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Kat's Pathology > Liver and Biliary Disease > Flashcards

Liver and Biliary Disease Flashcards

1
Q

How much does the liver weight?

A

1500g

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2
Q

What is the blood supply to the liver?

A

Portal vein.

Hepatic artery.

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3
Q

What are the cells of the liver? (6)

A 
Hepatocytes. 
Bile ducts. 
Blood vessels. 
Endothelial cells. 
Kupffer cells. 
Stellate cells.
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4
Q

What is the normal structure of the liver based on?

A

Based on the blood supply to the liver.

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5
Q

What leads to stellate cell activation?

A

Liver injury - i.e. loss of hepatocyte microvilli.

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6
Q

What do stellate cells do once activated? (3)

A

Deposition of scar matrix.
Loss of fenstrae.
Activate Kupffer cells.

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7
Q

What is the definition of cirrhosis? (4)

A

Whole liver involved.
Fibrosis.
Nodules of regenerating hepatocytes.
Distortion of liver vascular architechture: intra and extra hepatic (e..g gastro-oesophageal) shunting of blood.

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8
Q

What are the two ways in which cirrhosis is classified?

A

According to nodule size (micronodular or macronodular)

According to aetiology (alcohol/insulin resistance, viral hepatitis)

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9
Q

What are the complications of cirrhosis? (3)

A

Portal hypertension.
Hepatic encephalopathy.
Liver cell cancer.

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10
Q

Is cirrhosis reversible?

A

It can be.

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11
Q

What are the two primary causes of acute hepatitis?

A

Viruses.

Drugs.

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12
Q

What is the histological finding in acute hepatitis

A

Spotty necrosis.

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13
Q

What are the three primary causes of chronic hepatitis?

A

Viral hepatitis.
Drugs.
Auto-immune.

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14
Q

How is grade defined in chronic hepatitis?

A

Severity of inflammation.

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15
Q

How is stage defined in chronic hepatitis?

A

Severity of fibrosis.

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16
Q

What is the histological finding in interface hepatitis?

A

Piecemeal necrosis.

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17
Q

What percentage of people clear hepatitis C infection?

A

15-30% of people

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18
Q

What are the symptoms of chronic hepatitis C infection? (6)

A

Fatigue.
Upper right quadrant discomfort.
Transient loss of appetite.

Itching.
Depression.
Impaired memory.

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19
Q

What are some extrahepatic complications of chronic hepatitis C infection? (3)

A

Cryoglobuinaemia.
Glomerulonephritis.
Keratoconjunctivitis sicca.

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20
Q

What are some symptoms of hepatic insufficiency due to hepatitis C infection? (3)

A

Ascites.
Oesophageal varices.
Hepatic encephalopathy.

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21
Q

What is the average time to development of HCC due to chronic hepatitis C infection?

A

10-50 years.

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22
Q

What are the options for early stage HCC treatment? (3)

A

OLT
Surgery
Percutaneous ablation.

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23
Q

What should be considered to treat intermediate HCC?

A

TACE

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24
Q

What is done in terminal HCC?

A

Institute a supportive program.

25
Q

What are the three types of alcoholic liver disease?

A

Fatty liver.
Alcoholic hepatitis.
Cirrhosis.

26
Q

What is NAFLD/NASH?

A

Non-alcholic fatty liver disease.

Non-alcoholic steatohepatitis.

27
Q

What is NAFLD/NASH due to?

A

Due to insulin resistance associated with raised BMI and diabetes.

28
Q

How do you tell apart ALD and NAFLD?

A

Cannot do so histologically - reliant on the history.

29
Q

What is primary biliary cirrhosis.

A

Bile duct loss associated with chronic inflammation (with granulomas)

30
Q

What can be found in primary biliary cirrhosis.

A

Anti-mitochondrial antibodies.

31
Q

What is primary sclerosing cholangitis

A

Periductal bile duct fibrosis leading to loss of architechture.

32
Q

What is primary sclerosing cholangitis associated with?

A

Ulcerative colitis

33
Q

What risk is associated with primary sclerosing cholangitis

A

Increased risk of cholangiocarcinoma

34
Q

What is the investigation of choice for primary sclerosing cholangitis

A

ERCP

35
Q

What is haemochromatosis

A

Genetically determined increased gut iron absorption

36
Q

What gene is responsible for haemochromatosis

A

Chromosome 6

37
Q

What is the pathological process in haemochoromatosis

A

Parenchymal damage to organs secondary to iron deposition (bronzed diabetes)

38
Q

What is haemosiderosis

A

Accumulation of iron in macrophages

39
Q

What is the treatment for haemosiderosis

A

Blood transfusion

40
Q

What is Wilson’s disease

A

Accumulation of copper due to failure of excretion by hepatocytes

41
Q

What gene is responsible for Wilson’s disease

A

Chromosome 13

42
Q

Where does copper primarily accumulate in Wilson’s disease (2)

A

Liver and CNS (hepato-lenticular degeneration)

43
Q

What stain is used to detect Wilson’s

A

Rhodanine stain

44
Q

What condition are Kayser-Fleischer rings seen in?

A

Wilson’s disease.

They are golden-brown pigment deposits in descemet’s membrane in the peripheral of the iris.

45
Q

What are the ophthalmoligic manifestations of Wilson’s disease? (2)

A

Kayser-Fleischer rings.

Sunflower cataracts.

46
Q

What is autoimmune hepatitis

A

Interface hepatitis with plasma cells

47
Q

What are the biochemical markers of autoimmune hepatitis?

A

Anti-smooth muscle actin antibodies

48
Q

What is the primary treatment for autoimmune hepatitis?

A

Steroids.

49
Q

What is alpha-1-antitrypsin deficiency

A

Failure to secrete alpha-1-antitrypsin leading to intra-cytoplasmic inclusions and hepatitis/cirrhosis.

50
Q

What is drug-related injury of the liver

A

Any kind of liver disease can be caused by a drug

51
Q

What drug can cause hepatic toxicity

A

Paracetamol (acataminiphen)

52
Q

What are some causes of hepatic granulomas? (4)

A

Primary biliary cirrhosis.
Drugs.
TB.
Sarcoid.

53
Q

What are some benign liver tumours (3)

A

Liver cell adenoma
Bile duct adenoma
Haemangioma

54
Q

What are some causes of malignant liver tumours (2)

A

Secondary tumours.

Primary tumours.

55
Q

What is a common cancer than metastases to the liver.

A

Pancreatic cancer.

56
Q

What are some primary malignant liver tumours (4)

A

Hepatocellular carcinoma
Hepatoblastima
Cholangiocarcinoma
Haemangiosarcoma

57
Q

What is HCC associated with

A

Cirrhosis (especially in the West)

58
Q

What is cholangiocarcinoma associated with (3)

A

Primary biliary cirrhosis.
Worm infections.
Cirrhosis.

59
Q

Where can cholangiocarcinoma arise from (2)

A 
Intrahepatic ducts. 
Extrahepatic ducts (including gallbladder).

Kat's Pathology (105 decks)

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