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.
What is autoimmune hepatitis?
Active Chronic Hepatitis with Plasma Cells
- > F>M
- > Anti-smooth muscle actin antibodies in the serum
- > Steroid responsive
Autoimmune Hepatitis has VERY ACTIVE INFLAMMATION, flooded with inflammatory cells.
How does Alpha-1 Anti Trypsin Deficiency affect the liver?
Deficiency of A1AT in the blood
- > In the hepatocyte there is a gross excess.
- > These misfolded A1AT damages the hepatocytes.
- > Chronic Hepatitis – Cirrhosis.
Which areas of the liver are predominantly affected by paracetamol toxicity?
pale dead areas predominantly at zones 2->3
What are examples of benign liver tumours?
- > Liver Cell Adenoma COCP
- > Bile Duct Adenoma
- > Haemangioma
What are examples of malignant liver tumours?
SECONDARY TUMOURS i.e. Mets are most common
Primary Include
- > Hepatocellular Carcinoma
- > Hepatoblastoma
- > Cholangiocarcinoma
- > Haemangiosarcoma
What are cholangiocarcinomas associated with?
Ass. With PSC, Worm Infections, Cirrhosis
Can arise from intrahepatic ducts & extra hepatic ducts.
What is Wilson’s disease?
Accumulation of copper due to failure of excretion by hepatocytes into the bile
- > Genes on chromosome 13
- > Accumulates in the liver and CNS (hepato-lenticular degeneration) including Kayser-Fleischer rings
What is Primary Biliary Cholangitis?
Autoimmune Disease consisting of bile duct loss ass. with chronic granulomatous inflammation
- > F>M
- > Anti-mitochondrial antibodies are the Hallmark feature.
What is Primary Sclerosing Cholangitis?
Periductal bile duct fibrosis leading to its loss
-> Associated with UC
M>F
- > Bile Duct Imaging is Diagnostic i.e. ERCP, MRCP
- > Increased risk of Cholangiocarcinoma
What is PBC and PSC secondary to?
PBC is Bile Duct Loss secondary to Autoimmune Inflammation
PSC is Bile Duct Loss secondary to Fibrosis
What is haemochromatosis?
Genetically determined increased Gut Absorption leading to iron deposition at multiple organs
-> 1mg extra absorption per day, so it takes a while to reach to reach a critical stage.
Mutation of Chromosome 6; HFE – Hemochromatosis Iron Gene.
Common in Celtic Populations - AR.
What is “Bronzed Diabetes”?
Iron depositions in haemochromatosis causes bronzing of the skin, and is also deposited in the pancreas.
