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Histopath > Liver > Flashcards

Liver Flashcards

1
Q

What compromises portal triad

A

Bile duct
Hepatic artery
Portal vein

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2
Q

Which zone is closest to portal triad

A

Zone 1

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3
Q

Which hepatocyte in the zone Q receives more oxygen

A

Periportal hepatocyte

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4
Q

Which zone is close to terminal hepatic vein

A

Zone 3

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5
Q

Which zone has the most liver enzymes

A

Zone 3

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6
Q

Which hepatocyte is the most mature and metabolically active in zone 3

A

Perivenular hepatocyte

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7
Q

What cell phagocytoses antigens in liver

A

Kupffer cells

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8
Q

How much bile does liver synthesis per day

A

600 to 1000 ml/ day

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9
Q

Acute hep histopathology

A

Spotty necrosis

Small foci of periportal inflammation and infiltrates)

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10
Q

Biopsy of chronic hepatitis

A

Piecemeal necrosis
Lymphocyte infiltrates
Ground glass hepatocytes

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11
Q

Which aspect of chronic hepatitis histopathology shows critical stage in the evolution of hepatitis to cirrhosis

A

Bridging from portal vein to central vein

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12
Q

Histopathology of cirrhosis liver

A

Hepatocyte necrosis
Fibrosis
Nodules of regenerating hepatocytes (which lack normal acinar structure)
Disturbance of vascular architecture

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13
Q

Gene affected in haemochromatosis

A

HFE gene
Chromosome 6
Autosomal recessive.

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14
Q

Gene affected in Wilson’s disease

A

ATP7B gene
Chromosome 13
Autosomal recessive

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15
Q

Causes of micronodular cirrhosis

A

Modules <3 mm
Alcoholic hepatitis
Biliary tract disease

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16
Q

Causes of macronodular cirrhosis

A

Modules >3mm
Viral hepatitis
Wilson’s disease
Alpha anti trypsin deficiency

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17
Q

What scoring system used to assess prognosis in liver cirrhosis

A

Modified Child’s Pugh Score

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18
Q

What does modified child Pugh score assess

A 
Albumin 
Bilirubin 
Clotting (thrombin time) 
Distension (ascites)
Encephalopathy
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19
Q

Microscopic characteristics of hepatic steatosis (fatty liver)

A

Accumulation of fat droplets in the hepatocytes (Steattosis)
Chronic exposure can cause fibrosis

Fully reversible if alcohol avoided

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20
Q

Microscopic characteristics of alcoholic hepatitis

A

Mallory Denk bodies
Hepatocyte ballooning and necrosis due to accumulation of fat, water and proteins
Fibrosis

Seen acutely after a heavy night of drinking

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21
Q

Microscopic characteristics of alcoholic cirrhosis

A 
Micronodular cirrhosis (nodules <3mm) 
I.e small nodules and bands of fibrosis
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22
Q

Most common cause of liver disease in the West

A

Non alcoholic fatty liver disease

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23
Q

Which type of non alcoholic fatty liver disease can progress to cirrhosis

A

Non alcoholic steatohepatitis (NASH)

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24
Q

Which HLA CLASS ASSOCIATED WITH AUTOIMMUNE HEPATITIS

A

HLA DR 3

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25
Q

Antibodies associated with type 1 autoimmune hepatitis

A

Anti nuclear antibody
Anti smooth muscle antibody
Anti actin antibody
Anti soluble liver antigen antibody

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26
Q

Antibody associated with type 2 autoimmune hepatitis

A

Anti liver kidney microsomal antibody

27
Q

Primary biliary cirrhosis

Who is affected more m or f?

A

Female

28
Q

Autoimmune inflammatory destruction of medium sized INTRAHEPATIC BILE DUCTS and CHOLESTASIS with slow development of cirrhosis over many years

A

Primary biliary cirrhosis

29
Q

Biochem profile of Primary biliary cirrhosis

A

High ALP
High cholesterol
High IgM
Hyperbilirubinaemia (late)

30
Q

Antibody associated with Primary biliary cirrhosis

A

Antimitochondrial antibody

31
Q

What does the ultrasound scan show in Primary biliary cirrhosis

A

NO bile duct dilation

32
Q

Histology of Primary biliary cirrhosis

A

Bile duct loss with granulomas

33
Q

What can you treat Primary biliary cirrhosis with

A

Ursodeoxycholic acid in early phase

34
Q

Primary sclerosing cholangitis

Male or female affected more

A

Male

35
Q

Inflammation and obliterating fibrosis of extrahelatic and intrahepatic bile ducts and multi focal stricture formation with dilation of preserved segments

A

Primary sclerosing cholangitis

36
Q

Primary sclerosing cholangitis

Male or female affected more

A

Male

37
Q

What condition is Primary sclerosing cholangitis associated with

A

IBD in particular UC

38
Q

Biochem of Primary sclerosing cholangitis

A

High ALP

pANCA

39
Q

USS of Primary sclerosing cholangitis

A

Bile duct dilation

40
Q

ercp of Primary sclerosing cholangitis

A

Heading of bile ducts due to multifocal strictures

41
Q

Histology of Primary sclerosing cholangitis

A

Onion skinning fibrosis - concentric fibrosis

42
Q

What does Primary sclerosing cholangitis increase your risk of

A

Cholangiocarcinoma

43
Q

What is hepatic adenoma associated with

A

Oral contraceptive pill

44
Q

Most common benign lesion of liver

A

Haemangioma

45
Q

Causes of hepatocellular cirrhosis

A 
Hep B 
Hep C 
Alcoholic cirrhosis 
NAFLD
Haemochromatosis 
Aflatoxin
Androgenic steroids
46
Q

Investigation for hepatocellular carcinoma

A 
Alpha fetoprotein (raised)
USS
47
Q

Most common malignant liver lesion

A 
Secondary tumour (metastasis) 
Usually from GI/breast/bronchus
48
Q

CAuses of cholangiocarcinoma

A 
Primary sclerosing cholangitis 
Lynch syndrome type 2 
Parasitic liver disease 
Chronic liver disease 
Congenital liver abnormalities
49
Q

Investigation results of haemochromatosis

A

Iron RAISED
Ferritin RAISED
transferrin saturation > 45%
TIBC DECREASED

50
Q

Treatment for haemochromatosis

A

Venesection

Desferrioxamine

51
Q

Signs and sx of haemochromatosis

A 
Skin bronzing 
Hepatomegaly 
Diabetes 
Cardiomyopathy 
Hypogonadosm 
Pseudo gout
52
Q

Haemochromatosis

AR OR AD

A

Autosomal recessive

53
Q

Wilson’s disease Common affected age is

A

Common affected age 11-14 years

54
Q

Wilson’s disease AR OR AD

A

Autosomal recessive

55
Q

Wilson’s disease gene affected

A

Mutated gene ATP7B. (Chr13)

Mutated means decreases biliary copper excretion and deposition of copper in liver CNS and iris

56
Q

Histology of Wilson’s diseas e

A

Copper stains with rhodanine stain
Mallory bodies
Fibrosis

57
Q

Signs and sx of Wilson’s diseas e

A

Kayser Fleuscher rings - copper deposit in descemets membrane in cornea
Neuro - Parkinson’s, psychosis, dementia (basal ganglion involvement)
Liver disease - acute hepatitis, fulminant liver failure of cirrhosis

58
Q

Alpha anti 1 antitrypsin deficiency

Autosomal dominant or recessive

A

Autosomal dominant

59
Q

Alpha anti 1 antitrypsin deficiency

Histology

A

Intracytoplasmic inclusions of A1AT which stain with PERIODIC ACID SCHIFF

60
Q

Symptoms of Alpha anti 1 antitrypsin deficiency in children and adults

A

Kids - neonatal jaundice

Adults - emphysema, chronic liver disease

61
Q

Electrophoresis of Alpha anti 1 antitrypsin deficiency

A

Absent alpha globulin band

62
Q

Fitz Hugh Curtis Syndrome

A

RUQ pain from peri hepatitis

Violin string peri-hepatic adhesions

63
Q

3 theories of aetiology of endometriosis

A

Regurgitant/implantation from retrograde menstrual flow of endometrial cells
Metaplastic transformation of coelomic epithelial cells

Histopath (6 decks)

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