Liver Pathology Flashcards
What are the main functions of the liver?
Protein synthesis and coagulatory factors synthesis
When are AST and ALT released?
When there is injury or inflammation, they are released
In which other pathologies is serum lactate dehydrogenase released (LDH)?
In hemolytic anemia
What is hepatitis?
Inflammation of the liver, can be acute or chronic
What are the causes of hepatitis?
Hepatotropic viruses: A, B, C, D, E
What are the other causes of hepatitis?
Other viruses like EBV, CMV, and yellow fever
Autoimmune hepatitis
Drugs and toxins
What is the most common type of hepatitis?
Viral
What do hepatitis viruses cause?
Acute hepatitis that can progress to chronic
What does acute hepatitis usually present with?
Jaundice
Dark urine
Fever
Malaise
Nausea
Elevated liver enzymes (ALT> AST)
What causes the jaundice of viral hepatitis?
Both the conjugated and the unconjugated bilirubin
What does conjugated bilirubin indicate?
Problem with the biliary system
What does unconjugated bilirubin indicate?
Usually hemolytic anemia, especially in infants
When can chronic hepatitis progress into cirrhosis?
When the symptoms last over 6 months
What is the purpose of performing a biopsy exam?
Important for grading (inflammation) and staging (fibrosis) of the disease, which is then used to diagnose whether a patient needs antiviral treatments.
Why do doctors try to avoid performing a biopsy?
Because it is an invasive procedure, so unless it is a chronic case, doctors try to avoid it
What does HEV case in pregnancy?
Fulminant hepatitis
Which hepatitis virus kinds are considered to be acute?
Hepatitis A & E
What can HBV cause?
Acute hepatitis with joint pain and skin rash
What is the most common cause of chronic hepatitis?
Hepatitis C that can cause cryoglobulinemia
What is cryoglobulinemia?
When cryoglobulin is increased in the blood, abnormal proteins are elevated in the blood, and those proteins thicken in cold temperatures
What is a specific HDV characteristic?
HDV is dependent on HBV, superinfection is more severe than co-infection
What is the difference between co-infection and superinfection?
Co-infection: both infections occur at the same time
Superinfection: firstly infected with HBV and later on infected with HDV
What are the main clinical features of hepatitis?
Abdominal pain (caused by hepatomegaly, which is caused by inflammation)
Fever
Jaundice
What are the lymphocytes like in viral hepatitis?
Abnormal or enlarged from antigen stimulation
What are the pathological features of acute viral hepatitis?
Characterized by ballooning degeneration, apoptosis or lobular hepatitis
Portal infiltrate is minimal (T-lymphocytes)
What are the pathological features of acute viral hepatitis in severe cases?
Confluent or bridging necrosis with pan-lobular lymphocytic inflammation
What causes apoptosis in acute viral hepatitis?
Councilman body decrease triggered by cytotoxic T cells
Why is there pan-lobular inflammation in severe cases of acute viral hepatitis cases?
There are a lot of lymphocytes within the liver, so in severe cases, many of them are affected, leading to panlobular inflammation
What are the pathological features of chronic viral hepatitis?
The portal infiltrates are dense and prominent, also interface hepatitis and lobular hepatitis
Bridging necrosis and fibrosis
Ductular reactions
What is the hallmark of progressive chronic liver damage?
Bridging necrosis and fibrosis
Why is there fibrosis in the chronic viral hepatitis cases?
Infection will not be completely cleared, there will be some residue of chronic hepatitis
How do ductular reactions progress with the progression of chronic hepatitis?
Minimal in early stages of scarring but becomes extensive in late-stage disease
What does chronic viral hepatitis due to HCV show characteristically?
Portal tract expansion by a lymphoid cell forming lymphoid follicle
May show fatty change of scattered hepatocytes
Bile duct injury
What are the pathological features of HBV?
Ground-glass hepatocytes
Large, pale, finely granular cytoplasmic inclusions on H&E staining
What are ground glass hepatocytes and what causes them?
When you cannot see through the hepatocytes, caused by the accumulation of hepatitis B surface antigen
What does immunostaining confirm in HBV?
Presence of surface antigen (brown colour)
What are the different possible outcomes of hepatitis infection?
Subclinical
Acute hepatitis
Chronic hepatitis
Asymptomatic carrier
What is the definition of subclinical?
Not noticed during the infection period, but the patient has acquired antibodies
What are the possibilities of subclinical infection?
Recovery
What are the possible outcomes of acute hepatitis?
Recovery
Fulminant hepatitis –> Death or transplant
What are the possible outcomes of chronic hepatitis?
Recovery
Cirrhosis –> Hepatocellular carcinoma –> Death or Transplant
What is autoimmune hepatitis?
Autoimmune progressive hepatitis with genetic predisposition, associated with another auto-immune disease, with antibodies and response to immunosuppression therapy
What are the two types of autoimmune hepatitis?
Type 1: middle-aged women, antinuclear & anti-smooth muscle antibodies
Type 2: children & teenagers, anti-liver kidney microsomal & anti-liver cytosol antibodies
What happens if autoimmune hepatitis is not treated?
May follow indolent course, if untreated may cause liver failure or cirrhosis
What are the clinical and microscopical features of autoimmune hepatitis?
Share features of viral hepatitis, but plasma cells (unlike viral –> lymphocytes) predominate with hepatocyte rosettes
What are hepatocytes rosettes?
Hepatocytes that look like roses
What is the predictable drug and toxin-induced liver injury?
Acetaminophen, the toxic agent, is a toxic metabolite produced by the CYP450 system that causes acute liver failure that requires transplantation
What is the unpredictable (idiosyncratic) drug and toxin inducer liver injury?
Chlorpromazine, an agent that causes cholestasis in patients who are slow to metabolize it, and halothane and its derivatives can cause fatal immune-mediated hepatitis after repeated exposure
What is alcohol liver disease?
Damage to hepatic parenchyma due to consumption of alcohol
What is the progression of alcohol liver disease?
Alcohol fatty change –> Alcoholic or steatohepatitis –> Alcoholic steatofibrosis (cirrhosis)
What is fatty liver (steatosis)?
Accumulation of fat in hepatocytes (micro & macrovesicular steatosis)
What is the result of fatty liver?
Heavy, greasy liver
How is fatty liver disease resolved?
With abstinence
What is alcoholic steatohepatitis?
Characterized by hepatocellular damage seen as swelling of hepatocytes (ballooning) and necrosis