Liver and Biliary Disease Flashcards
What is the blood supply for the liver?
Dual Blood Supply i.e., Hepatic Artery and Portal Vein.
-> Drains into Central Vein, Hepatic Vein and onwards.
What types of cells are present i the liver?
- > Hepatocytes
- > Bile Ducts
- > Blood Vessels
- > Endothelial ells
- > Kupffer Cells
- > Stellate Cells
What is the portal triad?
Portal Triad consists of Portal Vein, Hepatic Artery and Bile Duct
Which direction does blood and bile flow in the liver lobule?
Opposite directions:
- Blood = From portal triad to central vein
- Bile = From central vein to bile duct
Which zone in the liver lobule is most metabolically active?
Zone 3
What is the normal liver pathology
Hepatocytes with microvilli, endothelial cells with spaces between them, Stellate cells sit between the endothelial and hepatocytes
-> Space of Disse.
What are the changes to a normal liver pathology during acute liver injury?
During Liver injury
- > Kuppfer cells activate
- > endothelial cells stick together reducing blood flow
- > Basement membrane like collagens secreted by activated stellate cells
- > Hepatocytes lose their microvilli
What is cirrhosis?
- > Describes the whole liver involvement. The global fibrosis is coupled with the regeneration of hepatocytes leading to nodule formation
- > The distortion of liver vasculature predisposes to intra and extra hepatic shunting of blood.
How is Cirrhosis classified?
i) according to nodule size i.e., Micro/macro nodular, 2mm.
ii) according to aetiology
What are complications of cirrhosis?
- > Portal Hypertension
- > Hepatic Encephalopathy
- > Liver Cell Cancer
What are acute and chronic causes of hepatitis?
Acute Hepatitis: Viruses, Drugs
[R] – Spotty Necrosis
Chronic Hepatitis: Viruses, Drugs, Auto-Immune
How do you stage and grade hepatitis?
Severity of Inflammation – Grade
Severity of Fibrosis - Stage
Describe the progression of hepatitis?
- “Portal Inflammation” Clear limiting plate, i.e. distinction between the portal tract and hepatocytes
- “Interface Hepatitis” No true limiting plate, T-Cell mediated destruction of hepatocytes
- “Lobular Inflammation” No obvious delineation, global inflammation
- “Fibrosis” Blue collagenous tissue present, in this slice we can see a fibrous pathway between the vascular supply and the central vein - bridging fibrosis. This allows a shortcut for the blood otherwise known as an intra-hepatic shunt
What are the stages of Alcoholic Liver Disease?
Step 1. Fatty liver
This is reversible and can occur even after a single episode of heavy drinking
Pale yellow colour as opposed to a beefy red
Step 2. Alcoholic Hepatitis
Features of which include the following, mainly seen in zone 3.
-> Balooning (+/- MALLORY DENK BODIES)
Swellling of the cells containing the pink Hyaline.
-> Apoptosis
-> Pericellular Fibrosis
Step 3. Cirrhosis
Pale, fatty change and small nodules forming.
Alcoholic Cirrhosis is typically micronodular
What is Non alcoholic fatty liver disease?
Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions caused by a build-up of fat in the liver. It’s usually seen in people who are overweight or obese.
Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease with key stages consisting of hepatic steatosis (NAFL), steatohepatitis (NASH), fibrosis, and eventual cirrhosis
-> Histologically looks like alcoholic liver disease
-> Actually associated with insulin resistance secondary to Diabetes and a raised BMI
-> Being recognised as one of the commonest causes of liver disease, world-wide.
