Liver Pathology

Question 1

Acetaminophen Overdose

What actually causes the liver damage?

Answer 1

Too much acetaminophen cannot be metabolized by your liver (overwhelms the glutathione). Therefore, the drug is made into NAPQI, a toxic metabolite

Question 2

Acetaminophen Overdose

How should it be treated?

Answer 2

NAC (N-acetylcysteine)

Question 3

What is the characteristic histologic marker of autoimmune hepatitis?

Answer 3

Plasma cell infiltrate

Question 4

“Interface hepatitis” almost always indicates the patient has…

Answer 4

Autoimmune hepatitis

Question 5

Autoimmune hepatitis

Describe the basic pathology and treatment

Answer 5

Presents as acute or chronic hepatitis. Elevated IgG and gamma globulins and auto-antibodies (ANA, anti SMA). T cell mediated autoimmunity

Treat with immunosuppression (steroids)

Question 6

Alcohol Fatty Liver Disease

Is it reversible? What causes it?

Answer 6

Generally yes

Short term ingestion of alcohol is most common cause

Question 7

Alcohol Fatty Liver Disease

How do the cells appear histologically?

Answer 7

Macrovesicular cells (nucleus pushed to the side with lots of fat in cells)

May see pericellular fibrosis

Question 8

What is Mallory Hyaline? What disease does it indicate?

Answer 8

Large proteinaceous debris in cells

Classic for alcoholic hepatitis

Question 9

Non Alcoholic Fatty Liver Disease

How might it appear histologically?

Answer 9

Could be identical to alcoholic fatty liver disease

Steatosis
Hepatocyte ballooning
Lobular inflammation

Question 10

Hemochromatosis

What are the causes?

Answer 10

Hereditary- homozygous recessive mutation

Secondary- excess transfusions or hemolysis

Question 11

Hemochromatosis

Treatment

Answer 11

Phlebotomy

Chelation

Question 12

Hemochromatosis

What is the pathological issue?

Answer 12

Iron deposition in parenchymal tissues

Elevated serum iron, ferritin

Elevated risk for hepatocellular carcinoma in setting of cirrhosis

Question 13

Hemochromatosis

What mutations may be present?

Answer 13

HFE gene mutation (chr 6)

C282Y Homozygote

H63D homozygote

Compound heterozygote for C282Y/H63D

Question 14

Wilson’s Disease

What is the basic pathological issue?

Answer 14

Copper accumulation in the liver and brain

Autosomal recessive disorder

Question 15

Wilson’s Disease

Symptoms

Answer 15

Low ceruloplasmin

Neuropsychiatric (Cu deposition in brain)

Kayser Fleischer rings (Cu deposition in eye)

Liver failure

Hemolytic anemia

Question 16

Wilson’s Disease

How would you diagnose it?

Answer 16

Screening - look for low ceruloplasmin

Check urine copper- should be high in Wilson’s

Liver biopsy and stain for copper

Look for KF rings in eyes

Question 17

Alpha 1 Antitrypsin Deficiency

What is the genetic mutation commonly associated?

Answer 17

PiZZ

Question 18

Alpha 1 Antitrypsin Deficiency

What is the basic pathological issue?

Answer 18

Errors in coding sequence to prevent its export from hepatocyte, resulting in cell death, inflammation, fibrosis, cirrhosis

Causes pulmonary emphysema

Question 19

Alpha 1 Antitrypsin Deficiency

How might this be viewed histologically?

Answer 19

PAS stain will be positive for cytoplasmic globules

Question 20

Budd-Chiari Syndrome

What is the primary pathological problem and symptoms?

Answer 20

Hepatic vein obstruction/thrombosis

Symptoms:
Hepatomegaly
Ascites
Abd pain
Hepatic dysfunction

Question 21

Budd-Chiari Syndrome

Commonly occurs with what disorders?

Answer 21

Myeloproliferative disorders

Inherited disorders of coagulation (Factor V Leiden)

Question 22

Budd-Chiari Syndrome

How does the liver appear grossly and on histology?

Answer 22

Large, congested liver

Engorged and congested sinusoids
Centrilobular congestion

Question 23

Veno-Occlusive Disease

Also known as…?

Answer 23

Sinusoidal obstructive syndrome

Question 24

Veno-Occlusive Disease

What patients most commonly get this disease?

Answer 24

Bone marrow transplant

Chemotherapy pts

Question 25

Veno-Occlusive Disease

What is the pathological issue? Symptoms?

Answer 25

Injury to sinusoidal endothelium resulting in occlusion of small hepatic veins

Also get fibrosis and obliteration of the central vein

Hepatomegaly
Weight gain
Jaundice

Question 26

Acute Fatty Liver of Pregnancy

When is is most likely to occur?

Answer 26

3rd trimester

Question 27

Acute Fatty Liver of Pregnancy

Describe the histology and pathology of the disorder

Answer 27

Microvesicular fatty infiltration of the liver

Leads to acute liver failure and encephalopathy

Question 28

Acute Fatty Liver of Pregnancy

Treatment

Answer 28

Need to induce labor ASAP