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SBCP Pathology > Liver: Medical > Flashcards

Liver: Medical Flashcards

1
Q

How many lobes does the liver have?

A

3

Right left and caudate

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2
Q

How many blood supplies does liver have?

A

2

Hepatic arterial and portal venous (65% from portal vein)

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3
Q

What drains blood from the liver?

A

Hepatic vein

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4
Q

What drains bile from liver?

A

Biliary tract

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5
Q

What is in the portal triads/tracts?

A

Hepatic artery, portal vein, bile duct

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6
Q

What is the anatomical unit of the liver? Which direction does the blood flow?

A

Hepatic lobule

Hexagonal structure, at the apical points are the portal tracts and in the centre is the hepatic vein.

Blood flows form portal tracts to the centre of the lobule

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7
Q

Difference between liver lobules and acini?

A

Lobules= structural unit, hexagonal unit with central vein at the centre

Acini= functional, centred on the dual blood supply with the central veins at the periphery. Divided into zones 1-3 of oxygenation

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8
Q

Functions of hepatocytes

A

Synthesis:

  • Bilirubin
  • Albumin
  • Clotting factors

Metabolise:
-Drugs

Contain:
-Enzymes (ALT/AST/GGT)

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9
Q

Which is a better marker of acute severe liver injury, albumin or coagulation factors?

A

Coagulation factors as albumin has a much longer half life

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10
Q

Where is ALP normally found?

A

In bile

Can b raised due to muscle or bone damage

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11
Q

Which viruses can affect the liver?

A

Hepatitis A,B,C,E

Rarely EBV or CMV

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12
Q

Imiaging investigations for any suspected liver disease? (4)

A

USS/CT for bile duct dilation

ERCP/MRCP to further assess bile duct dilatation

Endoluminal USS to look for mass in pancreatic head

Fibroscan for cirrhosis

CT/MRI liver

Liver biopsy

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13
Q

Does the liver produce immunoglobulins?

A

No

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14
Q

Causes of acute liver injury?

A 
Viral hepatitis
Alcohol
Drugs
Autoimmune
Biliary disease
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15
Q

What is chronic hepatitis?

A

Hepatitis > 6 months

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16
Q

At what bilirubin level is there clinical jaundice?

A

> 30 micromol/L

Hyperbilirubinaemia is >22

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17
Q

Most common cause of pre-hepatic jaundice?

A

Haemolytic anaemia (sickle cell, thalassaemia, drugs, infections)

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18
Q

Causes of hepatic jaundice

A 
Viral hepatitis
Alcoholic hepatitis
Drug induced liver disease
Autoimmune liver disease
PSC, PBC

**End stage cirrhosis (decompensation)

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19
Q

What causes cholestasis in liver?

A

Damage to hepatocytes or intra- or extrahepatic obstruction

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20
Q

What pattern of necrosis is seen with paracetamol toxicity?

A

Confluent (Centrizonal) necrosis

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21
Q

What pattern of necrosis is seen with individual hepatocyte death?

A

Spotty necrosis

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22
Q

What patterns of liver injury can be caused by drugs?

A 
Fatty change
Centrilobular necrosis
Massive necrosis
Hepatitis
Fibrosis
Granulomatous reaction
Cholestasis
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23
Q

Causes of chronic liver disease

A 
Viral hepatitis
Autoimmune hepatitis
Drug induced
Alcohol
NAFLD
PSC/PBC
**Metabolic: Haemochromatosis, Wilson's, anti alpha trypsin 1
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24
Q

What is secondary biliary cirrhosis?

A

Chronic biliary obstruction leading to liver cirrhosis

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25
Q

Causes of extrahepatic biliary obstruction

A

Stones
Benign stricture from PSC
Tumour

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26
Q

Symptoms of PBC

A

Middle aged females
Itch
Jaundice

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27
Q

What markers are raised in PBC?

A

*AMA (anti mitochondrial antibodies)

ALP and cholesterol

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28
Q

Histology: Portal tract lymphocytic infiltrate which destroys bile ducts +/- granulomas

A

PBC

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29
Q

What is ductopaenia?

A

Bile duct destruction

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30
Q

What is PBC?

A

Autoimmune ductopaenia

31
Q

What is PSC?

A

Chronic inflammation involving intra and extra hepatic bile ducts

32
Q

What bowel disease is linked to PSC?

A

UC

33
Q

Diagnosis of PSC?

A

MRCP will show beading

34
Q

Histology: periductal ‘onion skinning’ concentric fibrosis, ductopaenia

A

PSC

35
Q

How is bilirubin conjugated in the liver?

A

Made water soluble by binding to glucuronic acid by the enzyme GLUCURONYL TRANSFERASE

36
Q

Which viruses increase risk of HCC?

A

Hep B and C

37
Q

Which hepatitis has the most risk for chronic hepatitis?

A

C

38
Q

What type of virus is hepatitis?

A

RNA

39
Q

Transmission route of hep A?

A

Faecal oral

Benign and self limiting, no chronic infection or risk of chronic hepatitis

40
Q

Which hepatitis viruses have a carrier state?

A

B,C,D

41
Q

Which hepatitis viruses are spread though IV use?

A

BCD

42
Q

Two phases of Hep B viral growth?

A

Proliferative

Intergrative

43
Q

3 patterns of Hep B disease?

A

Acute disease and recovery

Asymptomatic carrier

Chronic infection and cirrhosis

44
Q

Important marker in hep B infection?

A

HBsAg

45
Q

What % of people with hep C are asymptomatic?

A

75% but much higher percentage develop chronic infection and cirrhosis

46
Q

What histological pattern of liver damage is cause by chronic hepatitis?

A

Interface hepatitis where inflammatory cells spill into adjacent hepatocytes

Also called piecemeal necrosis

47
Q

Example of a drug which can cause chronic hepatitis?

A

Methotrexate

48
Q

Which autoantibodies are present with autoimmune hepatitis

A

ASMA (anti smooth muscle)

ANA (anti nuclear)

49
Q

How is hepatitis graded and staged?

A

grade: necroinflammatory disease activity

stage 0-6: degree of fibrosis and nodularity

50
Q

True/false: Hep D infection is limited to persons already infected with Heb B

A

True

51
Q

Characteristics of liver cirrhosis? (Don’t learn off)

A
  1. Diffuse irreversible disruption of liver architecture
  2. Structurally abnormal REGENERATIVE nodules of hepatocytes
  3. Separated by bridging bands of fibrous tissue
52
Q

Features of decompensated liver failure

A 
Jaundice
Coagulopathy
Encephalopathy
Hypoproteinaemia
Hyperaldosteronism
53
Q

What causes portal hypertension?

A

Increased portal blood flow
Hepatic vascular resistance
A-V shunting

Causes ascites, splenomegaly, oesophageal varices, haemorrhoids, caput medusae

54
Q

What cancer are people with cirrhosis at risk of?

A

Hepatocellular carcinoma

55
Q

Where do oesophageal varcies commonly form?

A

At lower oesophagus at a site of portal-systemic anastomosis

56
Q

Most common cause of liver cirrhosis?

A

Alcoholic liver disease 60-70%

Also:
NASH
Viral hepatitis
Biliary disease
Hereditary Haemochromatosis
Autoimmune hep.
Wilsons
Alpha 1 anti trypsin deficiency
Idiopathic
57
Q

Histology of alcoholic liver disease: 3 overlapping patterns. Simple ____ or fatty change (80% of cases). ______ (10-20%). Cirrohosis (10%)

A

Steatosis (reversible fatty change)

Steatohepatitis

58
Q

Why does alcohol damage the liver? (3 factors)

A

Cellular energy diverted to alcohol metabolism instead of eg fat metabolism

Toxic acetaldehyde accumulation

Direct stimulation of collagen synthesis by alcohol

59
Q

Histology features of steatohepatitis

A

CHICKEN WIRE

Hepatocyte ballooning
Fat vacuoles

Mallory bodies (eosinophilic globules)

Neutrophil reaction
Fibrosis

60
Q

Examples of metabolic causes of chronic liver disease?

A

Haemochromatosis
WIlson’s
a1 anti trypsin deficiency

61
Q

Which gene is associated with haemochromatosis?

A

HFE gene mutation (C282Y)

62
Q

Pathogenesis of haemochromatosis?

A

Autosomal recessive

HFE gene mutation results in excessive iron absorption in small intestine

63
Q

Complications of haemochromatosis?

A

Iron deposits in liver, heart, pancreas etc.

Bronze pigmentation
DM (pancreas involvement)
Cardiac arrhythmias
Infertility
High risk of cirrhosis and HCC
64
Q

Diagnosis of hameachromatosis?

A

iron studies (transferrin and ferritin)

Histology

Genetic testing for C282Y mutation

65
Q

Histology of haemochromatosis: ____ _____ blue stain demonstrates granular distribution of iron in hepatocytes.

A

Perl’s Prussian blue stain

66
Q

Treatment of haemochromatosis

A

Venesection and iron chelating agents

67
Q

Inheritance pattern of WIlson’s

A

Autosomal recessive

68
Q

Pathology of WIlson’s disease

A

Accumulation of copper in hepatocytes due to mutation in Cu-transporting ATPase

Usually presents with brain/eye involvement

69
Q

Histology of WIlson’s

A

Non specific

May detect Copper in liver with stains but it is very patchy

70
Q

Diagnosis of WIlson’s

A

Confirmed by biochemistry (serum/urine.liver tissue Cu studies)

71
Q

Treatment for WIlson’s

A

Penicillamine (chelating agent)

72
Q

What characteristic Wilson’s sign appears on the peripheral iris?

A

Kayser-Fleischer RIng

73
Q

WHat is alpha 1 anti trypsin? How does deficiency cause disease?

A

It is a serum protease inhibitor, produced in the liver. (PiMM is normal phenotype, PiZZ is abnormal).

Causes cirrhosis of the liver and emphysema in the lung (because elastase activity is increased)

74
Q

What stain is used to diagnosis a1AT globules?

A

PAS

SBCP Pathology (24 decks)

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