Liver Pathology Flashcards
Types of pre-hepetic jaundice?
haemolysis of all causes
haemolytic anaemia
uncojugated bilirubin
Types of intra-hepatic jaundice?
acute liver failure alcoholic hepatitis cirrhosis bile duct loss pregnancy
Types of post-hepatic jaundice
Always involve the bile duct.
Congenital biliary atresia
Gallstones block the common bile ducts
Stricture of the common bile duct
Tumours
What is cirrhosis?
Bands of fibrosis separating regenerative nodules of hepatocytes
- hepatic microvasculature is altered
- hepatic function is lost
What are the complications of cirrhosis?
Portal hypertension, causing:
- oesophageal varices
- caput medusa
- haemorrhoids
Hypoalbuminaemia:
-ascites
Liver failure
Alcoholism results in abnormal metabolism of…
fats, which eventually leads to fatty liver (Steatosis).
What are the pathological features of alcoholic hepatitis?
hepatocyte necrosis
neutrophils infiltration
mallory bodies
pericellular bodies
What are the causes of NASH (non-alcoholic steatohepatitis)?
diabetes
obesity
hyperlipidaemia
What are the causes of pre-hepatic jaundice?
Generally, excess haem break-down:
- haemolysis
- haemolytic anaemias
- excess unconjugated bilirubin
What are the causes of intra-hepatic jaundice?
Death or injury to liver cells:
- acute liver failure (viral, drugs, alcohol)
- alcoholic heapatitis
- decompensated cirrhosis
- bile duct loss (PBC, PSC)
- pregnancy
What are the causes of post-hepatic jaundice?
Bile cannot be transported into the bowel:
-gallstones blocking the common bile duct
-stricture of the common bile duct
tumours (e.g. head of pancreas)
What are the causes of portal hypertension?
-Budd-CHiari syndrome (blockage of central veins draining liver lobules)
-Cirrhosis
-portal fibrosis
-sarcoidosis
portal vein sclerosis
What pathophysiology results from chronic cirrhosis?
- Ascites (albumin holds fluid in circulation - it is not produced; combined with portal hypertension)
- Oedema (hypoalbuminaemia)
- Haematemesis (reptured oesophageal varices)
- Spider naevi and gynaecomastia (hyperoestrogenism)
- Purpura and bleeding (reduced clotting factors)
- Coma (toxic gut bacterial metabolites are not eliminated)
- Infection (Kupffer cells reduce in numbers)
What is the pathogenesis of alcoholic liver disease?
- Peripheral release of fatty acids increases.
- Synthesis of fatty acids as triglycerides in hepattocytes increases.
- Acetylaldehyde - alcohol metabolite - damages liver cells
- Collagen synthesis increases in response to damage - fibrosis.
- Bands of fibrosis separate functional nodules.
Features of Hepatitis A?
- faecal-oral spread
- no carrier state
- virions cause hepatocyte damage
- mild illness
Features of Hepatitis B?
- spread via sex and blood products
- long incubation
- carriers exist
- antiviral immune response causes liver damage
Features of hepatitis C?
- blood products spread
- short incubation
- disease comes and goes, tends to be chronic
What autoimmune diseases cause chronic hepatitis?
- Primary Biliary Cirrhosis (PBC)
- Autoimmune hepatitis
- Primary Sclerosing Cholangitis (PSC)
What is Primary Biliary Cirrhosis (PBC)?
- chronic inflammation of the bile ducts
- PBC is associated with autoantibodies to mitochondria
- affects females
What is Autoimmune Hepatitis?
- causes chronic hepatitis
- IgG antibodies to smooth muscle are produced
- may be triggered by drugs
What is Primary Sclerosing Cholangitis?
- chronic inflammation of bile ducts
- causes fibrosis and destruction of bile ducts
- results in jaundice
- associated with Ulcerative Colitis
What is Haemochromatosis?
- iron storage disease
- genetic or acquired
- causes cirrhosis
What is Wilson’s Disease?
- inherited Copper metabolism disorder
- copper aggregates in liver and brain
- Kayser Fleischer corneal rings
- low serum Caerulomplasmin
- causes chronic hepatitis, CNS degeneration
