Liver Pathology

Question 1

Describe the main features of a portosystemic shunt

Answer 1

Anomalous venous connection between the portal system and the venous systemic system.
Allows much of the portal blood to bypass the hepatic parenchymal sinusoids.

Question 2

State which size of dog breed usually has each type of portosystemic shunt.

Answer 2

Extra-hepatic: Small dog breeds
Intra-hepatic - Large dog breeds

Question 3

In an intrahepatic congential portosystemic shunt, which vessels are connected?

Answer 3

Left or right portal vein branch with the hepatic vein or directly with the caudal vena cava,

Question 4

In an extrahepatic congential portosystemic shunt, which vessels are most commonly connected?

Answer 4

Left or right gastric vein or splenic vein and the caudal vena cava or azygous vein

Question 5

List four functional consequences of congenital portosystemic shunts

Answer 5

Reduced hepatic perfusion
Small liver - microhepatica
Poor growth
Hepatic encephalopathy

Question 6

List four post-hepatic conditions affecting outflow of blood from the liver

Answer 6

Heart disease - especially right sided congestive heart failure
Obstruction of hepatic veins or caudal vena cava
Hepatic passive venous congestion
Hepatomegaly

Question 7

List three intra-hepatic and pre-hepatic conditions associated with abnormal portal vein inflow.

Answer 7

Advanced chronic liver disease with fibrosis
Portal vein obstruction
Portal vein hypoplasia (especially in small dog breeds)

Question 8

List two consequences of portal hypertension

Answer 8

Ascites
Acquired portosystemic shunts

Question 9

List three substances that may be contained in vacuoles in cases of vacuolar hepatopathy

Answer 9

Lipid (fatty change)
Water (hydropic change)
Glycogen

Question 10

List three gross changes of the vacuolar hepatopathy

Answer 10

Enlargment
Altered colour
Altered consistency

Question 11

List two causes of lipid accumulation within the liver

Answer 11

Excess delivery of free fatty acids to hepatocytes
Reduced hepatocellular capacity to metabolise fats often due to hepatocellular injury.

Question 12

What is glycogen accumulation associated with?

Answer 12

Hyperadrenocortism or corticosteriod administration.

Question 13

What are the three major patterns of necrosis in the liver?

Answer 13

Focal
Zonal
Massive

Question 14

Which zone of the liver is most commonly infected in zonal necrosis?

Answer 14

Zone 3

Question 15

List three typical causes of zonal necrosis of the liver

Answer 15

Hypoxia
Exposure to some toxins
Severe viral infections

Question 16

State a cause of massive necrosis in the liver

Answer 16

Vitamin E/Selenium deficiency in pigs

Question 17

How can hepatocellular regeneration of the liver affect function?

Answer 17

Regeneration becomes nodular and with fibrosis distorts the hepatic architecture

Question 18

Define hepatitis

Answer 18

Inflammation of the liver parenchyma

Question 19

Define cholangitis

Answer 19

Inflammation of the biliary tree

Question 20

Define cholangiohepatitis

Answer 20

Inflammation of the biliary tree and hepatic parenchyma

Question 21

Define cholecystitis

Answer 21

Inflammation of the gall bladder

Question 22

List three key features of acute hepatitis

Answer 22

Acute inflammation
Necrosis
+/- Regenerative changes

Question 23

List four of the sequelae to acute bacterial hepatitis

Answer 23

Healing +/- scarring
Persistence of infection and chronic infammation
Abcess
Chronic hepatitis

Question 24

Explain how fibrosis can affect hepatic function

Answer 24

Fibrosis can interfere with hepatocyte contact with the blood in the sinusoids.
Fibrosis bridging between portal and central regions can contain vascular channels allowing blood to bypass hepatocytes.

Question 25

List three key features of an end-stage liver

Answer 25

Diffuse chronic changes
Disturbed lobular architecture
Distrubed hepatic vasculature

Question 26

List three types of primary hepatic neoplastic disease.

Answer 26

Hepatoceelular origin
Bile duct epithelium origin
Mesenchymal origin