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Surgery- Liver, Spleen and Pancreas > Liver: Anatomical Pathology > Flashcards

Liver: Anatomical Pathology Flashcards

1
Q

Name 7 inflammatory disorders of the liver:

A
  1. Hepatotropic diseases
  2. Acute Hepatitis
  3. Chronic hepatitis
  4. Alcoholic liver disease
  5. Haemochromatosis
  6. Wilson’s disease
  7. A1 anti-trypsin deficiency
  8. Neonatal Cholangeopathic cholestasis
  9. Primary biliary cirrhosis
  10. Primary sclerosis cholangitis
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2
Q

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.

A

Hepatitis A:

  • Self limiting.
  • Contracted through poor water sanitation.
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3
Q

How is Hepatitis B transmitted?

A

Blood and bodily fluids are vehicles of transmission

  • Semen
  • Saliva
  • Needle stick injury
  • Breast milk
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4
Q

What is the carrier state of Hepatitis B?

A

HBsAg for more than 6 months

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5
Q

Name 3 histological characteristics of the liver cells of a patient with acute hepatitis:

A
  1. Hepatocellular degeneration
  2. Inflammatory cells
  3. Kupffner cell hypertrophy
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6
Q

What are 3 main signs of acute hepatocellular injury?

A
  1. Apoptosis (spotty liver necrosis)
  2. Bridging necrosis (Confluent lytic liver cell necrosis)
  3. Fulminant hepatitis ( Massive liver necrosis)
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7
Q

What is a characteristic trait of hepatocyte injury in acute hepatitis?

A

Ballooning degeneration

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8
Q

What are the 2 patterns of hepatocyte cell death in Acute hepatitis?

A

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.
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9
Q

What are some characteristics of chronic hepatitis of the liver

A

Inflammation limited to portal tracts:

  • Lymphocytes, macrophages, occasional plasma.
  • Bridging necrosis.
  • Deposition of fibrous tissue.
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10
Q

There are 3 kinds of alcoholic liver disease:

A

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.
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11
Q

What is haemochromatosis?

A

Excessive accumulation of iron in parenchymal organs of the liver.

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12
Q

Name 4 organs that haemochromatosis manifests in:

A 
Liver: 
  - Micronodular cirrhosis. 
Pancreas: 
  - Diabetes Mellitus:- Bronze diabetes. 
Skin: 
  - Skin hyperpigmentation.
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13
Q

What 🧬 gene abnormality causes haemochromatosis?

- What pathology does it cause?

A

Abnormality of HFE gene

- Excessive iron absorption.

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14
Q

Name 4 causes of haemochromatosis:

A

Parental administration of iron:
- Blood transfusion.

Genetic defect of HFE gene.

Oral supplements.
- African potato (Bantu siderosis).

Ineffective erythopoeisis.

  • Sideroplastic Anaemia
  • Thalassemia.
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15
Q

Give 3 points on the pathogenesis of haemochromatosis:

A
  1. Lipid peroxidation: via free radical reaction.
  2. Stimulation of collagen formation.
  3. ROS reacting with iron and DNA
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16
Q

What is Wilson’s disease?

A

Autosomal recessive disorder

- Accumulation of toxic levels of copper in the liver

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17
Q

Name the organs that Wilson disease manifests in:

A

Eyes.
Liver.
Brain.

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18
Q

What are some causes of hepatitis?

A
  1. Autoimmune
  2. Drugs and toxins
  3. Viral hepatitis
    4 Metabolic: A1 anti-trypsin deficiency: Wilson’s disease
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19
Q

In Wilson’s disease, there is a deficiency in the copper binding protein in the blood.
- What is the protein called?

A

Ceruloplasmin

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20
Q

What is A1 antitrypsin deficiency?

A

This is an autosomal diseases marked by abnormally low levels of the protease inhibitor A1 anti-trypsin.
- It inhibits elastase and proteinase 3

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21
Q

When is the A1 anti-trypsin protease inhibitor released?

A

Released by neutrophils at the site of infection.

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22
Q

Which 2 main organs does A1 antitrypsin deficiency present itself?

A

Liver

  • Hepatitis
  • Cirrhosis
  • Massive liver cell necrosis.

Lung
- Panacinar emphysema

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23
Q

Name 3 organs that pt Wilson’s disease manifests in:

A

Liver

  • Fatty exchange
  • Cirrhosis
  • Hepatitis

Brain.

  • Atrophy
  • Cavitation

Eye
- Keyser Fleischer rings in the limbus of the cornea.

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24
Q

What are Keyser Fleischer rings?

A

These are brownish rings of discoloration in the limbus of the cornea.
- Deposition of copper in the descement membrane.

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25
Q

What is Reyes disease?

A

Fatty change in the liver and encephalopathy

  • Increased serum levels of ammonia
  • Mitochondirial hepatitis
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26
Q

What is Primary biliary cirrhosis?

A

Progressive cholestatic disease characterized by:

  • Non-suppurative, inflammatory destruction of intrahepatic bile ducts
  • Portal inflammation
  • Scarring

Eventual development of cirrhosis and liver failure

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27
Q

Explain the pathology of primary biliary cirrhosis:

A

Destruction of hepatic bile ducts
Portal inflammation
Scarring and cirrhosis

28
Q

What are the clinical features of primary biliary cirrhosis.

A
  • 6:1 Excess of serum alkaline phosphatase
    • Circulating anti-microbial antibodies.
    • Xanthomas and Xanthelasmas arise owing cholesterol retention.
29
Q

What is primary sclerosis cholangitis?

A

Inflammation and obliterating fibrosis of bile ducts with dilatation of preserved segments.
- Inflammatory bowel disease (ulcerative colitis).

30
Q

How does primary sclerosing cholangitis present on an barium column radiograph?

A

Presents as beading.

31
Q

Which gender is predominantly affected by primary sclerosing cholangitis?

A

Men

- 2:1 ratio

32
Q

Name 3 clinical features of primary sclerosing cholangitis:

A
  • Jaundice
    • Pruritus
    • Raised serum alkaline phosphatase
33
Q

Name the 3 main causes of liver failures

A
  1. Massive liver necrosis
    • Drugs: Rifampicin, Halothane, Isoniazid
    • Toxin-induced: Carbon tetrachoride, copper
    • Auto-immune hepatitis
    • Metabolic disease: Wilson’s disease
  2. Chronic liver disease
  3. Hepatic dysfunction without overt necrosis
    • Reyes disease, Acute fatty liver in pregnancy, Tetracycline toxicity
34
Q

What is Reyes disease?

A

Fatty change in the liver and encephalopathy

  • Increased serum levels of ammonia
  • Mitochondirial hepatitis
35
Q

What is Wilson’s disease

A

Autosomal recessive disorder

- Accumulation of toxic levels of copper in the liver in eyes, liver and brain.

36
Q

What are the clinical features of Liver failure ?

A 
Jaundice 
Hypoalbuminaemia 
Hyperammonemia (Seen in Reyes disease)
  - Leading to hepatic encephalopathy 
Fetor Hepaticus 
Impaired estrogen metabolism
37
Q

Define liver cirrhosis according to its presentation:

A

The normally functioning Vitamin A fat storing cells become activated to a transitional myofibroblast.

  • Bridging fibrous septa’s
  • Excess collagen
  • Parenchymal nodules
38
Q

What is the pathogenesis of liver cirrhosis?

A

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
>

39
Q

What is portal hypertension?

A

Increased resistance to portal blood flow

40
Q

What are prehepatic causes of portal hypertension?

A

Portal vein thrombosis

Schistosomiasis of the liver

41
Q

Name a hepatic causes of portal hypertension:

A

Cirrhosis

42
Q

What are post-hepatic causes of portal hypertension?

A
  • Right sided heat failure
    • Constrictive pericarditis
    • Hepatic venous outflow obstruction.
      Budd Chiari syndrome (Thrombosis of hepatic veins)
43
Q

What is the pathogenesis of portal hypertension?

A
  • 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.
44
Q

List 3 clinical consequences of portal hypertension:

A
  1. Ascites
  2. Porto-systemic shunts
  3. Splenomegaly
45
Q

What are Ascites?

A

Sinusoidal hypertension due to

  • Intestinal fluid leakage.
  • Percolation of hepatic lymph.
  • Renal retention of water and sodium.
46
Q

What are porto-systemic shunts:

A 
Abnormal connections between the portal vascular system and systemic circulation. 
These lead to: 
  - Esophago-gastric varices. 
  - Rectal Hemorrhoids 
  - Capet Medusae.
47
Q

What are the clinical consequences of splenomegaly?

A
  • Congestive splenomegaly

- Hypersplenism ( pancytopenia, splenomegaly, hyprcellular bone marrow)

48
Q

Name 3 circulatory disorders related to the liver:

A
  1. Portal vein thrombosis
  2. Passive congestion and centrolobular necrosis
  3. Hepatic vein outflow obstruction
49
Q

What is the general gross appearance of the liver in circulatory disorders of the liver?

A

Nutmeg liver

50
Q

What is the general microscopic appearance of the liver in circulatory disorders of the liver?

A

Centrolobular hemorrhagic necrosis.

51
Q

What is a consequence of portal vein thrombosis?

A

Intra-abdominal sepsis

  • Diverticulitis
  • Appendicitis
52
Q

What is a consequence of passive congestion and centro-lobular necrosis?

A

Right sided cardiac decompensation.

53
Q

What are 3 complications of liver cirrhosis?

A

Progressive liver failure.
Portal hypertension.
Hepatocellular carcinoma.

54
Q

Hepatic vein outflow obstruction:

- What is hepatic vein and inferior vena cava thrombosis?

A

The obstruction of 2 or more major hepatic veins.

  • Budd Chiari syndrome
  • Myeloproliferative disorders
  • Centrilobular congestion
55
Q

What disease/pathology is a consequence of a hepatic outflow obstruction?

A

Budd Chiari syndrome

56
Q

What is Budd Chiari syndrome?

A

The thrombotic occlusion of atleast 2 major hepatic veins.

57
Q

How does Budd Chiari clinically manifest in the body?

A

Liver enlargement
Pain
Ascites

58
Q

What histological disorder is associated with hepatic vein outflow obstruction?

A

Myeloproliferative disorders such as:

  • Polycythemia Vera.
  • Deficiencies in anti-thrombrin. APLP syndrome
59
Q

What are 3 examples of hepatic diseases in pregnancy?

A
  1. Preeclampsia
  2. Eclampsia
  3. Fatty liver disease in pregnancy
60
Q

What is the distinguishing trait between preeclampsia and eclampsia

A

When it is eclampsia

- Pregnant mom will present with convulsions and hyperreflexia.

61
Q

Preeclampsia a is a sub clinical hepatic disease with 3 distinct clinical features (HELp):
What are they.

A
  1. Hemolysis
  2. Elevated liver enzymes
  3. low Platelets
62
Q

How does Preeclampsia/eclampsia clinically present, as a general rule:

A

Maternal hypertension
Proteinuria
Edema
Coagulation abnormalities: DIC

63
Q

What is the macroscopic appearance of the liver in preeclampsia/eclampsia?

A

Haemorrhage and infarcts
Dissection of blood under Glisson capsule
Hepatic hematoma

64
Q

Discuss the fatality rate of Acute fatty liver in pregnancy:

A

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

65
Q

What evidence is found during testing for acute fatty liver in pegnancy?

A

Elevated levels of serum Aminotransfrase

66
Q

How is acute fatty liver in pregnancy diagnosed.

A

Liver biopsy is taken.

- Identification of micro-vesicular fatty transformation of hepatocytes.

67
Q

There are 3 main Liver cell carcinomas discussed in this section of work:
- What are they?

A

Benign
- Liver cell adenoma

Malignant

  • Hepatocellular carcinoma.
  • Fibromellar carcinoma variant

Surgery- Liver, Spleen and Pancreas (10 decks)

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