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Cellular Pathology > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

What are the categories of causes of liver injury

A 
Immune mediated 
Drug induced
Infectious 
Metabolic 
Mechanical
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2
Q

What are the causes of immune mediated liver injury

A

Autoimmune hepatitis
Primary bilary cholangitis
Primary sclerosing cholangitis
Transplant rejection

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3
Q

What are the causes of drug induced liver injury

A

Alcohol

Therapeutic agents

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4
Q

What are the infectious causes of liver injury

A

Hepatotropic viruses

Other infections

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5
Q

What are the causes of metabolic liver injury

A

Non alcoholic fatty liver disease

Inherited/acquired metabolic disease

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6
Q

What are the mechanical causes of liver injury

A

Biliary obstruction

Vascular disorders

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7
Q

When are liver biopsys needed

A

To give primary diagnosis

To give additional information about the primary diagnosis

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8
Q

What are the common ways of getting a liver biopsy

A

Percutaenous
Transjugular
Open (intra operative)

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9
Q

What is the problem with liver biopsy

A

The biopsy are small in size

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10
Q

What does the portal tract contain

A

Hepatic artery
Bile duct
Portal vein

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11
Q

What is the role of portal tract

A

Allow inflow of vascular blood and outflow of bile from liver

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12
Q

Where does blood from the portal vein drain into

A

Hepatic sinusoid which drains into the terminal hepatic vein (central vein)

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13
Q

What is the hepatic sinusoid lined by

A

Fenestrated sinusoidal endothelial cells

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14
Q

Where are kuppfer cells located

A

In the sinusoid

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15
Q

What are kupffer cells

A

Macrophages

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16
Q

What is the gap between sinusoidal cells and kuppfer cells called

A

Space of disse

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17
Q

What does the space of disse contain

A

Stellate cells

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18
Q

What is the role of stellate cells

A

Store fat in resting state

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19
Q

In disease which cells mediate fibrosis

A

Stellate cells

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20
Q

What ar the zones in the liver

A 
Zone 1 (periportal)
Zone 2 (mid zone)
Zone 3 (centrilobular zone)
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21
Q

What is zone 1

A

The zone that has the best oxygen supply and contains the portal tirad

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22
Q

What is in zone 3

A

Central vein

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23
Q

What is the portal triad

A

Portal vein
Bile duct
Hepatic artery

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24
Q

What is a common manifestation that occurs as a result of dmaage to the membrane of the sodium pottassium ATPase

A

Ballooning

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25
Q

Why is there ballooning

A

There is a damage/failure of the sodium potassium astpase which leads to intracellular accumulation of fluid

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26
Q

Why is there accumualtion of water, which ion enters the cells

A

Sodium

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27
Q

What formation forms within the ballooned hepatocytes

A

Mallory denk bodies

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28
Q

What are mallory denk bodies

A

Cytoplasmic inclusions i.e dense pink structures within the cytoplasm which are made of collapsed cystoskeletal fraemwork

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29
Q

What is steatosis

A

Accumulation of fat droplets within the hepatocytes composed of triglycerides, phospholipids and cholesterol

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30
Q

What does the fat droplets do to the nucleus

A

Push is to the edge

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31
Q

What is cholestasis

A

When the flow of bile from the liver is reduced or blocked

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32
Q

Where is bile made

A

In the liver

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33
Q

Where is bile stored

A

In the gallbladder

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34
Q

What are the histological features of cholestasis

A
  • bilirubinosistasis (accumulation of bile in the liver)
  • accumulaiton of copper
  • hepatocyte ballooning (feathery degeneration)
  • ductular reaction in portal tracts
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35
Q

Why do we get copper deposition/accumulation

A

Copper is usually excreted into the bile

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36
Q

Can accumulation of cooper be seen with a h and e stain

A

No

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37
Q

What stain can we use to see copper deposition

A

Orcein stain

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38
Q

Where can inflammation in the liver be from

A
  1. Cells that are resident in the normal liver

2. Cells that are recruited elsewhere that are mounted into the liver

39
Q

What are the normal liver immune cells

A

Dendritic cells
Sinusoidal endothelial cells
Kuppfer cells

40
Q

What can these cells create

A

Innate and adaptive immune repsonse

41
Q

What cells can become recruited to the liver from the blood stream

A

Immune cells

42
Q

Where does recruitment of immune cells occur in the liver

A

Portal tracts

Sinusoids

43
Q

In acute hepatitis what are the dominant cells

A

Lymphocytes and plasma cells instead of neutrophils

44
Q

What are the patterns of inflamamton seen in the liver

A

In portal regions

Lobular

45
Q

What will lobular inflammation show on histology

A

Lymphocytes (small cells with dark nuclei) recruited across sinusoids into the liver

46
Q

What can portal region inflammation be associated with

A

Interface hepatitis

Bile duct inflammatory

47
Q

What is interface hepaitis

A

Lymphocytes from the portal tract are extending out into the surrouding parenchyma and damaging hepatocytes

48
Q

What is a granulomatous inflammation

A

When a cell is surrounded by lymphocytes

49
Q

What can inflammation cause to the hepatocytes

A

Damage

50
Q

What can damage to the hepatocytes lead to

A

Apoptosis (programmed cell death)

51
Q

What is apoptosis

A

Programmed cell death

52
Q

What changes does apoptosis lead to in the hepatocyte

A

Cell shrinkage and formation of nuclear debris in a single hepatocytes

53
Q

What is necrosis

A

Uncoordinated cell death

54
Q

What changes does necrosis cause to hepatocytes

A

Cytoplasmis swelling

Fragmentation of the nucleus which affects many hepatocytes

55
Q

What does the liver have a high capacity for after injury

A

Regeneration

56
Q

What is the mechanism for regeneration in the liver

A
  • proliferation of differentiated cells

- proliferation of progenitor cells in the canal of hering

57
Q

Where is the canal of hering

A

Interface between the bile canaliculus and the bile ductile

58
Q

Where is bile made

A

In the canulliculi (space between hepatocytes)

59
Q

Where does bile drain into first

A

Bilary ductile

60
Q

Where does the bilary ductile drain into

A

The bile duct within the portal tract

61
Q

What will happen if the acute insult e.g alcohol is severe and persistent will you get regeneration

A

No we will get chronic liver disease

62
Q

What is the progression to chronic liver disease characterised by

A

Progressive fibrosis

Vascular remodelling

63
Q

What is the end stage of chronic liver disease

A

Cirrhosis

64
Q

How do we get fibrosis

A
  1. Damage to hepatocytes stimulate kuppfer cells to produce chemical mediators
  2. TNF and PDGF cause prolfieration of stellate cells/fibroblasts
  3. TGF beta cause collagen deposition and fibrogenesis
  4. This results in fibrosis in space of disse and formation of portal and central-central fibrous septa
65
Q

What happens if the damage is at the portal tract

A

Portal fibroblasts are activates and collagen is deposited which causes expansion of portal tract and portal-portal bridging fibrosis

66
Q

What is cirhossis characterised by

A

Loss of normal lobular architecture
Nodular regenerstion of hepatocytyes
Fibrosis

67
Q

What is a nodular regeneration of hepatocyte

A

When the hepatocyte nodulaes become completely surrounded by fibrous tissue

68
Q

What are the vascular chnages that occur in cirrhosis

A
  • loss of fenestration of the sinusoidal endothelium
  • perisinusoidal fibrosis (in space of disse)
  • increased resistance in portal tracts due to fibrosis
  • formation of septal shunts
  • thombi
69
Q

What are the clinical complications of cirrhosis

A
  • hepatocellular failure (jaundice, hypoalbuminea, bleeding tendency)
  • portal hypertension
  • hepatocellular carcinoma
70
Q

What are the efects of portal hypertension and what does it show as

A

Ascites
Splenomegaly
Porto-sytemitc shunts

71
Q

What are the causes to fatty liver disese

A

Alchol related fatty liver disease

Non alcohol related liver disease

72
Q

How does hepatocyte injury show on fatty liver disease

A

Steatosis
Ballooning
Mallory denk bodies
Apoptosis/necrosis

73
Q

In inflammation what cells are present

A

Lymphocytes

Neutrophils

74
Q

What can fibrosis in fatty liver disease be

A

Perisinusoidal

Portal

75
Q

Does fatty liver disease progress to cirrhosis

A

Yes

76
Q

In acute hepatitis what inflammatory cells predominate

A

Lymphocytes

Plasma cells

77
Q

What is the pattern of inflammation in acute hepatitis

A

Lobular

78
Q

What is the hepatocyte injury like

A

Swelling
Bilirubinostasis
Apoptosis/necrosis

79
Q

If the insult in acute hepatisis is resolved what happens

A

Regeneration

80
Q

What are the causes of acute hepatitis

A

Viral
Autoimmune
Drug mediated

81
Q

What is the definition of chronic hepatitis

A

Inflammation of the liver that continues for at least 6 months

82
Q

What is the pattern of inflammation in chronic hepatitis

A

Portal based

83
Q

Which cells in chronic hepatits predominate

A

Lymphocytes and plasma cells

84
Q

Is there fibrosis in chronic hepatitis

A

Yes

85
Q

If chronic hepatitis is left untreated what can it lead to

A

Cirrhosis

86
Q

What is chronic biliary disease

A

Bile duct injuyr

87
Q

What features does bile duct injury show on histology

A

Cholestasis with copper deposition
Swelling of biliary epithelial cells
Ulceration of large bile duct

88
Q

Where is inflammation centred in the chronic bilary disease

A

Bile duct

89
Q

Do we get fibrosis in chronic biliary disease

A

Yes

90
Q

What can fibrosis in chronic biliary disease lead to

A

Cirrhosis

91
Q

What are the 2 main chronic biliary disease

A

Primary biliary cholangitis (pbc)

Primary sclerosing cholangitis (psc)

92
Q

What are the charactertic lesion of primary biliary cholangits

A

Granuloma

93
Q

What is the characteristic lesion of primary sclerosing cholangitis (psc)

A

Periductal fibrosis

Cellular Pathology (19 decks)

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