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Liver Pathology Flashcards

1
Q

How much does the liver weigh?

A

1500g

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2
Q

Describe the blood supply to the liver.

A

Dual blood supply:

  1. Portal vein
  2. Hepatic artery
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3
Q

Name the cells of the liver

A
  1. Hepatocytes: Business cells – metabolic things
  2. Bile ducts: Plumbing – from hepatocyted to duodenum
  3. Blood vessels: Carry blood – inferior vena cava
  4. Endothelial cells: Lining blood vessels
  5. Kupffer cells: Macrophages
  6. Stellate cells: Many names, store Vitamin A –> differentiate into myofriboblasts cause scarring
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4
Q

Describe the picture.

A

Portal tract - hepatocytes around it and a limiting plate around it

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5
Q

Describe the picture.

A

Bright green – canaliculi

Dull green – hepatocytes

Sinusoids lined by endothelial cells – orange

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6
Q

What occurs to the stellate and endothelial cells in liver injury?

A

Stellate cells become activated and make collagen in the space of disse

Endothelial cells become continuous

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7
Q

What 4 things define liver cirrhosis?

A
  1. Whole liver involved
  2. Fibrosis
  3. Nodules of regenerating hepatocytes
  4. Distortion of liver vascular architecture: intra- and extra- hepatic (e.g. gastro-oesophageal) shunting of blood
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8
Q

How can we classify liver cirrhosis?

A

a) According to nodule size: micronodular or macronodular

b) according to aetiology

  1. Alcohol/Insulin resistance
  2. Viral hepatitis etc.
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9
Q

What are the complications of cirrhosis?

A
  1. Portal hypertension
  2. Hepatic encephalopathy
  3. Liver cell cancer
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10
Q

Is cirrhosis reversible?

A

Yes it can be. Needs to be treated aggresively

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11
Q

What is acute hepatitis and what is it caused by?

A
  1. viruses
  2. drugs

<6 months

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12
Q

What is chronic hepatitis and what is it caused by?

A
  1. viral hepatitis 2. drugs 3. auto-immune
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13
Q

Describe the picture.

A

Spotty necrosis from acute hepatitis

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14
Q

Define grade and stage.

A

Severity of inflammation = grade

Severity of fibrosis = stage

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15
Q

Describe the picture.

A

Portal inflammation (zone 1)

Inflammation has not passed the limitng plate

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16
Q
A

Interface hepatitis (piecemeal necrosis)

Inflammation crossed the limiting plate

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17
Q
A

Lobular inflammation

  • spotty necrosis
18
Q
A

FIBROSIS

Shunting of blood -> normal across the hepatocytes but here it goes down the centre and bypassing the hepatocytes

19
Q

Describe the progression of alcoholic liver disease.

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
20
Q
A

90% hepatocytes contain fat – large droplets

21
Q

What type of cirrhosis does alcohol produce?

A

Micro-nodular cirrhosis

22
Q

What does NAFLD look like histologically and what is it caused by?

A
  • 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
23
Q

Describe the picture. In what gender is it more common? What is the diagnostic test?

A
  • Granulomatous inflammation
  • Primary biliary cholangitis
  • F>M
  • Bile duct loss associated with chronic inflammation
  • Diagnostic test is detection of anti-mitochondrial antibodies
24
Q

Describe the picture. What gender is it more common in. What is it associated with? What is the diagnostic tests?

A
  • Primary sclerosing cholangitis
  • Onion skin fibrosis
  • Sclerosing = “getting thicker”
  • M>F
  • Associated with UC
  • Increased risk of cholangiocarcinoma
  • Diagnostic test is bile duct imaging
25
What is the picture showing? What is it caused by?
* Parenchymal damage to organs secondary to iron deposition (blue) - bronzed diabetes * Haemochromatosis * Genetically determined increased gut iron absorption * Gene on chromosome 6 (HFe)
26
What does the picture show? How is it caused?
* Kupffer cells accumulate iron * Haemosiderosis * Due to blood transfusion
27
What does the picture show? What stain has been used? What is it caused by? What is the sign? How is it diagnosed?
* Rhodadine stain for copper * Wilson's disease * Accumulation of copper due to failure of excretion by hepatocytes into the bile * Assessed by bopsy of biochemistry * Genes on chromosom 13 * Accumulates in the liver and CNS (hepatolenticular degneration) including Kayser-Felischer rings
28
What does the image show? What gender is it more common in? How is it diagnosed? How is it treated?
* Autoimmune hepatitis (lots of inflammation) * F\>M * Active chronic hepatitis with plasma cells * Anti-smooth muscle actin antibodies in the serum * Responds to steroids
29
What does the image show? What causes it?
* Alpha-one antitrypsin deficiency * Failure to secrete alpha-one antitrypsin * Intra-cytoplasmic inclusions due to misfolded protein * Hepatitis and cirrhosis
30
What does the image show?
Zone 3 damage - paracetamol toxicity - where the drug is metabolised
31
What are the specific and general causes of hepatic granulomas?
* **Specific causes:** * **​**PBC * drugs * **General causes:** * **​**TB * Sarcoid etc.
32
Name the benign liver tumours and their origin.
1. Liver cell adenoma - hepatocyte 2. Bile duct adenoma - billiary cells 3. Hemangioma - blood vessels
33
Describe the picture. In what gender is it more common and why?
* **Liver cell adenoma** * Sharply demarcated lesion * More common in women due to the oestrogen
34
Name the malignany liver tumours. Which ones are more common?
* Seondary tumours * Primary tumours Secondary much much more common – lots of blood from the circulation --\> tumour goes first to the liver
35
Describe the picture.
Multiple deposits - more likely to be a secondary tumour.
36
Describe the picture. What time of tumour is this.
* **Metastatic pancreatic cancer** * Adenocarcinoma - secrete mucin *
37
Name the primary malignant liver tumours and their origin.
1. Hepatocellular carcinoma - hepatocyte 2. Hepatoblastoma - hepatocyte 3. Cholangiocarcinoma - bile duct 4. Haemangiosarcoma - blood vessels
38
What is liver cell cancer usually accompanied by in the West?
Liver cirrhosis
39
What are cholangiocarcinomas associated with? Where can they arise from?
* Associated with: * PSC * Worm infections * Cirrhosis * Can arise from * Intrahepatic ducts * Extrahepatic ducts (including gall bladder)
40
What is the most common type of liver cancer?
Metastatic Adenocarcinoma
41
Kayser-Fleisher rings

Histopathology (14 decks)

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