Liver Pathology Flashcards
what makes up the portal triad
hepatic a
portal v
bile ductule
how is a hepatic lobule perfused
center = centrolobular v edges = bundles of portal triads
what are the risks and benefits of Z1 (periportal) in a hepatic lobule
most O2 - least at risk of ischaemia
inc risk from viral hep
what are the risks and benefits of Z3 (periventricular) in a hepatic lobule
most mature/metab active - most liver enz, least O2
inc risk ischemia, inc damage from metab toxis (alco, paracetamol)
what causes acute hepatitis
Hep A/E, drugs
acute hep histology
spotty necrosis
histo of chronic hep
piecemeal necrosis/ - loss of border between portal triad and perenchyma -> bridging fibrosis from portal V to central V
histology of cirrhosius
distortion of vasc architecture, hepatocyte nec, fibrosis
changes to nodule size of regenerating hepatocytes in cirrhosis
alcoholic -> micro
viral/ alpha1/wilsons -> macro
what are some complications of cirrhosis
portal HTN
hepatic encephalopathy
hepatocellular carcinoma
what are the 3 different types of alcoholic liver disease and how do the exist
can all co-exist
- hepatic steatosis
- alco hep
- alco cirrhosis
what is hepatic steaosis
lrg, pale yellow liver - due to fat droplets in hepatocytes
fully reversible
presentation and histo of alco hep
large, fibrotic liber
hepatocye balooning, mallory denk bodies, Z3 damage
presentation and histo of alcoholic ciurrhosis
shrunken brown liver, micronodular cirrhosis
how will NAFLD present
similar to ALD
distiguish based on Hx - insulin res, inc BMI, diabetes
associations of pri sclerosis cholangitis (PSC)
M>F
UC
cholangiocarcinoma
what is the antibody in PSC
pANCA
what will an ultrasound show in PSC
bile duct dilation, onion skinning fibrosis, beading of bile ducts
what are the asso of pri biliary cirrhosis (PBC)
F>M
inflammatory
asso w/ other AI cond
what is the antibody in PBC
anti-mitochondrial Abs
what will a USS show in PBC
bile duct loss with granulomas
no dilation
who is most likely to get AI hep
young or post-menopausal F with other AI cond
what are the 2 types of AI hep
T1 - anti-nuclear ab, anti-smooth muscle ab
T2 - anti liver/kidney microsomal IG
what is the histo of haemachromatosis
inc gut Fe absorbtion -> Fe deposits in hepatocytes -> damage
what is the inheritance and age range of haemachromatosis
auto rec
likely in 40-50y olds
how will haemachromatosis present
skin bronzing + diabetes + hepatomeg
what is the diagnostic inv for haemachromatosis
prussian blue stain
what is the Tx for haemachromatosis
venesection + desferroxamine
what is the inheritance and age of presentation of wilsons
Auto rec
11-14y
what is the histo of wilsons disease
failure of hepatocytes to sec copper into bile -> accum
what is the presentation of wilsons d
liver D, neuro degen (parkisonism), kaiser flescher rings (iris)
what is the diagnostic inv for wilsons d
rhodanin stain
what is the Tx for wilsons D
lifelong peniclillamine
what is the histo of alpha 1 antitrypsin def
failure to sec A1AT _> accum in hepato -> forms periorbital globules -> chronic hep
how will A1At def present
FHx resp issues
kids - neonatal jaundice
adults - emphysema with CLD
what are the risk factors for hepatic adenoma
oral contraceptive
what is the most common benign liver malig
haemangioma
what is the marker for hepatocellular carcinoma
AFP
what is hepatocellular carcinoma associated with
viral hep, alco cirr, NAFLD, aflatoxin
what is the histo of cholangiocarcinoma
capillary ingrowth
what cancer is associated with PSC
cholangiocarcinoma
where do liver cancers met
GIT, breast or bronchus
