Liver and Gallbladder Flashcards
Why would you do a stain to look at the reticulin network of a liver?
surround the hepatocyte plates & gives us an idea if the archetecture is in tact and if well differentiated neoplasms (won’t have reticular network) vs normal liver
What is one of the first responses of hepatocytes to reversible injury?
swelling becasue decreased production of ATP, inhibitin production of Na/K ATP pump, so cells will take on Na and fluid; potassium will leak out and the cells will swell
ischemic & certain toxic injury
What is steatosis?
occurs in injured hepatocytes
accumulation of fat within droplets/vesicles within the cells
- macrovesicular: one large droplet that displaces the nucleus
- larger than signet ring cell
- filled w/ fat not mucin
- due to injury, not neoplasm
- larger than signet ring cell
- microvesicular: lots of tiny lipid droplets & nucleus will be roughly central
- predominance
- tetracycline?
- valproic acid?
- Reye syndrome: children recovering from viral illness given asprin
- predominance
What are Mallory Bodies?
What is the most common cause of them?
aggregates of cytokeratins which are structural filaments within epithelial cells
densly eosinophilic
distinct borders, not bound by membranes
Commonly seen with alcoholic liver disease
Describe what you would expect to see on a slide showing hepatocyte necrosis
What are common causes of hepatocyte necrosis?
Toxic conditions & ischemia
often not see necrotic cell, but will see collections of neutrophils marking the place left by necrotic cells
also see ballooning of cells, showing what is leading up to necrosis
Describe the process of hepatocyte apoptosis
Under what conditions would you expect to see this?
Most likely to see with actue hepatitis
Programmed cell death
cells are going to shrink, they become more eosinophilic (well circumscribed) & the nucleus becomes very dark blue/black
cell will break into small membrane-bound bodies that will phagocytized by macrophages
no inflammation
What is shown in the provided sample?
If it was taken from the periportal area, what would you epect to be the cause?
lymphoid aggregates like this in the periportal area are very commonly seen in hepatitis C
What is happening in the provided images?
Neutrphils in steatohepatitis
if see a lot of plasma cells, (1) autoimmne hepatitis – esp in a young woman, and (2) acute hepatitis A
What is a special role of of the liver-specific macrophages?
What is their name?
Phagocytize bile
Kupffer cells
What condition is being displayed by the provided samples?
bile has a golden/green color on H&E
What is a unique feature of the liver cells?
it can regenerate
division of remaining viable hepatocytes – form nodules
hepatic stem cells & can become activated– form duct like structures
How does the liver respond to chronic inflammation & necrosis of groups of hepatocytes?
stellate cells, which are in a quiescent state in the liver can become activated if you have death of adjacent hepatocytes
store vitamin A in the quiescent state
when they become activated they, they interact with Kupfer cells, & a variety of other viable hepatocytes. they become myofibroblasts & start producting collagen – laying down scar
They are responsible for fibrosis in the liver
What is shown in the provided image?
If a patient stops drinking alcohol or you resolve the hep C, you can resolve a lot of the fibrous tissue
doesn’t happen in all cases & will never completely go away
What are teh causes of liver failure?
- A
- acetaminophen
- hepatitis A (other countries)
- autoimmune hepatitis (middle aged women)
- B
- hepatitis B (chronic or acute)
- C
- Hepatits C (usually chronic)
- cryptogenic (don’t know what caused it– fatty liver disease?)
- D
- drugs/toxins (acute)
- hepatitis D (acute)
- E
- Hepatitis E (acute, pregnant women)
- eosteric (wastepasket)
- Wilson disease,
- alpha1-antitrypsin deficiency
- Budd-Chiari
- F
- fatty liver disease
What are the characterisitcs of acute liver disease?
most common causes?
- occurs within 26 weeks of liver injury
- assumes no pre-existing liver disease
- may have massive hepatic necrosis
- most common causes
- drugs/toxins
- acetaminphen
- hepatotrophic viruses
- other viruses
- autoimmune hepatits
- drugs/toxins
What type of liver failure is shown in the provided image?
- Acute liver failure: massive necrosis
- acute acetaminophen poisoning is a great example
- massive necrosis
- acute acetaminophen poisoning is a great example
- liver is pale and has speckled apearance
- due to areas of necrosis
- the darker areas are viable hepatocytes, but the light areas a spaces of necrosis (near the central vein)
What are characteristics of acute viral hepatitis?
If you were unsure it was viral, what else woul you include on the differential diagnosis?
- Hepatitis A (acute– typically not fulminant; no chronic)
- Hepatitis B (most will be asymptomatic - small percentage will get chronic)
- if born with it, more likely to have chronic
- also carcinogenic
- Hepatitis C (most do not know they were exposed, and don’t realize until they present with end stage liver disease)
- Anything with chronic hepatitic increases risk to develop cirrhosis & adenocarcinoma
- Damage largely due to immune response rather than the virus itself
- elevated transaminases
- cholestasis (conj. bilirubin elevated)
- diagnosed via serologic test
- differential diagnosis
- autoimmune hepatitis
- Wilson disease
- drug- or toxin-induced hepatitis
Leading causes of chronic liver failure?
Main complication associated with chronic liver failure?
- chronic hepatitis B & C
- non-alcoholic fatty liver disease
- alcoholic liver disease
- biliar diseases
- primary hemochromatosis
- cryptogenic (unkown cause)
- rare inherited disoders (Wilson disease, alpha1-antitrypsin deficiency)
Most commonly associate with cirrhosis (a diffuse process) – not synonymous
What is portal hypertension?
What are the 3 different categories of causes?
Impedence of the blood flow through the liver due to increased resistance – blood will take an easier route so it doesn’t have to go through the liver
- prehepatic- impeding the blood flow into the liver
- portal vein thrombosis
- portal vein stenosis
- massive splenomegaly
- intrahepatic- impeding the blood flow through the liver
- cirrhosis
- schistosomiasis
- massive fatty change
- other diseases
- posthepatic- blood is backing up from something beyond the liver
- right heart failure
- constrictive pericarditis
- hepatic vein obstruction
What are the consequences of cirrhosis?
- ascites: pushing fluid into intraperitoneal
- spontaneous bacterial peritonitis
- hepatorenal syndrome
What comopses the lympoid aggregates seen in viral acute hepatits?
T-lymphocytes
What characteristic of viral hepatitis is shown in the sample provided?
interface hepatitis, the chronic inflammation is spilling out into the surrounding hepatocytes & may see necrosis & apopsosis as well
What is the name of this apearance of hepatocyte?
It is most characteristic of what type of viral hepatitis?
Ground glass hepatocytes
hepatitis B
