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Gastrointestinal Module > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

Cirrhosis

A

Chronic end stage liver disease with diffuse fibrosis, diffuse loss of lobular architecture, diffuse formation or regenerative nodules

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2
Q

Cirrhosis etiology

A

Liver damage by excess alcohol
Liver damage by viruses ( HBV, HCV, HBV+D)

Biliary disease
Congenital diseases ( Wilson’s disease, a-1 anti trypsin deficiency, galactoseMia,tyrosinosis)
Drugs ( a-methyl dopa, anti cancer ).
Cryptogenic

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3
Q

Fibrosis in cirrhosis

A

Irréversible

Bundles of portal portal , portal central , central , broad bands, that replace adjacent lobules

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4
Q

Loss of architecture in cirrhosis

A

Done by diffuse scars

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5
Q

Nodules formation in cirrhosis

A

Micronodular (less than 3mm)

Macronodular (more than 3mm)

Mixed nodular cirrhosis

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6
Q

Pathogenesis of cirrhosis

A

Causative agent
Fibrosis by type 1&3 collagen in space of disse and lobules
Impaired nutrients and solutes diffusion
Loss of fenestrations in sinusoids
Mpaired transfer of products (albumin, lipoproteins, clotting factors) hepatocytes into blood
Fibrous tissue by ito cells due to cytokines Etc
Portal hypertension due to increased resistance in sinusoids caused by narrowing, nodules and fibrosis compressing portal vein

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7
Q

Complications of portal hypertension

A

Ascites
Portosystemic shunt
Congestive splenomegaly
Hepatic encephalopathy

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8
Q

Pathogenesis of ascites in cirrhosis

A

Sinusoidal hypertension
Hypoproteinemia
Low peritoneal reabsorption of fluid
interstitial leakage from capillaries due to portal hypertension
renal retention of sodium and water from secondary hyperaldosteronism

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9
Q

Hepatocellular failure

A

Progressive
Loss of function over 80% to see failure symptoms.
70-95% mortality

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10
Q

Features of hepatic failure

A 
Jaundice 
hypoalbuminemia 
coagulation defects
Hyperammonemia
Fetor hepaticus
High hepatic enzyme in serum 
Gynecomastia
Testicular atrophy
Male hypogonadism
Palmar erythema
Spider angiomas
Muscle wasting 
Hypoglycemia
Hepatic encephalopathy
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11
Q

Hepatic encephalopathy

A

Metabolites normally processed and eliminated by the liver gain entrance to the brain

Brain edema , severe loss of hepatic function, neurological signs , hyper reflexia, seizures, asterixis

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12
Q

Hepatorenal syndrome

A

Appear like renal failure with no intrinsic morphologic or functional causes for renal failure

Drop in renal output 
Rising bun and creatinine 
Hyperosmolar urine with no protein 
Abnormal sediment 
Low sodium
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13
Q

Complications of cirrhosis

A

Portal HPT (ascites, haemorrhoids, varices, splenomegaly)

Hepatocellular failure p

Hepatocellular ca

IInfections pneumonia duodenal ulcers TB

Circulatory disturbances- clubbing of fingers, cyanosis, peripheral vasodilation

Anorexia and wasting

Hypothermia

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14
Q

Hepatic adenoma

A

Benign tumors of hepatocytes that occur mostly in women ( because of oral pill)

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15
Q

Focal nodular hyperplasia

A

Nodular lesion that resembles cirrhosis

5 to 15 cm

Can protrude and can be pedunculated

Has central scar where fibrous septa radiate

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16
Q

Most common tumor of the liver

A

Hepatic hemangioma’s

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17
Q

Hepatic hemangioma incidence

A

All ages

both sexes

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18
Q

What type of tumor is more common primary or secondary

A

Secondary

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19
Q

Type of malignant tumor

A

Hepatocellular carcinoma’s( to hepatitis , mostly HBV)
Hepatoblastoma ( young childhood)
Angiosarcoma (vinyl chloride ..)

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20
Q

Main primary malignant tumors of liver

A

Hepatocellular carcinoma (90%)

Cholangiocarcinomas(10%)

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21
Q

Cholangiocarcinoma linked to

A

Thorotrast and opistorchis infections

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22
Q

Hepatocellular carcinoma pathogenesis

A

HBV or HCV repeated cycles of replication

Accumulation of mutations
HBV x protein disrupt growth mechanism control
Aflatoxins activated and form mutagenic DNA adducts

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23
Q

Etiology of hepatocellular carcinoma

A 
HBV
HCV
Cirrhosis
Haematochromatosis
Tyrosinosis
Drugs 
Chemicals
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24
Q

Morphology of hepatocellular carcinoma

A

Enlarged liver
Paler
Yellowish necrotic areas
Areas of hemorrhage

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25
Q

Variant fibrolamellar type

A 
Good prognosis 
Not associated to HBV or cirrhosis 
Affects young male and females in 20-40 
Well differentiated hepatocytes 
Fibrous stroma
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26
Q

Steatosis

A

Accumulation of fat in hepatocytes

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27
Q

Cholestasis

A

Accumulation of bilirubin in hepatocytes

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28
Q

Most severe consequence of liver disease

A

Liver failure

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29
Q

Acute liver disease

A

Sudden and massive hepatic destruction

Encephalopathy and coagulopathy that occurs within 26weeks of initial liver injury

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30
Q

Chronic liver failure

A

Progressive and insidious liver injury over decades leading to hepatic failure

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31
Q

Acute on chronic liver failure

A

Unrelated acute injury superimposes on a well compensated late stage chronic disease

32
Q

Mortality rate in persons with hepatic failure without transplant

A

80%

33
Q

Etiology of acute liver injury

A

Drugs and toxins (acetaminophen)

Hepatitis (autoimmune, A,B,E)

34
Q

Acute liver failure morphology

A 
Massive hepatic necrosis 
Broad parenchyma loss
Islands of regenerating hepatocytes 
Liver initially enlarged (hepatocytes swelling, inflammatory infiltrates, edema)
then Shrunken liver
35
Q

Clinical presentation of acute liver failure

A 
Nausea
Vomiting 
Jaundice 
Encephalopathy (subtle behavior abnormalities, confusion, stupor, deep coma...)
Coagulation defects (vit k and clotting factors synthesis impairment ) 
Alteration of bile formation 
Cholestasis 
Portal hypertension 
Hepatorenal syndrome
36
Q

Hepatorenal syndrome

A

Renal failure occurring in liver failure

37
Q

Etiology of chronic hepatic failure

A

Chronic hepatitis b , c
Non alcoholic fatty liver
Alcoholic liver disease
Cirrhosis

38
Q

Portal hypertension types

A

Prehepatic
Intrahepatic
Post hepatic

39
Q

Major prehepatic conditions

A

Obstructive thrombosis
Massive splenomegaly
Narrowing of portal vein

40
Q

Major posthepatic conditions

A

Severe right sided heart failure
Constrictive pericarditis
Hepatic vein outflow obstruction

41
Q

Major intrahepatic conditions

A

Cirrhosis
Schistosomiasis
Fatty change
Sarcoidosis

42
Q

Complications of portal hypertension

A

Ascites
Pprtosystemic venous shunts
Congestive splenomegaly
Hepatic encephalopathy

43
Q

Ascites

A

Accumulation of excess fluid in peritoneal cavity

44
Q

Main cause of ascites

A

Cirrhosis

45
Q

Type of fluid in ascites

A

Serous

46
Q

Mnemonic for causes of acute liver failure

A 
A : acetaminophen, Hepatitis (A and  autoimmune) 
B : Hepatitis B
C : Hepatitis C, cryptogenic
D: Drugs/toxins, hepatits D
E: Hepatitis E , esoteric causes
F : fatty change of micro-vesicular type
47
Q

Is hepatitis A self limited and benign

A

Yes.

48
Q

Can HAV give chronic hepatitis

A

No

49
Q

Can HAV give rise to acute liver failure ?

A

Rarely. Fatality rate very low also ( 0.1-0.3%)

50
Q

Symptoms of HAV

A

Non specific
Fatigue
Loss of appetite
Jaundice

51
Q

HAV mode of transmission

A

Ingestion of contaminated water and foods

Shed in stool so feco oral contamination

52
Q

HAV prevention

A

Vaccination

53
Q

Marker of acute infection of HAV

A

IgM

54
Q

Lifelong immunity in HAV ?

A

Possibly by igG anti HAV

55
Q

Différent Fate of hepatitis B

A 
Acute hepatitis 
Non progressive chronic hepatitis 
Progressive chronic hepatitis ( ending either cirrhosis)
Acute hepatic failure 
Asymptomatic carrier state
56
Q

HBV Transmission

A

Horizontal transmission
Minor breaks in the skin
Sex
Drug abuse

57
Q

Prevention HBV

A

Vaccination

58
Q

Major cause of liver disease worldwide

A

HCV

59
Q

HCV risk factors

A

Drug abuse
Mutiplr sex partners
Surgery
Needle stick injury

60
Q

HCV family

A

Flaviridae

61
Q

Gross morphology of acute viral hepatitis

A

Normal liver or slightly mottled

62
Q

Histologic morphology of hepatitis

A

Lymphoplasmacytic infiltrate
Spotty necrosis
Lobular hepatitis
May have Necrosis (cytoplasmic remnants, cell membrane rupture, hepatocytes dropout)
May have apoptosis (hepatocytes shrink, eosinophils, pyknosis, karryorhexis)

63
Q

Main toxic agent causing chronic liver failure

A

Alcohol

64
Q

Most common cause of acute liver failure necessitating liver transplantation in the US

A

Acetaminophen

65
Q

Forms of alcoholic liver disease

A

Hepatocellular steatosis/ fattychange

Alcoholic hepatitis

Steatofibrosis

66
Q

Alcoholic liver disease morphology - hepatic steatosis

A

fatty liver with accumulation of lipid droplets that push nucleus aside

Large liver yellow and greasy

67
Q

Is fatty change reversible

A

Yes

68
Q

Alcoholic liver disease morphology - alcoholic hepatitis

A

Hepatocytes swelling and necrosis

Mallory denk bodies ( clumped amorphous eosinophils in hepatocytes)

Neutrophilic reaction - accumulate around degenerating hepatocytes

69
Q

Alcoholic liver disease morphology - alcoholic steatofibrosis

A

Sclerosis of central veins
Chicken wire fence pattern (perisinusoidal scar accumulates in space of disse and spread outward encircling hepatocytes )
Cirrhosis installs

Micronodular(laennec cirrhosis)

70
Q

Are women more predispose to hepatic injury ?

A

Yes

71
Q

Non alcoholic fatty liver disease causes

A

Insulin resistance giving hepatic steatosis

Hepatocellular oxidative injury in liver cell necrosis

72
Q

Non alcoholic fatty liver disease histologies

A

Mononuclear cells
Less neutrophils
Mallory denk bodies

73
Q

Most reliable diagnostic tool for NAFLD

A

Biopsy for fatty

74
Q

Hemochromatosis

A

Excessive iron absorption

Deposit in parenchymal organs ( liver, pancreas..)

75
Q

Secondary hemochromatosis

A

Accumulation of iron due to excess parentéral administration of iron

76
Q

Hemochromatosis presentation

A

Micronodular cirrhosis
Diabetes mellitus
Abnormal skin pigmentation

Hepatomegaly
Abd pain

77
Q

Wilson disease

A

Impaired copper excretion into bile

Gastrointestinal Module (15 decks)

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