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Case 9: Liver > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

What is the 2 manners of cell death in livers

A
  1. Lysis: hepatocytes swell & rupture
  2. Apoptosis: programmed cell death
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2
Q

What is the 4 distributions of necrosis & describe

A
  1. Focal: irregular distribution of single or small groups of necrotic hepatocytes
  2. Confluent: particular region of lobule due to drugs, toxins or ischaemia (centrilobular mid region of lobule or periportal)
  3. Massive/submassive: all/most hepatocytes destroyed due to hepatitis, poisons or drugs
  4. Interface hepatitis: death of single hepatocytes occurring in peri-portal region
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3
Q

What is characteristic of massive/submassive necrosis

A

Bridging links at portal triad w/ central vein caused by acute or chronic hepatitis , drug induced hepatitis or autoimmune hepatitis

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4
Q

When does regeneration occur

A

In response to cell death

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5
Q

What is the 2 outcomes of regeneration

A
  1. Complete recovery: acute injury w/ preserved of reticulum framework
  2. Disorganised lobular architecture: chronic injury
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6
Q

When does degeneration & accumulation occur

A

When there is cell injury but not cell death

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7
Q

What is the two types of degeneration & accumulation

A
  1. Ballooning degeneration: hepatic enlargement w/pale cytoplasm due to water retention
  2. Steatosis: fat accumulation w/ 2 subtypes
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8
Q

What is the 2 types of steatosis

A

A. Macro-vesicular: single & large droplet that displaces the nucleus (alcohol & obesity)
B. Micro-vesicular: large number of tiny droplets & nucleus remain central (acute fatty liver & pregnancy)

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9
Q

What is the 2 classes inflammation is classified into

A
  1. Nature: acute, chronic or granulomatous
  2. Site: portal, lobular or between portal tract & parenchyma
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10
Q

What is the 3 types of granulomatous inflammation

A
  1. Foreign body
  2. Necrosting due to TB
  3. Non-necrotising due to drugs or sarcoidosis
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11
Q

What occur in response to chronic inflammation

A

Fibrosis

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12
Q

What is the two steps of fibrosis

A
  1. Initially pericellular, periportal or perivenular fibrosis
  2. Bands of fibrosis surround nodules of regenerating hepatocytes (cirrhosis)
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13
Q

Define jaundice

A

The yellowing of the skin, sclera & mucous membranes due to increase of conjugated/unconjugated bilirubin due to cholestasis

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14
Q

What is cholestasis

A

Impaired drainage of bile to the duodenum

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15
Q

What is the 3 things that leads to unconjugated bilirubinaemia

A
  1. Prehepatic: overproduction due to haemolysis
  2. Hepatic: impaired cellular uptake due to drugs or sepsis
  3. Hepatic: decrease hepatocellular conjugation due to hereditary transferase impairments
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16
Q

What is the 3 things that leads to conjugated bilirubinaemia

A
  1. Hepatic: impaired hepatocelliular secretion as in hepatitis due to viruses, alcohol or drugs
  2. Intra-& extra hepatic bile duct loss
  3. Extrahepatic biliary obstruction (gallstones)
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17
Q

What is brain damage in neonates called

A

Kernicterus

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18
Q

What is the 3 common causes of acute liver disease

A
  1. Viruses
  2. Drugs
  3. Alcohol
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19
Q

What is the 4 common causes of chronic liver disease

A

> 6 months
1. Viruses: HBV, HDV, HCV, autoimmune hepatitis
2. Drugs
3. Alcohol
4. Cryptogenic

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20
Q

What is the 4 stages of viral hepatitis

A
  1. Asymptomatic
  2. Acute hepatitis
  3. Fulminant hepatitis
  4. Chronic hepatitis
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21
Q

What is asymptomatic viral hepatitis w/ acute & chronic infection

A
  1. Acute infection: pt is well w/ + serology
  2. Chronic infection: carrier of infection usually MTCT w/ little/no inflammation & large hepatocytes w. Ag)
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22
Q

What is acute viral hepatitis

A

Acute febrile illness w/ clinical jaundice

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23
Q

What is fulminant viral hepatitis

A

Massive liver necrosis w/ progression to liver failure w/ encephalopathy
If survive regenerative capacity but if to prolonged leads to post necrotic cirrhosis

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24
Q

What is macroscopic features of fulminant viral hepatitis

A

Small liver w/ dull, wrinkled & firm capsule, flabby substance & bile staine

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25
Q

What causes chronic viral hepatitis

A

HBV & HCV

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26
Q

How is chronic viral hepatitis injury graded according to

A

Inflammation, necrosis & fibrosis/architectural disturbance

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27
Q

Define cirrhosis

A

A diffuse process characterized by the replacement of the normal liver architecture by regenerating nodules of hepatocytes which are surrounded by bands of fibrosis

28
Q

What is the appearance of micronodular cirrhosis

A

Liver is small & firm w/ uniform fine nodules (1-5mm) surrounded by fibrous septa

29
Q

What is the appearance of macronodular cirrhosis

A

Irregular shaped w/ small & large nodules (5cm) containing fibrous septa & portal tracts

30
Q

What is 7 causes of cirrhosis

A
  1. Alcohol causing micronodular cirrhosis
  2. Viral hepatitis w/ B/C causing micronodular cirrhosis & post necrotic cirrhosis causing macronodular cirrhosis
  3. Autoimmune hepatitis
  4. Primary & secondary biliary cirrhosis
  5. Genetic diseases (haemochromatosis & Wilson’s disease)
  6. Cryptogenic
  7. Not true cirrhosis = parasitic & cardiac cirrhosis
31
Q

What is the 3 consequences of cirrhosis

A
  1. Liver failure
  2. Portal hypertension
  3. Hepatocellular carcinoma
32
Q

What is the 3 causes of liver failure

A

Massive heaptic necrosis
Cirrhosis
Hepatic dysfunction w/o necrosis

33
Q

What is the clinical features of liver failure

A

Jaundice
Hyperammonaemia
Impaired oestrogen metabolism (palmar erythema, spider angioma, hypogonadism & gynaecomastia)
Foetor hepaticus

34
Q

Why is liver failure life threatening

A

Failure of other organ systems, coagulopathy & hepatic encephalopathy

35
Q

Define portal hypertension

A

Increased portal venous pressure

36
Q

What is 3 causes of portal hypertension

A
  1. Hepatic: cirrhosis
  2. Prehepatic: portal vein thrombosis
  3. Post-hepatic: severe cardiac failure
37
Q

What is the 4 consequences of portal hypertension

A
  1. Ascites
  2. Porto systemic vascular shunt/varices
  3. Splenomegaly
  4. Hepatic encephalopathy
38
Q

Define ascites

A

Transudate in peritoneal cavity

39
Q

Explain ascites mechanism of action

A

Increased capillary pressure exacerbated by decrease s-albumin due to liver failure
Increase hepatic lymph drainage into peritoneal cavity
Renal sodium retention due to decrease intravascular volume

40
Q

Explain varices mechanism of action

A

Blood bypass high venous pressure of portal veins & return to heart via systemic vein collaterals

41
Q

What is the appearance of the spleen in splenomegaly

A

Spleen is red & firm when cut
Prominent red pulp w/ congestion of sinusoids & atrophy of white lymphoid tissue

42
Q

What is hepatic encephalopathy

A

Complex neuropsychiatric syndrome (disturbance in consciousness & behaviour, personality change & fluctuating neurological signs)

43
Q

What contribute to the cause of hepatic encephalopathy

A

Raised blood ammonia

44
Q

What is 2 common primary benign neoplasm in liver pathologies

A

Adenoma & haemoangioma

45
Q

What is a common primary malignant neoplasms in liver pathologies

A

Hepatocellular carcinoma

46
Q

What is 3 predisposing factors of HCC

A
  1. HBV
  2. Cirrhosis
  3. Toxins produced by fungi
47
Q

State 2 ways in which HCC is spread

A
  1. Haematogenous spread to lungs, brain & bone
  2. Regional lymphatic spread
48
Q

What is the macroscopic appearance of HCC

A

Single/numerous large masses or rarely diffused
Soft, yellow/brown & can be partly necrotic, haemorrhagic or bile stained
Venous invasion often present

49
Q

What is the prognosis of HCC

A

Poor & die of cachexia, liver failure or bleeding varices

50
Q

What is cholangiocarcinoma

A

Intra hepatic bile duct carcinoma not associated with cirrhosis at the helium of the liver causing obstructive jaundice

51
Q

Who is prone to get a hepatoblastoma & why

A

Occur in children <2 years
Contain immature embryonic tissue as an essential component arising from during fetal or early postnatal development

52
Q

What is the most common tumour in the liver

A

Metastatic tumours

53
Q

What is the 2 types of liver abscesses

A
  1. Amoebic
  2. Pyogenic
54
Q

How does an amoebic liver abscess arise

A

Transport of trophozoites form large bowel via portal vein to liver

55
Q

What is the morphology of an amoebic liver abscess

A

Singular or multiple in right lobe

56
Q

What is the morphology of an pyogenic liver abscess

A

Solitary or multiple

57
Q

What is 4 ways in which pyogenic liver abscess arise

A
  1. Bile ducts as ascending cholangitis
  2. Portal vein as portal pyaemia
  3. Hepatic artery as part of septicaemia
  4. Direct spread
58
Q

What is iron overload called

A

Haemachromatosis

59
Q

What is primary/genetic haemachromatosis

A

Homozygous recessive disorder

60
Q

What is 3 causes of secondary haemachromatosis

A
  1. Transfusions
  2. Ineffective erythropoiesis
  3. Increase oral intake of iron
61
Q

What is Wilsons disease & what can it cause

A

Depositions of copper
Can cause acute or chronic hepatitis & cirrhosis

62
Q

What 3 factors influence alcohol induced disease

A
  1. Duration
  2. Level of excess
  3. Individuals response
63
Q

What 3 pathologies can be found w/ alcohol induced disease

A
  1. Steatosis
  2. Acute alcoholic hepatitis
  3. Micronodular cirrhosis
64
Q

What is acute alcoholic hepatitis

A

Hepatocytes necrosis w/ infiltrates of neutrophils w/ fatty changes/ cholestasis & Mallory bodies

65
Q

What is the sequence of event in acute alcoholic hepatitis

A

Early injury to centrilobular, perivenular & pericellular fibrosis then cirrhosis for prolonged period

Case 9: Liver (8 decks)

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