Liver Pathology Flashcards by selcan icli

What are the categories of causes of liver injury

Immune mediated 
Drug induced
Infectious 
Metabolic 
Mechanical

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What are the causes of immune mediated liver injury

Autoimmune hepatitis
Primary bilary cholangitis
Primary sclerosing cholangitis
Transplant rejection

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What are the causes of drug induced liver injury

Alcohol

Therapeutic agents

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What are the infectious causes of liver injury

Hepatotropic viruses

Other infections

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What are the causes of metabolic liver injury

Non alcoholic fatty liver disease

Inherited/acquired metabolic disease

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What are the mechanical causes of liver injury

Biliary obstruction

Vascular disorders

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When are liver biopsys needed

To give primary diagnosis

To give additional information about the primary diagnosis

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What are the common ways of getting a liver biopsy

Percutaenous
Transjugular
Open (intra operative)

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What is the problem with liver biopsy

The biopsy are small in size

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What does the portal tract contain

Hepatic artery
Bile duct
Portal vein

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What is the role of portal tract

Allow inflow of vascular blood and outflow of bile from liver

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Where does blood from the portal vein drain into

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

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What is the hepatic sinusoid lined by

Fenestrated sinusoidal endothelial cells

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Where are kuppfer cells located

In the sinusoid

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What are kupffer cells

Macrophages

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What is the gap between sinusoidal cells and kuppfer cells called

Space of disse

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What does the space of disse contain

Stellate cells

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What is the role of stellate cells

Store fat in resting state

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In disease which cells mediate fibrosis

Stellate cells

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What ar the zones in the liver

Zone 1 (periportal)
Zone 2 (mid zone)
Zone 3 (centrilobular zone)

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What is zone 1

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

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What is in zone 3

Central vein

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What is the portal triad

Portal vein
Bile duct
Hepatic artery

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

Ballooning

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Why is there ballooning

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

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

Sodium

What formation forms within the ballooned hepatocytes

Mallory denk bodies

What are mallory denk bodies

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

What is steatosis

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

What does the fat droplets do to the nucleus

Push is to the edge

What is cholestasis

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

Where is bile made

In the liver

Where is bile stored

In the gallbladder

What are the histological features of cholestasis

- bilirubinosistasis (accumulation of bile in the liver) - accumulaiton of copper - hepatocyte ballooning (feathery degeneration) - ductular reaction in portal tracts

Why do we get copper deposition/accumulation

Copper is usually excreted into the bile

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

What stain can we use to see copper deposition

Orcein stain

Where can inflammation in the liver be from

1. Cells that are resident in the normal liver | 2. Cells that are recruited elsewhere that are mounted into the liver

What are the normal liver immune cells

Dendritic cells Sinusoidal endothelial cells Kuppfer cells

What can these cells create

Innate and adaptive immune repsonse

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

Immune cells

Where does recruitment of immune cells occur in the liver

Portal tracts | Sinusoids

In acute hepatitis what are the dominant cells

Lymphocytes and plasma cells instead of neutrophils

What are the patterns of inflamamton seen in the liver

In portal regions | Lobular

What will lobular inflammation show on histology

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

What can portal region inflammation be associated with

Interface hepatitis | Bile duct inflammatory

What is interface hepaitis

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

What is a granulomatous inflammation

When a cell is surrounded by lymphocytes

What can inflammation cause to the hepatocytes

Damage

What can damage to the hepatocytes lead to

Apoptosis (programmed cell death)

What is apoptosis

Programmed cell death

What changes does apoptosis lead to in the hepatocyte

Cell shrinkage and formation of nuclear debris in a single hepatocytes

What is necrosis

Uncoordinated cell death

What changes does necrosis cause to hepatocytes

Cytoplasmis swelling | Fragmentation of the nucleus which affects many hepatocytes

What does the liver have a high capacity for after injury

Regeneration

What is the mechanism for regeneration in the liver

- proliferation of differentiated cells | - proliferation of progenitor cells in the canal of hering

Where is the canal of hering

Interface between the bile canaliculus and the bile ductile

Where is bile made

In the canulliculi (space between hepatocytes)

Where does bile drain into first

Bilary ductile

Where does the bilary ductile drain into

The bile duct within the portal tract

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

No we will get chronic liver disease

What is the progression to chronic liver disease characterised by

Progressive fibrosis | Vascular remodelling

What is the end stage of chronic liver disease

Cirrhosis

How do we get fibrosis

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

What happens if the damage is at the portal tract

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

What is cirhossis characterised by

Loss of normal lobular architecture Nodular regenerstion of hepatocytyes Fibrosis

What is a nodular regeneration of hepatocyte

When the hepatocyte nodulaes become completely surrounded by fibrous tissue

What are the vascular chnages that occur in cirrhosis

- 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

What are the clinical complications of cirrhosis

- hepatocellular failure (jaundice, hypoalbuminea, bleeding tendency) - portal hypertension - hepatocellular carcinoma

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

Ascites Splenomegaly Porto-sytemitc shunts

What are the causes to fatty liver disese

Alchol related fatty liver disease | Non alcohol related liver disease

How does hepatocyte injury show on fatty liver disease

Steatosis Ballooning Mallory denk bodies Apoptosis/necrosis

In inflammation what cells are present

Lymphocytes | Neutrophils

What can fibrosis in fatty liver disease be

Perisinusoidal | Portal

Does fatty liver disease progress to cirrhosis

Yes

In acute hepatitis what inflammatory cells predominate

Lymphocytes | Plasma cells

What is the pattern of inflammation in acute hepatitis

Lobular

What is the hepatocyte injury like

Swelling Bilirubinostasis Apoptosis/necrosis

If the insult in acute hepatisis is resolved what happens

Regeneration

What are the causes of acute hepatitis

Viral Autoimmune Drug mediated

What is the definition of chronic hepatitis

Inflammation of the liver that continues for at least 6 months

What is the pattern of inflammation in chronic hepatitis

Portal based

Which cells in chronic hepatits predominate

Lymphocytes and plasma cells

Is there fibrosis in chronic hepatitis

Yes

If chronic hepatitis is left untreated what can it lead to

Cirrhosis

What is chronic biliary disease

Bile duct injuyr

What features does bile duct injury show on histology

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

Where is inflammation centred in the chronic bilary disease

Bile duct

Do we get fibrosis in chronic biliary disease

Yes

What can fibrosis in chronic biliary disease lead to

Cirrhosis

What are the 2 main chronic biliary disease

Primary biliary cholangitis (pbc) | Primary sclerosing cholangitis (psc)

What are the charactertic lesion of primary biliary cholangits

Granuloma

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

Periductal fibrosis