease, diabetes, pgimented skin and myocardial damage.

A

Haemochromatosis.

32
Q

anti-smooth muscle antibodies leading to interface hepatitis with plasma cells

A

autoimmune hepatitis

33
Q

Rx of AI hepatitis

A

steroids

34
Q

failure of secretion if a1-antitrypsin leading to elevated levels in the hepatocytes and decreased levels in the blood.

A

a1-AT def

35
Q

2 specific causes of hepatic granulomas

A

PBC

drugs

36
Q

2 general causes of granulomatous disease which can affect the liver

A

TB

sarcoid

37
Q

area of the hepatic lobule that will be damaged in paracetamol toxicity

A

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.

38
Q

metabolite in paracetamol toxicity that causes liver damamge

A

NAPQI

39
Q

histology showing intra-cytoplasmic inclusions

A

a1-antitrypsin def

the inclusions contain the built up a1 AT

40
Q

chronic hepatitis and intersitial lung disease showing a restrictive pattern on spirometry

A

a1-AT

41
Q

benign liver tumor that is common in females, has increased incidence in pregnancy and on high dose OCP

A

liver cell adenoma

42
Q

common benign tumor of the liver endothelial cells

A

haemangioma

43
Q

commonest malignant cancer in the liver

A

secondary metastases - portal vein means all tumours from all over the body will pass through liver. especially pancreas, bowel usually adenocarcinoma

44
Q

primary liver tumor that is common in children and usually occurs with other tumours

A

hepatoblastoma

45
Q

primary liver tumour associated with cirrhosis in the western world and hepatitis in LEDCs.
histology shows and increase in nuclear:cytoplasmic ration

A

HCC

46
Q

primary liver tumour associated with PSC, worms and cirrhosis. may see papillary invaginations

A

cholangiocarcinoma

can arise from the intrahepatic or extrahepatic bile ducts (including gall bladder ca)

47
Q

benign liver tumour that presents with abdo pain, intraperitoneal bleeding. can be associate with OCP

A

liver adenoma

48
Q

most common benign lesion of the liver

A

haemangioma

49
Q

top 3 causes of cirrhosis

A
  1. ALD
  2. NAFLD
  3. chronic viral hep - b c d
50
Q

size of nodules in macronodular vs micronodular

A 
<3cm = micro
>3cm = macro
51
Q

macroscopic: large pale yellow greasy liver
microscopic: accumulation of fat droplets in hepatocytes (steatosis)
can lead to cirrhosis

A

fatty liver

52
Q

anti-LKM Ig

A

type 2 autoimmune hepatitis

53
Q

ANA, anti-SMA, anti-actin, anti-soluble liver antigen (SLA)

A

type 1 autoimmune hepatitis

54
Q

anti-mitochondrial abs

A

PBC

55
Q

inflammation and obliterative fibrosis of extrahepatic and intrahepatic bile ducts leading to stricture formation and dilatation of the preserved segments. increased ALP.

A

PSC

56
Q

ERCP shows beading of the bile ducts due to multifocal strictures

A

PSC

57
Q

associated with UC and increased risk of cholangiocarcinoma

A

PSC

58
Q

increased serum ALP, increased cholesterol, bile duct loss with granulomas. presents with fatigue, pruritis, abdo discomfort and xanthelasma. USS shows no bile duct dilatation.

A

PBC

59
Q

intracytoplasmic inclusions which stain with periodic acid Schiff

A

a1-AT def

60
Q

rhodanine stain positive

mallory bodies and fibrosis on microscopy

A

Wilsons disease

Histopath (13 decks)

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