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Histopathology > Liver Pathology > Flashcards

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
Q

What is the picture showing? What is it caused by?

A
  • Parenchymal damage to organs secondary to iron deposition (blue) - bronzed diabetes
  • Haemochromatosis
  • Genetically determined increased gut iron absorption
  • Gene on chromosome 6 (HFe)
26
Q

What does the picture show? How is it caused?

A
  • Kupffer cells accumulate iron
  • Haemosiderosis
  • Due to blood transfusion
27
Q

What does the picture show? What stain has been used? What is it caused by? What is the sign? How is it diagnosed?

A
  • 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
Q

What does the image show? What gender is it more common in? How is it diagnosed? How is it treated?

A
  • 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
Q

What does the image show? What causes it?

A
  • Alpha-one antitrypsin deficiency
  • Failure to secrete alpha-one antitrypsin
  • Intra-cytoplasmic inclusions due to misfolded protein
  • Hepatitis and cirrhosis
30
Q

What does the image show?

A

Zone 3 damage - paracetamol toxicity - where the drug is metabolised

31
Q

What are the specific and general causes of hepatic granulomas?

A
  • Specific causes:
    • ​PBC
    • drugs
  • General causes:
    • ​TB
    • Sarcoid etc.
32
Q

Name the benign liver tumours and their origin.

A
  1. Liver cell adenoma - hepatocyte
  2. Bile duct adenoma - billiary cells
  3. Hemangioma - blood vessels
33
Q

Describe the picture. In what gender is it more common and why?

A
  • Liver cell adenoma
  • Sharply demarcated lesion
  • More common in women due to the oestrogen
34
Q

Name the malignany liver tumours. Which ones are more common?

A
  • Seondary tumours
  • Primary tumours

Secondary much much more common – lots of blood from the circulation –> tumour goes first to the liver

35
Q

Describe the picture.

A

Multiple deposits - more likely to be a secondary tumour.

36
Q

Describe the picture. What time of tumour is this.

A
  • Metastatic pancreatic cancer
  • Adenocarcinoma - secrete mucin
    *
37
Q

Name the primary malignant liver tumours and their origin.

A
  1. Hepatocellular carcinoma - hepatocyte
  2. Hepatoblastoma - hepatocyte
  3. Cholangiocarcinoma - bile duct
  4. Haemangiosarcoma - blood vessels
38
Q

What is liver cell cancer usually accompanied by in the West?

A

Liver cirrhosis

39
Q

What are cholangiocarcinomas associated with? Where can they arise from?

A
  • Associated with:
    • PSC
    • Worm infections
    • Cirrhosis
  • Can arise from
    • Intrahepatic ducts
    • Extrahepatic ducts (including gall bladder)
40
Q

What is the most common type of liver cancer?

A

Metastatic Adenocarcinoma

41
Q
A

Kayser-Fleisher rings

Histopathology (14 decks)

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