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
