Liver Pathology Flashcards
How heavy is the liver?
1.5 kg
What is the blood supply to the liver?
Dual: hepatic artery (20%) and portal vein (80%)
What are the cells of the liver?
Hepatocytes Bile ducts Blood vessels Endothelial cells Kupffer cells Stellate cells
What is the key parts of the definition of cirrhosis?
Whole liver involved
Fibrosis
Nodules of regenerating hepatocytes
Distortion of liver vasculature- intra and extra hepatic shunting of blood
Why are intrahepatic shunts bad?
There is unfiltered toxic blood
How do you classify cirrhosis?
Nodule size: micronodular vs macronodular
Aetiology: alcoholic/ insulin resistance (more likely to be micronodular)/ viral hepatitis (more likely to be macronodular)
What are the complications of cirrhosis?
Portal hypertension (may present with palpable spleen)
Hepatic encephalopathy
Liver cell cancer
What causes acute hepatitis?
Viruses
Drugs
What causes chronic hepatitis?
Viruses
Drugs
Autoimmune
How do you evaluate chronic hepatitis histology?
Severity of inflammation = grade
Severity of fibrosis = stage
What are the stages of ALD?
Fatty liver
Alcoholic hepatitis
Cirrhosis
What are the features of alcoholic hepatitis?
Ballooning ( +/- Mallory Denk Bodies)
Apoptosis
Pericellular fibrosis
Mainly seen in Zone 3
What is NAFLD?
Histologically looks like alcoholic liver disease
Due to insulin resistance associated with raised BMI and diabetes
Becoming recognised as one of the commonest causes of liver disease, world-wide
What is PBC?
Previously primary biliary cirrhosis.
F> M
Bile duct loss associated with chronic inflammation (with granulomas)
Diagnostic test is detection of anti-mitochondrial antibodies
What is PSC?
M > F Periductal bile duct fibrosis leading to loss Associated with ulcerative colitis Increased risk of cholangiocarcinoma Diagnostic test is bile duct imaging
What is haemochromatosis?
Genetically determined increased gut iron absorption
Gene on chromosome 6 (HFe)
Parenchymal damage to organs secondary to iron deposition (bronzed diabetes)
Prussian blue stain is used to pick out iron
What is haemosiderosis?
Accumulation of iron in macrophages NOT hepatocytes
No inflammation
Blood transfusion for treatment
What is Wilsons disease?
Recessive disease (Chromosome 13, heteroallelic): Accumulation of copper due to failure of excretion by hepatocytes into the bile
Assessed by biopsy (Rhodanine stain for copper) or biochemistry
Accumulates in the liver and CNS (hepato-lenticular degeneration) including Kayser-Fleishcer rings
Causes cell damage
What is AIH?
F>M
Active chronic hepatitis with plasma cells
Anti-smooth muscle actin antibodies in the serum
Responds to steroids
What is Alpha 1 Antitrypsin deficiency?
Failure to secrete alpha-one antitrypsin
Intra-cytoplasmic inclusions due to misfolded protein
Hepatitis and cirrhosis
Presents in neonatal period with giant cell hepatitis
What is DILI?
“any kind of liver disease can be caused by a drug” ie. hepatocellular and / or cholestatic
10% of drug reactions involve the liver
Liver is the site for xenometabolism
May be dose-related or idiosyncratic
What are hepatic granulomas caused by?
Specific causes:
PBC
drugs
General causes:
TB
Sarcoid
Other infective aetiologies etc.
What are the benign liver tumours?
1) liver cell adenoma
2) bile duct adenoma
3) haemangioma
What are the malignant liver tumour classed as?
- secondary tumours (more common)
2. primary tumours
What is the anatomy of the portal venous system?
The superior mesenteric vein drains from the gut into the portal vein
The inferior mesenteric vein joins the splenic vein into the portal vein
The short gastric veins, left gastric vein, and umbilical vein drain into the portal vein
The portal veins splits off into the right and left branches then into segmental veins and venules
What are the primary liver tumours?
- hepatocellular carcinoma
- hepatoblastoma (primitive hepatocytes-children)
- cholangiocarcinoma
- haemangiosarcoma (blood vessels)
What is liver cell cancer (HCC) associated with?
Usually associated with cirrhosis especially in the West.
What are the associations of cholangiocarcinomas?
Associated with:
PSC
Worm infections
Cirrhosis
Can arise from: intrahepatic ducts extrahepatic ducts (including gall bladder)
Why are extrahepatic shunts bad?
Blood cannot get through liver- porto-systemic anastomoses have increased pressure
What is acute hepatitis classes as?
<6 months
Chronic > 6 months
Are Hepatitis B and C acute or chronic?
Both
Is alcoholic related fatty change reversible?
Yes
Where is fibrosis in viral and alcoholic hepatitis?
Viral = zone 1 Alcoholic = zone 3
How does paracetamol toxicity cause damage?
Paracetamol converted to toxic metabolite in the liver and can cause damage
Zone 3 damage (most drug metabolism here)
What is a granuloma?
Organised collection of activated macrophages
