Liver: Anatomical Pathology Flashcards
Name 7 inflammatory disorders of the liver:
- Hepatotropic diseases
- Acute Hepatitis
- Chronic hepatitis
- Alcoholic liver disease
- Haemochromatosis
- Wilson’s disease
- A1 anti-trypsin deficiency
- Neonatal Cholangeopathic cholestasis
- Primary biliary cirrhosis
- Primary sclerosis cholangitis
The hepatotropic viruses include: Hepatitis A, B, C, D and E.
Mention whether:
- Hepatitis A is an Acute or Chronic illness.
- How it is contracted.
Hepatitis A:
- Self limiting.
- Contracted through poor water sanitation.
How is Hepatitis B transmitted?
Blood and bodily fluids are vehicles of transmission
- Semen
- Saliva
- Needle stick injury
- Breast milk
What is the carrier state of Hepatitis B?
HBsAg for more than 6 months
Name 3 histological characteristics of the liver cells of a patient with acute hepatitis:
- Hepatocellular degeneration
- Inflammatory cells
- Kupffner cell hypertrophy
What are 3 main signs of acute hepatocellular injury?
- Apoptosis (spotty liver necrosis)
- Bridging necrosis (Confluent lytic liver cell necrosis)
- Fulminant hepatitis ( Massive liver necrosis)
What is a characteristic trait of hepatocyte injury in acute hepatitis?
Ballooning degeneration
What are the 2 patterns of hepatocyte cell death in Acute hepatitis?
Lytic cell necrosis
- Focal loss of hepatocytes
- Scavenger macrophage aggregate in areas -> hepatocyte loss.
Apoptosis
- Mediated by anti-viral cytotoxic T-cells
- Shrikage -> become eosinophillic -> fragmented nuclei.
What are some characteristics of chronic hepatitis of the liver
Inflammation limited to portal tracts:
- Lymphocytes, macrophages, occasional plasma.
- Bridging necrosis.
- Deposition of fibrous tissue.
There are 3 kinds of alcoholic liver disease:
Hepatic steatosis:
- Microvesicular.
- Reversible in the case of alcohol cessation.
Alcoholic hepatitis:
- Hepatocyte swelling and necrosis.
- Mallory bodies: cytokeratin intermediate filaments visible as eosinophilic
- Neutrophillic reaction.
- Fibosis.
Cirrhosis:
- Irreversible damage to the liver due to excessive alcohol consumption.
- Ischemic necrosis.
- Fibrous obliteration of nodules.
What is haemochromatosis?
Excessive accumulation of iron in parenchymal organs of the liver.
Name 4 organs that haemochromatosis manifests in:
Liver: - Micronodular cirrhosis. Pancreas: - Diabetes Mellitus:- Bronze diabetes. Skin: - Skin hyperpigmentation.
What 🧬 gene abnormality causes haemochromatosis?
- What pathology does it cause?
Abnormality of HFE gene
- Excessive iron absorption.
Name 4 causes of haemochromatosis:
Parental administration of iron:
- Blood transfusion.
Genetic defect of HFE gene.
Oral supplements.
- African potato (Bantu siderosis).
Ineffective erythopoeisis.
- Sideroplastic Anaemia
- Thalassemia.
Give 3 points on the pathogenesis of haemochromatosis:
- Lipid peroxidation: via free radical reaction.
- Stimulation of collagen formation.
- ROS reacting with iron and DNA
What is Wilson’s disease?
Autosomal recessive disorder
- Accumulation of toxic levels of copper in the liver
Name the organs that Wilson disease manifests in:
Eyes.
Liver.
Brain.
What are some causes of hepatitis?
- Autoimmune
- Drugs and toxins
- Viral hepatitis
4 Metabolic: A1 anti-trypsin deficiency: Wilson’s disease
In Wilson’s disease, there is a deficiency in the copper binding protein in the blood.
- What is the protein called?
Ceruloplasmin
What is A1 antitrypsin deficiency?
This is an autosomal diseases marked by abnormally low levels of the protease inhibitor A1 anti-trypsin.
- It inhibits elastase and proteinase 3
When is the A1 anti-trypsin protease inhibitor released?
Released by neutrophils at the site of infection.
Which 2 main organs does A1 antitrypsin deficiency present itself?
Liver
- Hepatitis
- Cirrhosis
- Massive liver cell necrosis.
Lung
- Panacinar emphysema
Name 3 organs that pt Wilson’s disease manifests in:
Liver
- Fatty exchange
- Cirrhosis
- Hepatitis
Brain.
- Atrophy
- Cavitation
Eye
- Keyser Fleischer rings in the limbus of the cornea.
What are Keyser Fleischer rings?
These are brownish rings of discoloration in the limbus of the cornea.
- Deposition of copper in the descement membrane.
What is Reyes disease?
Fatty change in the liver and encephalopathy
- Increased serum levels of ammonia
- Mitochondirial hepatitis
What is Primary biliary cirrhosis?
Progressive cholestatic disease characterized by:
- Non-suppurative, inflammatory destruction of intrahepatic bile ducts
- Portal inflammation
- Scarring
Eventual development of cirrhosis and liver failure
Explain the pathology of primary biliary cirrhosis:
Destruction of hepatic bile ducts
Portal inflammation
Scarring and cirrhosis
What are the clinical features of primary biliary cirrhosis.
- 6:1 Excess of serum alkaline phosphatase
- Circulating anti-microbial antibodies.
- Xanthomas and Xanthelasmas arise owing cholesterol retention.
What is primary sclerosis cholangitis?
Inflammation and obliterating fibrosis of bile ducts with dilatation of preserved segments.
- Inflammatory bowel disease (ulcerative colitis).
How does primary sclerosing cholangitis present on an barium column radiograph?
Presents as beading.
Which gender is predominantly affected by primary sclerosing cholangitis?
Men
- 2:1 ratio
Name 3 clinical features of primary sclerosing cholangitis:
- Jaundice
- Pruritus
- Raised serum alkaline phosphatase
Name the 3 main causes of liver failures
- Massive liver necrosis
- Drugs: Rifampicin, Halothane, Isoniazid
- Toxin-induced: Carbon tetrachoride, copper
- Auto-immune hepatitis
- Metabolic disease: Wilson’s disease
- Chronic liver disease
- Hepatic dysfunction without overt necrosis
- Reyes disease, Acute fatty liver in pregnancy, Tetracycline toxicity
What is Reyes disease?
Fatty change in the liver and encephalopathy
- Increased serum levels of ammonia
- Mitochondirial hepatitis
What is Wilson’s disease
Autosomal recessive disorder
- Accumulation of toxic levels of copper in the liver in eyes, liver and brain.
What are the clinical features of Liver failure ?
Jaundice Hypoalbuminaemia Hyperammonemia (Seen in Reyes disease) - Leading to hepatic encephalopathy Fetor Hepaticus Impaired estrogen metabolism
Define liver cirrhosis according to its presentation:
The normally functioning Vitamin A fat storing cells become activated to a transitional myofibroblast.
- Bridging fibrous septa’s
- Excess collagen
- Parenchymal nodules
What is the pathogenesis of liver cirrhosis?
Progressive fibrosis
- In normal liver concentrated to portal tracts and around central veins
- Occasional bundles in spaces of disse
- Type 4 Collagen along hepatocytes in space of Disse.
- Type 1 had 3 collagen deposition in the lobule creating broad septal tracts.
- Reorganization of microvasculature
> Blood shunts around parenchyma
>
What is portal hypertension?
Increased resistance to portal blood flow
What are prehepatic causes of portal hypertension?
Portal vein thrombosis
Schistosomiasis of the liver
Name a hepatic causes of portal hypertension:
Cirrhosis
What are post-hepatic causes of portal hypertension?
- Right sided heat failure
- Constrictive pericarditis
- Hepatic venous outflow obstruction.
Budd Chiari syndrome (Thrombosis of hepatic veins)
What is the pathogenesis of portal hypertension?
- Increased resistance to portal blood flow
- Compression of terminal hepatic veins by perivenular scarring.
- Anastomoses bt/w arterial and portal blood systems in fibrous septae.
List 3 clinical consequences of portal hypertension:
- Ascites
- Porto-systemic shunts
- Splenomegaly
What are Ascites?
Sinusoidal hypertension due to
- Intestinal fluid leakage.
- Percolation of hepatic lymph.
- Renal retention of water and sodium.
What are porto-systemic shunts:
Abnormal connections between the portal vascular system and systemic circulation. These lead to: - Esophago-gastric varices. - Rectal Hemorrhoids - Capet Medusae.
What are the clinical consequences of splenomegaly?
- Congestive splenomegaly
- Hypersplenism ( pancytopenia, splenomegaly, hyprcellular bone marrow)
Name 3 circulatory disorders related to the liver:
- Portal vein thrombosis
- Passive congestion and centrolobular necrosis
- Hepatic vein outflow obstruction
What is the general gross appearance of the liver in circulatory disorders of the liver?
Nutmeg liver
What is the general microscopic appearance of the liver in circulatory disorders of the liver?
Centrolobular hemorrhagic necrosis.
What is a consequence of portal vein thrombosis?
Intra-abdominal sepsis
- Diverticulitis
- Appendicitis
What is a consequence of passive congestion and centro-lobular necrosis?
Right sided cardiac decompensation.
What are 3 complications of liver cirrhosis?
Progressive liver failure.
Portal hypertension.
Hepatocellular carcinoma.
Hepatic vein outflow obstruction:
- What is hepatic vein and inferior vena cava thrombosis?
The obstruction of 2 or more major hepatic veins.
- Budd Chiari syndrome
- Myeloproliferative disorders
- Centrilobular congestion
What disease/pathology is a consequence of a hepatic outflow obstruction?
Budd Chiari syndrome
What is Budd Chiari syndrome?
The thrombotic occlusion of atleast 2 major hepatic veins.
How does Budd Chiari clinically manifest in the body?
Liver enlargement
Pain
Ascites
What histological disorder is associated with hepatic vein outflow obstruction?
Myeloproliferative disorders such as:
- Polycythemia Vera.
- Deficiencies in anti-thrombrin. APLP syndrome
What are 3 examples of hepatic diseases in pregnancy?
- Preeclampsia
- Eclampsia
- Fatty liver disease in pregnancy
What is the distinguishing trait between preeclampsia and eclampsia
When it is eclampsia
- Pregnant mom will present with convulsions and hyperreflexia.
Preeclampsia a is a sub clinical hepatic disease with 3 distinct clinical features (HELp):
What are they.
- Hemolysis
- Elevated liver enzymes
- low Platelets
How does Preeclampsia/eclampsia clinically present, as a general rule:
Maternal hypertension
Proteinuria
Edema
Coagulation abnormalities: DIC
What is the macroscopic appearance of the liver in preeclampsia/eclampsia?
Haemorrhage and infarcts
Dissection of blood under Glisson capsule
Hepatic hematoma
Discuss the fatality rate of Acute fatty liver in pregnancy:
Ranges from moderate to sub clinical hepatic dysfunction
- Elevated AMT levels
May lead to hepatic failure
Leading to Coma and death later on in the pregnancy
What evidence is found during testing for acute fatty liver in pegnancy?
Elevated levels of serum Aminotransfrase
How is acute fatty liver in pregnancy diagnosed.
Liver biopsy is taken.
- Identification of micro-vesicular fatty transformation of hepatocytes.
There are 3 main Liver cell carcinomas discussed in this section of work:
- What are they?
Benign
- Liver cell adenoma
Malignant
- Hepatocellular carcinoma.
- Fibromellar carcinoma variant
