Liver

Question 1

what provides blood supply to the liver

Answer 1

hepatic portal vein

hepatic arteruy

Question 2

what are kupffer cells

Answer 2

resident macrophages in liver

Question 3

what are stellate cells and what is their role in the liver

Answer 3

store vitamin A

become myofibroblasts > lay down collagen > reponsible for scarring in liver disease

Question 4

what makes up a portal triad

Answer 4

hepatic artery, portal vein, bile duct

Question 5

what is the ratio of hepatic triads to central vein?

Answer 5

6:1

Question 6

what are the three zones in the liver

Answer 6

1: periportal
2: midzone
3: perivenular

Question 7

describe cells in zone 3 of the liver

Answer 7

more metabolically active, but least. oxygen

Question 8

why are endothelial cells in the liver uniquer

Answer 8

they don’t sit on basement membrane

they are discontinuous (large spaces)

Question 9

what is the space of disse

Answer 9

the space between endothelial cells and hepatocytes, where stellate cells sit

Question 10

what occurs in liver injury

Answer 10

kupfer cells activate
gaps in EC collapse
stellate cells secrete collagen in space of disse
leads to inflammation and fibrosis

Question 11

define cirrhosis

Answer 11

fibrosis of the whole liver,

• nodules of regenerating hepatocytes
• distortion of vascular architecture
• intra and extra hepatic shunting

Question 12

is chirrhosis reversible or irreversible

Answer 12

REVERSIBLE

Question 13

what is seen on histology of ACUTE HEPATITIS

Answer 13

spotty necrosis

Question 14

what does GRADE indicate in chronicv hepatitis

Answer 14

the level of inflammation

Question 15

what does STAGE indicate in chronic hepatitis

Answer 15

the SPREAD of fibrosis (F0-F4)

Question 16

what are the three histological patterns in alcoholic liver disiease

Answer 16

1. Fatty liver
2. alcoholic hepatitis
3. cirrhosis

Question 17

explain features of fatty liver / steatosis

Answer 17

pale, fatty liver
fatty pockets on histology
reversible

Question 18

explain histologycal features of alcoholic heparitis

Answer 18

Ballooning of hepatocytes

Mallory denk bodies

Question 19

what is primary biliary cholangitis

Answer 19

AI destruction of intrahepatic bile ducts > buildup of bile > cholestasis > slow cirrhosis over many years

Question 20

what is PBC findings on histology

Answer 20

bile duct loss associated with chronic INFLAMMATION and granuloma

Question 21

what is the diagnostic. test for PBC

Answer 21

antimitochondrial anribodies (AMA)

Question 22

what is primary sclerosing cholangitis

Answer 22

Ai destruction of INTRA and EXTRA hepatic bile ducts

Question 23

what is histology of PSC

Answer 23

• periductal bile duct FIBROSIS (concentric rings) leading to SCLEROSIS
• stricture formation
• bile duct DILATATION

Question 24

what is the histological difference between PBC and PSC

Answer 24

PBC=inflammation

PSC=FIBROSIS

Question 25

what disease is PSC associated with

Answer 25

Ulcerative cholitis

Question 26

what is haemochromatosis

Answer 26

increased iron gut absorption> iron deposition in parenchymal cells > organ damage

Question 27

what gene causes haemochromatosis

Answer 27

HFe gene on chr 6

Question 28

what is haemosiderosis

Answer 28

``` iron overload (i.e. from blood transfusion) presents as accumulation of iron in macrophages ```

Question 29

what do you use to see keiser fleisher rings in Wilson

Answer 29

slit lamp

Question 30

what stain do you use for wilson disease

Answer 30

Rhodanine stain | turns golden brown against blue counter stain

Question 31

what antibodies will be +ve for AI hepatitis

Answer 31

ASMA, anti-LMK

Question 32

what does AI hepatitis respond to

Answer 32

steroids

Question 33

what is alpha1 antitrypsin deficiency

Answer 33

failure to secrete alpha 1 antitrypsin into the blood excess of a1a in hepatocytes > damges them > chronic hepatitis ephysema

Question 34

what are associations for hepatocellular carcinoma

Answer 34

AFP+ cirrhosis in west viral infections in developing countries

Question 35

what is cholangiocarcinoma associated with

Answer 35

PSC worm infection cirrhosis

Question 36

what is the histology in chronic hepatitis

Answer 36

1. portal inflammation 2. piecemeal necrosis 3. lobular inflammation 4. bridging from portal vein to central vein

Question 37

what is piecemeal necrosis

Answer 37

cannot see the border between portal tract and partenchyma

Question 38

explain the pathophysiology behind extrahepatic shunting in fibrosis

Answer 38

FIBROTIC BRIDGES from PORTAL VEIN to CENTRAL VEIN > extrahepatic shunting

Question 39

what are the main causes of cirrhosis

Answer 39

1. alcoholic liver disease 2. non-alcoholic fatty liver disease 3. chronic viral hepatitis

Question 40

explain classification of regenerating nodules in liver disease

Answer 40

micronodular: <3mm macronodular: >3mm

Question 41

what are macroscopic fts of a hepatic steatosis

Answer 41

large, pale, yellow, greasy liver

Question 42

what are microscophic fts of a hepatic steatosis

Answer 42

fat droplets in hepatocytes

Question 43

what are macroscopic fts of an alcoholic hepatitis

Answer 43

large, fibrotic liver

Question 44

what are microscopic fts of an alcoholic hepatistis

Answer 44

ballooning of hepatocytes | Mallory denbk

Question 45

what are macroscopic fts of an alcholic cirrhosis

Answer 45

yellow-tan, fatty, enlarged | transforms into shrunken non-fatty brown organ

Question 46

what are microscopic fts of alcoholic cirrhosis

Answer 46

Micronodular cirrhosis (small nodules and bands of fibrous tissue)

Question 47

what does USS show for PBC

Answer 47

no dilatgation of bile ducts

Question 48

How do you manage PBC

Answer 48

ursodeoxycholic acid

Question 49

What does USS show for PSC

Answer 49

bile duct dilatation

Question 50

what does ERCP show for PSC

Answer 50

beading of bile ducts

Question 51

what does histology show for PSC

Answer 51

onion skinning fibrosis (concentric)

Question 52

what do people with PSC have a higher risk for (in terms of malignancy)

Answer 52

cholangiocarcinoma

Question 53

what are causes of hepatocellular carcinoma

Answer 53

cirrhosis (so all causes of cirrhosis) aflatoxin aspergillus