Liver Pathology Flashcards
What is ballooning degeneration?
What are conditions in which it occurs? (3)
Ballooning degernation is depletion of ATP with loss of volume control
It results from severe cell injury including ischemia, cholestasis, toxicity due to alcohol
What are causes of macrosteatosis? (list)
Obesity, alchol, drugs/toxins, HepC, ischemia, TPN, CF, metabolic
What are causes of microsteatosis?
Fatty liver of pregnancy Drugs (valproate) Toxins Inherited diseases Reye's syndrome
What are causes of unconjugated hyperbilirubinemia?
Physiologic jaundice
Bilirubin overproduction: hemolysis, hematomas, dyserythropoiesis
Diminished bilirubin uptake (RH failure)
Inherited disorders: UGT1A1- Cigler Najjar and Gilbert Syndrome
What is kernicterus?
Complication of severe unconjugated hyperbilirubinemia– circulating free bilirubin crosses BBB and desposits within neurons of basal ganglia
What are some of the pathologic appearances of cholestasis in liver? (3)
Feathery degeneration of hepatocytes
Rosetting/psuedoglandular arrangement of hepatocytes in prolonged cholestasis
Portal expansion and bile duct proliferation in obstructive cholestasis
What are two major types of hepatocellular necrosis?
Cytolytic: irreversible ballooning of hepatocytes due to defective osmotic regulation resulting in cell swelling/death. Toxic cause
Coagulative: architecture of dead tissue preserved; results from ischemic damage
Describe the difference between confluent and zonal necrosis
Confluent: Death of groups of adjacent hepatocytes (“like a geographic area”)
Zonal: confluent necrosis that exhibits a zonal distribution in the lobule
What are the lab measurements that are taken to evaluate liver disease?
Hepatocyte integrity: AST, ALT, LDH
Biliary function: BR, bile acids, canalicular enzymes (Alk-Phos, GGT)
Synthetic function: Albumin, coagulation factors, ammonia
What is the mechanism for chronic injury outcome?
Chronic injury==>Kipper cell activation==>Activation of stellate cells==>liver fibrosis==>Cirrhosis
Describe the gross/histological appearance of cirrhosis
What are the leading cause of cirrhosis?
Gross: parenchymal nodules surrounded by fibrous tissue
Histo: islands of parenchyma with tons of fibrotic tissue between
Leading causes: HepB/C, NAFLD, alcoholic liver disease
Acute Liver Failure:
What are most common causes? What are complications of liver failure? (2)
Common causes: Viral hepatitis (worldwide), acetaminophen overdose (West)
Complications include cerebral edema/intracranial hypertension
Describe the histological appearance of acetaminophen toxicity
Confluent coagulative necrosis involving mid-zones (II/III)
Describe gross and histological appearance for fulminant liver failure
Gross: significantly shrunken liver
Histo: parenchymal loss results in central vein and portal tract looking very similar due to reticulin collapse (“accordion collapse of veins”)
Contrast the morphological features of acute vs. chronic hepatitis
Acute: Ballooning degeneration, apoptosis, cholestasis, little mononuclear infiltrate
Chronic: Bridging necrosis, dense mononuclear infiltrate, fibrosis of portal veins
Describe the etiologies associated with variety of inflammatory cell types
Hepatotropic viruses: lymphocytes Bacteria: neutrophils Mycobacteria/fungi: granulomas Autoimmune: lymphocytes/plasma cells Drugs: eosinophils Transplant rejection: eosinophils and lymphocytes
Describe the histological features for acute hepatitis (2)
Hepatocellular injury with lobular inflammation
Giant cells
What are types of necrosis observed with severe acute hepatitis? (2)
Confluent necrosis due to parenchymal collapse
Bridging necrosis resulting in portal-portal or portal-central linking
What are etiologies of granulomatous hepatitis (5)
Infections: TB Foreign body reactions Drug reactions Autoimmune disease Primary biliary cirrhosis
What are the etiologies for chronic hepatitis? (4)
Chronic viral hepatitis
Autoimmune hepatitis
Metabolic diseases: A1antitrypsin deficiency or Wilson’s disease
Drugs
What do grade and stage measure in liver biopsy of chronic hepatitis case?
Grade: severity of inflammation and cellular injury
Stage: extent of fibrosis
What is interface activity?
Interface activity refers to inflammation/hepatocellular injury at border between portal tract and the lobule (“limiting plate”)
Describe morphological features of HepB vs. HepC
Both: lobular and portal infiltration
HepB: Evidence of antigen on staining (surface/core antigen), ground glass hepatocytes (accumulation of HepB surface protein)
HepC: More pronounced fat infiltration (steatosis)
Describe epidemiology of autoimmune hepatitis
Female preponderance (70-90%) Association with other autoimmune diseases (PSC)
What are the difference types of autoimmune hepatitis (2)
Type I: anti-SMA/ANA with peak incidence 16-30yo
Type II: anti-LKM, peak incidence 10yo
Type II is more aggressive
Describe the histology of autoimmune hepatitis?
chronic hepatitis (lobular hepatitis) with plasma cell infiltrate
