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MD2 Surgery and Anaesthesia > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

What is the classical liver lobule?

A

Unit drained by central vein

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2
Q

What is the portal lobule?

A

Unit supplied and drained by portal triad

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3
Q

What is the central acinus?

A

Unit supplied and drained by terminal branches of portal triad

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4
Q

What are the three acinar zones?

A 
1
- Most nutrients and oxygen
- Most toxic metabolites
2
3
- Least nutrients and oxygen
- Most susceptible to ischaemic change
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5
Q

What causes ascites?

A

HTN in portal tract

Low albumin levels

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6
Q

Which liver function tests tell you about liver synthesis function?

A 
Albumin
Prothrombin time (INR)
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7
Q

Which liver function tests tell you about hepatocellular damage?

A

ALT

AST

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8
Q

Which liver function tests tell you about bile duct damage?

A

ALP

GGT

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9
Q

Which liver function tests tell you about hepatic bile secretion?

A

Bilirubin

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10
Q

What are albumin levels like in acute and chronic liver disease?

A

Normal in acute liver damage, due to 20-day half-life

Slow decline in chronic disease

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11
Q

What governs the decline of prothrombin time?

A

Short half-life of coagulation factors

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12
Q

Where are GGT and ALP located?

A

Bile canaliculi

Sinusoids

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13
Q

Secondary to what conditions are GGT and ALP induced?

A

Cholestasis
EtOH > GGT
- Good test in alcoholics to determine if abstaining from alcohol

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14
Q

Where else in the body is ALP found, other than the liver?

A

Bone

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15
Q

Which of the transaminases is more liver specific?

A

ALT

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16
Q

Which of the transaminases is relatively higher in chronic liver disease?

A

AST, especially in alcoholic hepatitis

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17
Q

How long does it take for transaminases to rise after hepatic injury?

A

24 hours

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18
Q

Where are the transaminases located?

A

Predominantly in periportal hepatocytes

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19
Q

What form of bilirubin rises in prehaptic hyperbilirubinaemia?

A

Unconjugated

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20
Q

What form of bilirubin rises in intrahepatic hyperbilirubinaemia?

A

Conjugated

Unconjugated

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21
Q

What form of bilirubin rises in post-hepatic hyperbilirubinaemia?

A

Conjugated

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22
Q

What are common alcoholic liver diseases?

A

Steatosis
Alcoholic steatohepatitis (ASH)
Cirrhosis

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23
Q

What is the histology of steatosis?

A

Microvesicular and macrovesicular fat

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24
Q

What is the histology of ASH?

A

Steatosis
Ballooning degeneration
Mallory’s hyaline
PMN satellitosis

25
Q

What are the clinical features of alcoholic steatohepatitis?

A 
Generally unwell
Low fever
Tender hepatomegaly
Often icteric
\+/- diarrhoea
\+/- nausea and vomiting
Transaminases may be greatly elevated
26
Q

What is non-alcoholic steatohepatitis?

A

Histologically similar to ASH
Usually less severe
Hepatic manifestation of metabolic syndrome
Thought to be most common cause of idiopathic cirrhosis

27
Q

What are the prehepatic causes of portal hypertension?

A

Portal vein thrombosis
Stenosis
Compression

28
Q

What are the intrahepatic causes of portal hypertension?

A 
Perivenular fibrosis
Cirrhosis
Schistosomiasis
Severe steatosis
Sarcoidosis
29
Q

What are the post-hepatic causes of portal hypertension?

A

Hepatic vein obstruction
Severe right heart failure
Constrictive pericarditis

30
Q

Of which condition is perivenular fibrosis a feature?

A

Alcoholic steatohepatitis

31
Q

What are common benign liver neoplasms?

A

Hepatic adenoma
Focal nodular hyperplasia (FNH)
Bile duct hamartoma = von Meyenburg complex
Bile duct adenoma = prebiliary gland hamartoma
Cavernous haemangioma

32
Q

What are common malignant liver neoplasms?

A

Hepatocellular carcinoma
Cholangiocarcinoma
Angiosarcoma
Metastases

33
Q

What is the histopathology of hepatocellular carcinoma?

A 
Abnormal architecture
- Trabeculae >3 cells thick
- Abnormal bile canalicular architecture
50% or less alpha-foetal protein +ve in immunostains
Bile production in some
34
Q

What are the causes of chronic hepatitis?

A 
Chronic viral hepatitis
Autoimmune hepatitis (AIH)
Drug induced
Metabolic
- Wilson's disease
- Alpha-1 antitrypsin deficiency
Idiopathic
35
Q

What are the causes of acute viral hepatitis?

A

HAV
HBV
HCV (rare)
HEV

36
Q

What is the pattern of damage in acute viral hepatitis?

A

Predominantly lobular inflammation

Hepatocellular injury

37
Q

What are the causes of chronic viral hepatitis?

A

HBV
HCV
HDV

38
Q

What is the pattern of damage in chronic viral hepatitis?

A

Predominantly portal inflammation

39
Q

What defines chronic viral hepatitis?

A

More than 6 months with hepatitis, due to viral infection

40
Q

What is the clinical presentation of chronic viral hepatitis?

A

Chronic fatigue
Generally unwell
Poor appetite
Low level nausea

41
Q

What are the pathological findings in chronic viral hepatitis?

A

Low level elevation of transaminases
Periportal +/- lobular hepatocellular inflammation and necrosis
Portal fibrosis > cirrhosis
Nodular regeneration

42
Q

What are some of the complications of chronic viral hepatitis?

A

Portal HTN
Liver failure
Hepatocellular carcinoma

43
Q

How is AIH diagnosed?

A

AutoAbs

44
Q

Which antibodies are positive in type 1 AIH?

A 
Smooth muscle Abs (SMA)
Antinuclear Abs (ANA)
45
Q

Which antibodies are positive in type 2 AIH?

A

Liver-kidney microsomal Abs (LKM1)

46
Q

Which antibodies are positive in type 3 AIH?

A

Antisoluble liver Ag/liver pancreas Abs (anti-SLA/anti-LP)

47
Q

What is the treatment for autoimmune hepatitis?

A

Steroid therapy > good response

48
Q

What is the histology of autoimmune hepatitis?

A

Dense periportal inflammation with plasma cells
Lymphocytic piecemeal/bridging necrosis
Milder forms often seen

49
Q

What is primary biliary cirrhosis?

A

Non-suppurative autoimmune cholangitis characterised by

  • Increased ALP and GGT
  • Antimitochondrial Abs (AMA)
  • Increased IgM
  • Typically affects middle aged females
50
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid

Poor response to steroids

51
Q

What is the pathophysiology of primary biliary cirrhosis?

A 
Immune attack on small bile ducts
Chronic cholestasis and loss of small bile ducts
Variable periportal hepatitis
Progression to cirrhosis
Overlap syndrome with AIH exists
52
Q

What is primary sclerosing cholangitis?

A

Fibrosing and lymphocytic cholangitis > irregular stenoses and strictures
Usually involves intrahepatic and extrahepatic bile ducts
Overlap syndrome with AIH exists

53
Q

How is primary sclerosing cholangitis diagnosed?

A 
Cholangiography
- Irregular strictures and beading
- +/- diverticula
- Pruned tree
Liver biopsy when cholangiography non-diagnostic
54
Q

What are the histological features of primary sclerosing cholangitis?

A

Onion skin periductular fibrosis

Loss of bile ducts

55
Q

What gene defect causes haemochromatosis?

A

HFE gene defect on ch 6

56
Q

How is haemochromatosis diagnosed?

A 
Raised serum ferritin
Raised serum transferrin saturation
Genetic testing: C282Y, H63D
Hepatic iron index (HII)
Hepatic dry weight iron
Liver biopsy
57
Q

What are the features of a liver biopsy from someone with haemochromatosis?

A

Fibrosis > cirrhosis
Fe overload in hepatocytes
Hepatocellular carcinoma/precursors may be detected
Negligible inflammation/necrosis

58
Q

What are common causes of hepatic granulomas and granulomatous hepatitis?

A

Sarcoidosis
Primary biliary cirrhosis
TB
Drugs

MD2 Surgery and Anaesthesia (31 decks)

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