Liver Pathology Flashcards

1
Q

Demographic of liver disease?

A

1.9% of all deaths due to liver disease
Eight leading cause of death

7.2/100.000/year chronic liver disease

57% Hepatitis C
24% Alcohol related
9% Non-alcoholic fatty liver
4% Hepatitis B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Indications and purpose of a liver biopsy?

A

Indications:
Acute and chronic liver dysfunction
Hepatomegaly
Space occupying lesions

Purpose
Cause
Severity (stage of progression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Liver biopsy methods?

A

Open (per-operative)
Laparoscopic
Trans-jugular
Fine needle aspiration cytology
Per-cutaneous
blind
targeted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis of liver disease?

A

Functional abnormalities:
Metabolism
Protein
Carbohydrate
Lipid
Bile acid
Bilirubin
Hormone and drug
Removal of microbes/toxins
Exctretion
Immunological function

Pathological manifestations:
Limited number of pathological response patterns to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Manifestation of liver disease?

A

Intracellular accumulation
Fatty change (steatosis)
Iron
Copper / Copper assoc. protein
Storage disease

Liver cell necrosis
Liver cell apoptosis
Inflammation
Cholestasis
Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathogenesis of liver regen and damage?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aetiology of acute liver diease?

A

ACUTE
Infective Hepatitis
Autoimmune
Toxic
Vascular Damage
Biliary Obstruction
gall stones
tumours

Metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aetiology of chronic liver injury?

A

CHRONIC
Infective Hepatitis
Autoimmune
Toxic
Vascular Damage
Biliary Disease
primary biliary cirrhosis
sclerosing cholangitis
graft vs host disease
transplant rejection
Metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of acute hepatitis?

A

Hepatitis viruses
EB Virus, CMV
Leptospirosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tell me about the hep viruses?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tell me about he hep viruses and IG response in acute liver injury?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tell me about hep and IG response in chronic viral injury?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Visual diff in acute and chronic hepititis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hep B stats?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hep C stats?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Autoimmune hep?

A

Acute, fulminant onset
chronic active hepatitis (anti SM, ANA, LKM1 antibodies)

17
Q

Describe changes in alcoholic liver disease?

A

Fatty change (steatosis)
Steatohepatitis:
Spotty (focal) liver cell necrosis
Neutrophils
Mallory’s hyaline:
eosinophilic globules of intermediate filaments in hepatocytes
Perivenular fibrosis
Micronodular cirrhosis

18
Q

What causes Non-Alcoholic Steato-Hepatitis (NASH)Non-Alcoholic Fatty Liver (NAFL)?

A

Diabetes mellitus
Drugs
Parenteral nutrition
Intestinal by-pass surgery

19
Q

Describe Drug-induced hepatotoxicity?

A

Intrinsic hepatotoxins
e.g. paracetamol
Idiosyncratic hepatotoxins
hypersensitivity
metabolic

May lead to
hepatitis
cholestasis
fatty change (steatosis)
fibrosis

20
Q

Causes of hepatocellular damage?

A
21
Q

Vascular pathology that causes liver disease?

A

acute:

hypotension
right sided cardiac failure
hepatic venous outflow obstruction (Budd-Chiari)

Chronic:

right sided cardiac failure
venoocclusive disease

22
Q

Hepatic venous outflow obstruction and veno-occlusive diease?

A

Membranous obstruction
Tumours
Hepatic venoocclusive disease
alkaloids
Senecio (ragwort)
Crotalaria (bush tea)
alcoholic liver disease
blood disorders
radiotherapy
cytotoxic drugs

23
Q

Biliary obstruction, acute and chronic?

A

Acute:

Gallstones

tumours

Chronic:

primary biliary cirrhosis
Antimitochondrial antibodies

sclerosing cholangitis
 With IBD (UC)

graft vs host disease
transplant rejection

Metabolic
iron overload - Genetic haemochromatosis (chromosome 6p) C282Y mutation HFE gene (see pic)

Chronic anaemia
increased absorption
multiple transfusions
High dietary intake
Alcoholic liver disease
Chronic liver failure
Porphyria cutanea tarda

-1-antitrypsin deficiency
PiZ mutation; PiZZ phenotype
Cathepsin, elastase, proteinase inhibition
Wilson’s disease (copper overload)
Chr 13 Copper transporting ATPase

24
Q

List metabolic diseases for carb, protein, glycoprotein and lipid?

A

Carbohydrate: glycogen storage disease
galactosaemia
Protein: tyrosinaemia
urea cycle disorders
Glycoprotein: mucopolysaccharidoses
Lipid: lipidoses

25
Q

What is Cirrhosis?

A

diffuse process in which the normal lobular architecture is destroyed and the parenchyma is converted into structurally abnormal nodules of liver cells separated by bands of fibrosis

It is an irreversible condition that represents the end stage of chronic liver cell damage and regeneration occurring simultaneously

26
Q

Causes of cirrhosis?

A

Alcoholic liver disease 60%-70%
Non-Alcoholic Fatty Liver Disease ? high
Viral Hepatitis 10%
Autoimmune hepatitis
Chronic cholestatic liver disease 5-10%
Iron and copper overload 5%
Drugs & toxins Rare
-1-antitrypsin deficiency Rare
Idiopathic 10-15%

27
Q

types of nodules in cirrhosis?

A

Micronodular:
nodules up to 3mm
Macronodular
nodules more than 3mm (up to 30mm)

28
Q

Consequences of cirrhosis

A

Impaired liver function:
hypoalbuminaemia
oedema
reduced synthesis of coagulation factors
bleeding
decreased metabolism of endogenous oestrogens
testicular atrophy
gynaecomastia
spider naevi

failure of detoxification
encephalopathy (decompensated cirrhosis)
alcohol binge
intercurrent infection
gastrointestinal bleed
shock
hepatocellular carcinoma
hepatorenal syndrome

Portal hypertension:
varices at sites of porto-systemic anastomosis
oesophageal
rectal
peri-umbilical (caput medusae)
splenomegaly
portal vein thrombosis

29
Q
A