liver pathology

Question 1

what are the identifying histological features of a normal liver?

Answer 1

Identify the lobular structure including the central vein and portal triad (portal vein, hepatic artery and bile duct)

Question 2

what makes up the portal triad?

Answer 2

the portal vein, hepatic artery and bile duct

Question 3

what are the identifying histological features in alcoholic liver disease, (fatty change)?

Answer 3

Identify the changes in the hepatocyte corresponding to fatty change
Can you find immune cells infiltrating the sample?

Question 4

what are the identifying histological features in chronic active hepatitis?

Answer 4

Identify infiltrating immune cells
Any regions of fibrosis (should be a small amount)
Is there fatty change in the sample

Question 5

what are the identifying histological features in Alcoholic cirrhosis?

Answer 5

Identify regions of extensive fibrosis and miconodular cirrhosis
Is there any evidence of fatty change?
Are there immune cells in the sample?

Question 6

what are the identifying histological features in Metastatic adenocarcinoma?

Answer 6

Locate the border between the normal liver and the tumour
Describe the appearance of the tumour cells and their arrangement (fibrosis in the tumour region)
What kind of structure are the tumour cells forming (or attempting to form)?

Question 7

what are the identifying histological features in Centrilobular necrosis?

Answer 7

Identify regions of extensive apoptosis/necrosis
Try to orient with respect to the circulation

Question 8

what are the two main types of fatty acid liver disease?

Answer 8

Alcoholic liver disease
Non-alcoholic liver disease

Question 9

what is a fatty liver?

Answer 9

lipid drops build up in fatty droplets in the hepatocytes in the perenchyma

Question 10

what are the symptoms of fatty liver?

Answer 10

mild jaundice
steatosis
fatty stool

Question 11

what is Red Oil O?

Answer 11

Lysochrome (fat-soluble dye)
Can be visualised in bright light and fluorescent microscopy

Question 12

what counter stain is used with Red oil O?

Answer 12

haematoxylin (stains nuclei blue)

Question 13

what are the three forms of alcohol induced liver injury?

Answer 13

Steatosis (fatty change)
Alcoholic steato-hepatitis
Fibrosis- leads to cirrhosis

Question 14

what are the causes of excessive alcohol intake?

Answer 14

steatosis
dysfunction of mitochonria, microtubules and cellular membranes
oxidative stress

Question 15

what is the overall effect of excessive alcohol intake?

Answer 15

varying degrees of inflammation and hepatocyte death

Question 16

what is significant alcohol intake?

Answer 16

more than 80g per day

Question 17

what are the features of seatosis?

Answer 17

Fatty change
Perivenular fibrosis

Question 18

what are the features of hepatitis?

Answer 18

Liver cell necrosis
Inflammation
Mallory bodies
Fatty change

Question 19

what are the features of cirrhosis?

Answer 19

Fibrosis
Hyperplastic nodules

Question 20

what is irreversible liver damage?

Answer 20

cirrhosis, fibrotic change occurs

Question 21

what is the inflammatory stage of liver damage?

Answer 21

steatohepatisis

Question 22

what are the differences between a fatty liver and a normal liver?

Answer 22

Discolouration of fatty liver due to fatty change (becomes yellowish)
The fatty liver is enlarged compaired to the normal liver

Question 23

what are the histological differences between a normal liver and a fatty liver?

Answer 23

In the fatty liver, the vacuoles appear empty due to the lipid droplets in the hepatocytes (they are actually empty as the lipid is lost during slide processing

Most of the hepatocytes of the liver show evidence of lipid accumulation

Question 24

when is liver damage irreversible?

Answer 24

when there is fibrotic remodeling of the underlying reticulin framework

Question 25

what are the two alcohol-induced causes for the infiltration of inflammatory cells into the liver?

Answer 25

1. Hepatocyte damage and necrosis/apoptosis
2. Absorbing endotoxins from the gut
   - both cause the release of cytokine attracting inflammatory cells

Question 26

what other cells are important in the pathogenesis of alcoholic liver disease?

Answer 26

Kupffer cells: respond to endotoxins and release cytoines that stimulate HSCs
Hepatic stellate cells (HSCs): differentiate into myofibroblasts and initiate fibrosis

T cells and macrophages can be involved in clearing apoptotic and necrotic cells

Question 27

what can we see histologically in the iver foloowing chronic alcohol intake?

Answer 27

Fatty change (empty vacuoles in the cells where the lipid was stored before being lost in slide processing

Question 28

what does fibrosis develop into if the stimulus is not removed?

Answer 28

fibrosis leads to remodeling and eventually, this will cause nodules due to fibrotic septa/bridges that isolate the regenerating hepatocytes.

Question 29

how do nodules form?

Answer 29

nodules are caused by fibrosis isolating a region of replicating cells

Question 30

what does a compromised liver have a green tinge?

Answer 30

discoloured due to cholestasis

Question 31

what happens when fibrosis surrounds the hepatocyte island?

Answer 31

They lose proper connection to the blood flow, and are unable to secrete bile/bilirubin. Also impairs the blood flow through the liver, leading to systemic effects due to portal hypertension