Liver (LS) Flashcards
1
Q
- necrosis/degeneration of the liver
- most common response to hepatic injury
A
Hepatosis
2
Q
What 2 things can trigger caspase activation → Apoptosis?
A
- TNF-a
- Fas Ligand
3
Q
List the 3 morpholoical patterns of hepatocellular degeneration.
A
- Random
- Zonal
- Massive
4
Q
Which morphological pattern is of diagnostic importance but of little significance on hepatic fxn?
A
Random hepatocellular degeneration/necrosis
5
Q
Causes of Random Hepatocellular Degeneration?
(3)
A
- Bacteriema
- Septicemia
- Viruses
6
Q
“Sawdust Liver” in Cattle is an example of what pattern of hepatocellular degeneration?
A
random hepatocellular degeneration/necrosis
7
Q
Lesion of “Sawdust Liver” in cattle?
A
minute, yellowish foci of coagulative necrosis distributed throughout liver
8
Q
Causes of Centrilobular Hepatocellular Degeneration/ Necrosis?
(5)
A
- Hypoxia
- Right sided HF
- Rift Valley fever
- ICH
- Toxic
9
Q
Necrosis of an entire hepatic lobule or contiguous lobule.
(ALL hepatocytes w/in affected lobule are necrotic)
A
Massive Hepatocellular Degeneration/Necrosis
10
Q
Causes of Massive Hepatocellular Degeneration/Necrosis?
(4)
A
- Vit E, Se deficiency → pigs
- Toxic
- Plants
- Chemicals
11
Q
Lesions of Massive Hepatocellular Degeneration/Necrosis?
A
extreme periacinar necrosis w/ remaining normal zones
12
Q
Which of the 3 zones of the hepatocyte is most well nurished?
A
Zone 1
(Periportal)
13
Q
List 2 diseases that are examples of massive hepatocellular degeneration/necrosis?
A
- Hepatosis dietetica ⇒ swine
- Massive Liver Necrosis ⇒ sheep
14
Q
Characteristics of Hepatosis dietetica in Swine?
(4)
A
- Vitamin E/Se deficiency
- hemorrhagic massive necrosis
- deep red, friable liver
- may have ascites, “mulberry heart dz” & “ white mm. dz”
15
Q
Characteristics of Massive Liver Necrosis in Sheep?
A
- areas of California
- Birdfood Trefoil (Lotus tenuis)
- hepatoxicity
- Photosensitization
16
Q
How does hepatic regeneration take place?
A
replication of mature hepatocytes → incr. in lobular size
17
Q
What 2 factors stimulate hepatocyte replication?
A
- TGF-a
- Hepatocyte GF
18
Q
What factor inhibits hepatocyte proliferation?
A
TNF-B
19
Q
When will scarring occur during hepatic regeneration?
A
If the normal extracellular matrix scaffolding is damaged
20
Q
The space of Disse holds _____ ______ that are responsible for producing collagen.
A
stellate cells
(or Ito cells, lipocytes)
21
Q
Hepatic fibrosis?
A
overall increase in the extracellular matrix w/in the liver
22
Q
What are Stellate cells normally responsible for?
A
primary storage site for retinyl esters (Vit A)
23
Q
What happens to stellate cells (Ito cells/lipocytes/HSCs) when the liver is injured?
A
become activated → change phenotype to myofibroblast type →
synthesize collagen types: I, III, & IV → hepatic fibrosis
24
Q
Pathogenesis of Fibrosis?
A
HSC change & start making collagen → fibrosis → progressive bridging→nodular regeneration
25
Which form of hepatic necrosis if more likely to impair hepatic function?
* Bridging fibrosis (from one portal tract to another)
26
Migrating nematode larvae lead to what form of fibrosis?
focal or multifocal hepatic fibrosis
| (random)
27
Definition of Cirrhosis?
diffuse hepatic fibrosis w/ hyperplastic nodule formation
28
Term that refers to proliferation of new biliary ducts w/in portal areas & periportal regions
Biliary **hyper**plasia
29
What is the hallmark of Cirrhosis?
total absence of any normal lobular architecture
30
Lesions characteristic of Cirrhosis?
| (4)
* total loss of normal lobular architecture
* shrunken, fibrotic, mulit-nodular nodules
* regenerative nodules
* "bunch of grapes" _+_ shunts
31
Causes of Cirrhosis?
| (4)
* chronic toxicity
* obstruction
* Right sided heart failure → chronic congestion
* chronic hepatitis
32
Which pattern of Cirrhosis is usually assocaited with acute toxic hepatitis?
Portal Cirrhosis
| (Hobnail liver)
33
Which pattern of Cirrhosis shows scarring around central veins & generally lacks the essential features of cirrhosis?
Cardiac Cirrhosis
34
What are some possible consequences of hepatic dysfunction & failure?
(7)
* Icterus/jaundice
* Hepatic coma
* Metabolic disturbacnes
* Vascular & hemodynamic alterations
* Cutaneous manifestations
* Hepatorenal syndrome
* Accumulation of wastes
35
List the species & condition where hepatic encephalopathy is common?
(3)
* **Ruminants & horses** → hepatic failure
* **Dogs & Cats** →congenital portosystemic shunts
* **ALL** → end stage liver dz. (cirrhosis)
36
List the 2 metabolic disturbances of hepatic failure!
* bleeding tendencies
* hypoalbuminemia
37
Causes of hypoalbuminemia?
| (2)
* Decreased production → severe, chronic liver dz.
* Portal Hypertension → ascites → pulls albumin out of vasculature
38
Pathogenesis of vascular & hemodynamic alterations of hepatic failure?
* Fibrosis→ increased resistance→portal hypertension→acquired portosystemic shunts
* increased pressure + decreased albumin= ascites
39
Name the syndrome that has CS of:
## Footnote
crusting, erosions & ulceration of the epidermis of muzzle, mucocutaneous areas of face, footpads & pressure points of the skin in some dogs with severe hepatic dz.
Hepatocutaneous syndrome
AKA
Necrolytic migratory erythema
AKA
superficial necrolytic dermatitis
40
List the typical cutaneous lesions associated with Hepatocutaneous syndrome.
(3)
* alopecia
* erythemia
* necrosis
41
Which form of photosensitization is hepatic dysfunction responsible for?
Secondary photosensitization
42
What animals does secondary or hepatogenous photosensitization occur in?
herbivores w/ impaired excretion of phylloerythrin in bile
43
Which breed of sheep are more prone to secondary photosensitization due to an inherited defect?
* Mutant Corriedale Sheep
* inability to excrete conjugated bilirubin
44
How do regenerative nodules arise? Age related?
* response to hepatic injury
* no
45
**Congential porphyria** is a metabolic disorder seen in what two species?
* Cattle
* Cats
46
Pathogensis of **Congenital porphyria**?
abnormal heme metabolism→abnormal excretion & accumulation of **porphyrins** → porphyrins are photodynamic
47
Give 3 examples of **disturbances of liver growth**.
* Nodular hyperplasia
* Regenerative nodules
* Cholangiocellular (biliary) hyperplasia
48
What species get **Nodular hyperplasia**? Hepatic Dysfunction?
* Dog → old
* No, does not cause significant hepatic dysfunction
49
How can you distinguish regenerative nodules?
* significant fibrosis
* only a single portal tract apparent
50
Hepatic lipidosis/fatty liver/steatosis is normal in what animals?
Chicks up to 3 days old
51
Causes of Fatty Liver?
| (LOTS)
* *_Dietary_*- starvation, choline deficiency
* Ketosis
* Pregnancy toxemia
* Toxic & anoxic
* Bovine Fatty Liver Syndrome → fat cow syndrome
* Feline Fatty Liver Syndrome → fat cat won't eat!
* Hyperlipidemia → horses & sheep
* Hepatic lipidosis → ponies, mini's & donkeys
* *_Endocrine_* → DM, Hypothryoidism
52
Pathogenesis of Fatty Liver?
increase FAs/carbs → abnormal hepatocyte function → esterification of FFAs to TGs → decreased apoprotein synthesis →impaired secretion of lipoprotein
53
Lesions of Fatty Liver
| (7)
* pale tan to yellow
* swollen
* friable
* enhanced lobular pattern (nutmeg liver)
* greasy
* bulging edges
* **floats in formalin**
54
Lesions of Glycogen Accumulation?
| (4)
* hepatomegaly
* pallor
* fatty degeneration
* nutmeg liver
55
**Glycogen accumulation** in the liver occurs with metabolic alterations due to what 2 things?
* DM
* Glycogen storage Dz.
56
**Steroid-Induced Hepatopathy** is seen primarly it what species?
DOGS!!!
57
Etiology of Steroid-Induced Hepatopathy?
Iatrogenic
**Hyper**adrenocorticism
58
Pathogenesis of Steroid-induced Hepatopathy?
**Glucocorticoids induce glycogen synthetase** enhancing hepatic storage of glycogen
59
List the 3 types of Amyloidosis.
* Primary
* Secondary
* Inherited/Familial
60
Primary amyloidosis is a defect in what?
AL from IG/plasmacytomas
61
**What is the most common form of amyloidosis in vet med**?
**Secondary amyloidosis**
62
Secondary amyloidosis is assocaited w/ what 2 things?
chronic infection
tissue destruction
63
Secondary amyloidosis is a defect in what protein?
serum amyloid-associated (SAA) protein
64
**Inherited/familial Amyloidosis** is seen in what breeds?
* **Shar-Pai dogs**
* **Abyssinian cats**
* **Siamese cats**
65
Cu accumulation occurs in what animals?
* Sheep → poor storage regulation
* Dogs → hereditary disorders of Cu metabolism
66
What does Cu toxicosis lead to (@ the cellular level)?
production of reactive O2 species → destructive lipid peroxidation rxns
67
Causes of Cu Toxicosis in Rumis?
| (3)
* Dietary excess
* _+_ molybdenum
* Pastures containing Pyrrolizidine alkaloids
68
List plant species that contain **pyrrolizidine alkaloids**!
* *Heliotropium* spp.
* *Crotalaria* spp.
* *Senecio* spp.
69
How to Pyrrolizidines prevent hepatocellular proliferation?
via their toxic action on the spindle during mitosis
70
Dog breeds with hereditary disorders of Cu metabolism?
(3)
Dalamatians
Bedlington terriers
West Highland white terries
71
How is biliary excretion of Cu impaired in dogs with hereditary disorders of Cu metabolsim?
abnormal Cu binding by metallothionein
72
Sequelae of Chronic Cu Poisoning in Sheep?
acute, severe intravascular hemolysis & hepatocellular necrosis
73
Sequelae of hereditary disorders of Cu metabolism in Bedlington & West Highland white terriers?
(5)
* ongoing necrosis of hepatocytes
* chronic inflammation
* fibrosis
* cirrhosis
* hepatic failure
74
Tensions lipidosis (steatosis) is seen in what 2 animals?
Cattle
Horses
75
Lesions of Tension lipidosis? Pathogenesis?
* discrete, pales areas of parenchyma adjacent to ligament attachement sites
* impede blood supply due to tension on the liver capsule → hypoxia → hepatocyte lipidosis
76
Does tension lipidosis cause signifcant functional loss to the liver?
NO!
77
List the 3 forms of Portosystemic shunts.
* **Congenital**
* Intrahepatic
* Extrahepatic
* **Acquired**
* usually extrahepatic
78
Where are congenital portosystemic shunts usually limited to?
* a single, large-caliber vessel
* in absence of hepatic dz.
79
When do **Intrahepatic portosystemic shunts** occur?
when the **ductus venosus fails to close** @ birth
80
Where are **Intrahepatic** portosystemic shunts often located? in what animals?
* **Left side** of liver
* large breed dogs
81
Where to **Congenital Extrahepatic portosystemic shunts** often occur? What animals?
* Portal vein to azygous vein anastomoses
* more often in small breed dogs
82
Where can Acquired Portosytemic Shunts be located?
* cranial mesenteric veins - caudal vena cava
* renal veins - caudal vena cava
83
Causes of **Prehepatic** Portal Hypertension
* portal vein thrombosis
* tumors
* increased splenic flow
84
Causes of **Intrahepatic** Portal Hypertension?
* **anything that causes Cirrhosis (most common)**
85
Causes of **Posthepatic** Portal Hypertension?
* Chronic passive congestion
* thrombosis of hepatic veins (**Budd-Chiari syndrome**)
* vena cava/hepatic vein obstruction
86
Changes in blood flow that result from portal hypertension
blood can't easily pass through liver → bypasses liver & flows into small veins which feed directly into the vena cava → veins become engorged, dilated, tortuous & rupture → collateral veins form (same thing happens) → bleeding
87
Sequelae of Portal Hypertension?
| (3)
* Ascites
* Splenomegaly
* Hemolysis
88
Causes of **Acute** Passive Congestion?
| (3)
* acute HF
* shock
* barbiturate overdose
89
"Brisket dz" & pulmonary hypertension are other names for?
high altitude dz.
90
Causes of **Chronic** Passive Congestion of the liver?
(4)
* chronic right-sided HF
* obstruction of the hepatic vein
* lobar congestion
* valvular insufficiency → tricuspid endocardiosis
91
Gross appearance of **Passive** Congestion
| (2)
* nutmeg liver
* mottled w/ red center & yellow peripheral lobular appearance
92
Cardiac sclerosis/cirrhosis means?
post-necrotic fibrosis around the central veins
93
Dz characterized by intimal thickening & occulsion of the central vein by fibrous CT.
Hepatic Venoocclusive Dz.
94
Etiology of Hepatic Venoocclusive Dz.
| (2)
* Hepatotoxicity → pyrrolizidine, alkaloid, aflatoxin
* Vitamin A toxicosis in Cheetahs!
95
Sequelae of Hepatic venoocclusive dz.
| (4)
* passive hepatic congestion (nutmeg liver)
* ascites
* hepatic failure
* icterus
96
Marked dilation of sinusoids in areas where hepatocytes have been lost is known as? Common in what animals?
Telangiectasis
Cattle
97
Lesions of Telangiectasis?
multiple variable sized, red foci
98
Penetrating wounds to the liver cause what? Where?
* discrete areas of inflammation _+_ necrosis
* capsule
* Hepatic parenchyma
99
Characteristics of **Acute Hepatitis**?
* inflammation
* hepatocellular necrosis
* Apoptosis
(varies by host response & stage of lesion)
100
3 Causes of **Acute Hepatisis**?
B acterial
Protozoal
Viral
101
What is a common **bacterial** cause of **acute hepatisis** in **neonates**? **How** does it get in?
* ***E. coli***
* seeds the liver via **umbilical vein (Naval ill)**, portal venous system or hepatic arterial system
102
When does **Chronic Hepatisis** result?
after **continued inflammation** due to a **persistant Ag stimulus**
103
Characteristics of **Chronic Hepatisis**?
| (3)
* fibrosis
* mononuclear cells
* regeneration
104
How does **chronic, suppurative hepatisis** manifest?
as discrete or multiple abscesses
105
What form of hepatisis is due to primary infection of another organ that spreads to the liver?
Nonspecific Reactive Hepatisis
106
Lesion of **Nonspecific, Reactive Hepatisis**?
(4)
* scattered pale foci
* no evidence of necrosis
* pigemented MØs
* reactive Kuppfer cells
107
Characteristics of **Cholangitis**?
inflammation centered on the biliary tract
108
Inflammation of the gallbladder?
Cholecystitis
109
Refers to **inflammation** that affects the **biliary tracts & hepatic parenchyma**
Cholangiohepatisis
110
Things that cause **Necrotizing Hepatitis**?
(give main categories)
* **Viral**
* ICH (K9 Adenovirus 1)
* Herpesvirus
* Rift Valley Fever
* **Bacterial**
* *C. haemolyticum* → bacilary hemoglobinuria
* *C. novyi* Type D → infectious necrotic hepatisis
* *C. piliforme* → Tyzzer's Dz.
* Lepto
* *Francisella tularensis* → tularemia in rodents/rabbits
* Salmonella
* **Protozoal**
111
Causes of **Suppurative Hepatisis**
| (5)
* *Yersinia* spp.
* *Nocardia* spp.
* *Actinomyces* spp.
* *A. pyogenes*
* *Fusobacterium necrophorum*
112
Causes of **Nonspecific Hepatitis**
| (5)
* Salmonellosis
* *Campylobacter fetus* infection
* Listeriosis
* Coccifiosis in rabbits
* metazoan parasites
113
How does Herpesvirus affect the liver?
| (4)
* necrotizing
* livers are swollen, friable, pale
* mottled
* _+_ hemorrhages
114
What causes bacillary hemoglobinuria in cattle & sheep?
*C. hemolyticum* takes over following damage by *F. hepatica*
115
**Infectious necrotic hepatits (Black dz)** is most common in **sheep & cattle**. Is caused by?
***C. novyi* Type B** takes over following ***F. hepatica* migration**
116
What animals get **Tyzzer's Dz**. due to ***C. piliforme***?
(5)
* Rodents
* Foals
* Calves
* Dogs
* Cats
117
How does **Leptospirosis** lead to liver damage?
Ischemic injury to centrilobular areas due to intravascular hemolytic anemia
118
Cause of **Granulomatous Hepatisis**?
| (3)
* **Mycoses (fungal)**
* TB
* **FIP (can be pyogranulomatous too)**
119
What 2 nematodes cause **Milk Spots** on **Pig** Livers ?
* *Ascaris suum*
* *Stephanurus dentatus*
120
What **migrating nematode** causes liver pathology in **Horses**?
***Strongylus*** spp.
121
What **2 migrating nematode larvae** causes liver problems for **dogs**?
* ***Capillaria hepatica***
* ***D. immitis***
122
What Cestodes cause **Cysticercosis/Echinococcosis**?
* ***T. hydatigenal***
* ***E. granulosus* (hydatid cysts)**
123
Most common liver fluke of ruminants?
*F. hepatica*
124
2 examples of **Idiosyncratic hepatoxins**?
* prolonged Halothane exposure
* Diazepam Toxicity → cats
125
Give the 3 step detoxification process.
1. biotransformation
2. conjugation
3. transport across the cell membrane → excreted
126
Characteristic lesion seen as a result of Pyrrolizidine Alkaloids?
megalocytes
127
Susceptibility to Pyrrolizidine Alkaloids?
Swine \> sheep \> cattle & horses
128
Mycotoxins that cause toxic liver damage? Where?
(5)
* Alfaltoxin B1, B2, G1, G2 & M1→ *Aspergillus* spp.
* midzonal lesions
129
Pathogensis of White Phosphourus (in rodenticide)?
IF SURVIVE PAST DAY 5
* liver disease = periportal necrosis, severe fatty changes
130
Why is White Phosphorus so dangerous to the liver?
does **NOT** require bioactivation
131
How do Chlorinated Hydrocarbons affect the liver?
(CCL4 used to be an anthelminthic)
* bioactivated by MFO system →CCl3 -
* centrilobular necrosis
* Lipidosis
132
Cresols (in "clay pigeons & asphalt shingles) causes what in pigs?
hemorrhagic necrosis (centrilobular to massive)
133
Syndrome of **acute hepatic necrosis** in **young, rapidly growing pigs** caused by **Vit E &/o Se deficiency**?
Hepatosis dietetica
| (Nutritional hepatic necrosis)
134
Refers to **pale, fatty livers** in **SHEEP** that develop from a **nutritional Cobalt deficiency**?
**White Liver Dz!**
135
Affected horses have hepatic failure after an injection containing equine serum
→ hepatic encephalopathy, icterus, intravascular hemolysis
Theiler's Dz. (Equine serum sickness)
136
"Dish-rag" liver is seen in what Dz?
Theiler's Dz
| (Equine Serum Sickness)
137
List the Primary, Epithelial Neoplastic Dzs.
(4)
* Hepatocellular adenoma (hepatoma)
* " carcinoma
* Cholangiocellular adenoma
* " carcinoma
138
What is a frequent, malignant neoplasm seen in SHEEP?
(rare in others!)
Hepatocellular carcinoma
139
What is the most common primary hepatic neoplasm in **cats**?
(benign, not in others)
Cholangiocellular adenoma
140
Malignant, primary neoplasms that occurs in all species?
Cholangiocellular carcinoma
141
List the top 3 Secondary (metastatic) Neoplasms in order of occurrence!
1. Lymphosarcomas
2. Melanomas
3. Hemangioscarcomas
142
Lesions of Granulomatous Hepatitis?
* numerous tan-yellow caseous, nodular masses
* size: 0.5-3 cm
* Scattered thoroughout hepatic parenchyma
