Liver Flashcards
What infectious agent caused this hepatitis?
letpospirosis
What is the response of the liver to chronic injury? (aka what changes will be observed in the liver?)
fibrosis and nodular regeneration
What is occuring at the portal areas?
Why?
arteriole hyperplasia, oval cell hyperplasia, lobular atrophy
PSS
What are the additional vessels seen going from the portal v. to the vena cava?
Why do they form in this case of acquired PSS?
shunting vessels
form as a result of increase heptic blood flow resistance from chronic hepatic injury that causes secondary fibrosis.
Describe the area of necrosis?
massive hepatocellular necrosis
The picture below shows a viral inclusion body for a dog that presented with acute hepatic necrosis and blue eye. What is the likely DDX?
CAV-1 (infectious CN hepatitis)
In which two species is lipidosis of the liver common?
cats and cows
Histo from liver (gross morph- reticular pattern, local hemorrhage, edges rounded, hepatomegaly)
lymphoma in the liver
Liver Pattern?
Cause?
Reticular pattern
aka nutmeg liver
Chronic passive congestion results in centrilobular atrophy & fibrosis
R-heart failure (HCM) or vena caval obstruction (HW)
With a random hepatocellular pattern, what is the likely cause?
hematogenous infection (bacteria, viruses)
ex: salmonella
Morphologic forms of toxic hepatic injury
1. Acute injury
a. Generally cytotoxic
b. Necrosis – CCl4, mycotoxins
c. Degeneration – steroids
d. Lipidosis – anticonvulsants, antineoplastic drugs 2. Chronic Injury
a. Cytotoxic – multifocal necrosis, degeneration, lipidosis
b. Fibrosis and cirrhosis – pyrrolizidine alkaloids, aflatoxins
c. Chronic active hepatitis – copper
3. Vascular injury
a. Hepatic v injury – pyrrolizidine alkaloids
* *4. Neoplasia**
a. Carcinomas – aflatoxins, nitrosamines
b. Adenoma
c. Sarcomas – vinyl chloride-induced hemangiosarcoma
adenocarcinoma or adenoma?
biliary adenocarcinoma
(umbilicated [aka naval like center, pit depresson] necrotic centers)
What is more common in cats- biliary or liver cysts?
biliary cysts
Biliary hyperplasia and fibrosis in the liver is commonly seen with which toxicosis?
Pyrrolizidine alkaloids
cholelithiasis
Why are palm nuts toxic to the liver?
contain cycasin which is converted to toxic methlazoxymethanol by bacteria in GI
Causes of hepatomegaly?
- congestion
- lipidosis
- amyloidosis
- neoplasia
- acute diffuse hepatitis
What infectious cause of hepatitis can be observed with this staining?
leptospirosis
This pattern in the liver is indicative of what?
Potential Causes?
Chronic Passive congestion
Cz: heartworms, HCM
Top three causes for this condition in animals?
cirrhosis (chronic damage)
- pyrrolizidine alkaloid toxicosis
- chronic drug therapy (ex: anticonvulsants)
- chronic R sided heart disease
Which zone of the liver is affected here?
centrilobular (most susceptible to ichemic damage)
Why are the kidney and urine from a bedlington terrier gunmetal grey/black?
Copper tox causes intravascular hemolysis (hemoglobunuria)
What is observed in the histo slide of liver?
What leads to this?
nodular hyperplasia
response to chronic injury to liver
Differentiate between hepatitis, cholangitis, cholangiohepatitis.
- Hepatitis – inflammation of liver parenchyma
- Cholangitis – inflammation of the biliary system
-
Cholangiohepatitis – inflammation of the portal areas and biliary system with extension into
the liver parenchyma
Tension lipidosis
cows
Causes of hepatitis
Describe the post-mortem changes observed in the liver specimens?
Left: rot
Right: air bubble, friable, odorous
What is the pattern observed in the liver?
What is the condition observed in the heart of the cat?
Why does the liver have that pattern based on the heart condition?
Reticular pattern
HCM
Chronic passive congestion
Infectious cause of heptatitis?
ascarids (ascaris suum)
Which type of dogs are more likely to have intrahepatic or extrahepatic PSS?
intrahepatic= large breed dogs
extrahepatic= small breed dogs
Cystic adenoma
What is the condition?
In which species/breed is this common?
Polycystic (cysts in liver and kidney)
Common in Persian cats (gene mutation)
What condition is observed here?
Cause?
Telangiectasia- dilation of groups of sinusoids (dark red irregular areas in the liver is pooled blood)
unknown etiology (underlying parenchyma is normal)
What are the two classes of toxins that affect the liver and how do they affect the liver?
- Intrinsic: produce consistent hepatotox in a dose-dependent manner (CCl4, aflatoxins, pyrrolizidine alkaloids)
- Idiosyncratic toxins: sporadic hepatotox (NSAIDs, anesthetics, anticonvulsants)
What are the two general types of PSS?
- congenital
- acquired (primary/secondary to portal hypertension)
What is depicted?
abscesses in liver (ascending umbilical infection in a puppy)
Histo signs associated with toxicosis seen in these pictures?
megakarycytosis/karyolysis
Bile back up in liver parenchyma and fibrosis
What is the arrow pointing to?
fibrosis (horse with alkaloid toxicity)
What is accumulating in this liver?
Location?
Likely DDX?
glycogen
midzonal
coticosteroid admin or Cushing’s (less likely to be storage disease)
A dog presents for acute hepatic necrosis and blue eye (corneal edema). The liver is shown below (pale areas w/ WBC infiltration). What is the likely DDX?
CAV-1 (infectious CN hepatitis)
Causes for centrilobular hepatic damage?
- hypoxia (anemia, hemolysis, congestion)
- toxins (CCl4, chloroform)
Periportal liver damage is often due to toxins that do not require X by X to be active.
Give an example.
metabolism
cP450
(ferrous sulfate)
Two general classifications for the cause of fatty liver?
- physiologic:
- late pregnancy, lactation, DM, starvation
- pathologic:
- incr. TG & FA synthesis
- incr. lipolysis & uptake FFA
- Decr. FA oxidation
- Decr. apoprotein synthesis
- Decr. lipoprotein secretion
How can you tell apart necrobacillosis infection in the liver and tuberculosis? hint: physical appearance and species
tuberculosis- more granular, larger, seen mainly in elephants and primates
The following liver was observed from a cat. What are the sinusoids filled with?
Which breeds of cats are predisposed to this condition?
What is the condition often associated with?
amyloid
Abyssinian, Siamese, Oriental shorthair, Shar pei
chronic inflammation (liver is large & friable)
What occurred?
Why is this considered rare in the liver?
hepatic infarct
dual blood supply (30% hepatic a.; 70% portal v.)
What is the condition observed?
In which type of dog is it common?
What structure persists?
intrahepatic PSS
large breed dog
ductus venosus
A fat and anorectic cat presents in liver failure, is icteric and has head pressing/stargazing. What is the likely DDX?
Cause? Tx?
hepatic lipidosis
idiopathic/consequence of a number of diseases
get them to eat to tx
Liver Pathology
This is a histo slide of the gallbladder.
What is the material filling the lumen?
What consequence does this have on the fxn of the GB?
mucocoele (blocks bile= cholestasis)
In small breed dogs with extrahepatic PSS, where are common locations for shunts? Which is common in cats?
- Atresia of portal v (no SX fix)
- Portal-azygous
- Portal-caudal vena cava
- gastric v.-vena cava (cats)
What are three things that can accumulate in the liver?
lipids
amyloid
glycogen
Capsular fibrosis
Milk spot liver (from parasite larval migrations)
What are two animals that are specifically sensitive to copper toxicosis?
sheep (fed cattle feed)
Bedlington terrier
Top three causes for massive liver damage pattern?
- viral infections (some spp. herpes)
- toxins (blue-green algae)
- tranfusions rxns (serum sickness in horses)
Is midzonal hepatic damage common?
Causes?
rare
toxins (aflatoxins, corticosteroids)
Adenocarcinoma or adenoma?
adenoma
A small liver is observed in a patient with no congenital microhepatia. What is the likely DDX?
PSS
Copper accumulation in the liver
Most common causes for hepatic infarct?
- neoplasia
- arteritis
- sepsis
- heat stroke
- endocarditis
What are the general classifications of hemodynamic/vascular liver disorders
- anemia
- congestion
- infarction
- PSS
- telangiectasia (dilation of groups of sinusoids)
This is a liver from a cat. Based on the histo slide, what is the likely DDX?
cholangiohepatitis
A cow presented with this liver.
What is the cause and what condition is this a common sequelae?
abcesses from bacterial invasion of the liver
rumen acidosis
What condition is observed on this histo liver slide?
lipidosis
inflammation of the gall bladder is called what?
cholecystitis
What is the pattern on the liver called that looked like light is bouncing off of it?
What does it indicate?
What other common sequelae is seen?
divitis? spicular pattern
liver damage (HW/ toxin)
ascites
What is the device used for this extrahepatic shunt repair procedure? Why would you not want to just ligate the vessels?
ameroid constrictor
Slowly squeezes the vein shut to prevent from portal hypertension and creation of new shunts
Describe the general categories of neoplastic causes of liver disease?
- hepatic nodular hyperplasia
- hepatoma
- hepatocellular/biliary carcinomas
- metastatic neoplasms (hemangiosarcom/LSA)
In what age of dogs do we typically see hepatocellular carcinomas/biliary carcinomas? How can the two be grossly differnetiated?
What type of neoplasm is depicted?
uncommon dogs >10yrs
hepatocellular carcinomas: one massively enlarge liver lobe
biliary carcinomas: multiple nodules scattered throughout liver, umbilicated
Explain in general how the liver responds to acute and chronic damage.
What is the point of no return in irreversible damage to the liver and change in liver architecture?
Bridging fibrosis
Which area of the liver is most affected by anemia?
centrilobular (lowest O2 conc.)
Causes of microhepatia?
- starvation
- PSS
- Chronic hepatocellular injury with secondary fibrosis
- Hepatocellular necrosis
Type of neoplasia?
You would expect to see these cells on a blood smear…
hemangiosarcoma
schistocytes
Is this likely a primary tumor of liver or a local metastasis?
local metastasis (mammary adenocarcinoma)
multi-focal multi-sized nodules
What are the 5 hepatocellular damage patterns?
- Random- very common
- Centrilobular-common
- Midzonal-rare
- Periportal
- Massive- entire lobule necrotic (diffuse- necrosis of the entire liver)
Process of transforming toxins in the liver to active metabolites
bioactivation (biotransformation)
What is seen in the picture?
Common species?
Tension lipidosis (from where liver attached)
cows
A 2 yr old siamese cat presents for anorexia, vomiting, fever. There is a palpabl fluid abdominal wave and the animal is icteric. The liver appears below (pyogranulomatous inflammaiton with inflammatory cells around the portal triad). Likely DDX?
FIP
Name two common metastatic neoplasms to the liver?
- hemangiosarcoma
- LSA
A dog presents with depression, anorexia, vomiting, CNS signs- head pressing and star gazing. What is your likely DDX and what blood test results would support your DX?
- PSS
- decreased BUN, increased ammonia, BA elevated post-prandial (not recycled back through liver b/c shunt away from the liver)
Picture of Gall bladder
Describe the pathology.
Is it clinically relevant?
poly-cystic mucosal hyperplasia of the GB
Incidental finding
Common cause of lipidosis in the cow?
physiologic: negative energy balance in late pregnancy and lactation
With large breed dogs that have intrahepatic PSS- what structure often fails to close?
ductus venosus
issues with macro/micro vasculature
