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RUSVM Pathology 2 > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

How much cardiac output goes to the liver?

A

25%

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2
Q

What structural unit of the liver contains the bile duct, portal vein, hepatic artery, and the nerves/lymphatic?

A

Portal triads

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3
Q

Clinical signs appear after _____% of the parenchyma injury

A

75

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4
Q

Biomarkers of liver function are??

A

Elevated - AST, ALT, LDH, alkaline phsophatase, gamma-glutamic transpeptidates

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5
Q

What are portals of entry of infectious agents to the liver?

A

Hematogenous

Retrograde through biliary and pancreatic ducts

Direct extension through the liver capsule

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6
Q

What are the mechanisms of liver injury?

A

Metabolic bioactivaion of chemicals

Stimulation of autoimmunity

Stimulation of apoptosis

Disruption of Ca homeostasis

Canalicular injury

Mitochondrial injury

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7
Q

What are causes of liver atrophy?

A

Increased catabolism
Decreased blood flow
Decreased bile flow
Pressure

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8
Q

Does the liver have regenerative capacity?

A

Yes

Stimulated by growth factors -> 60% of liver will regenerative within a week

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9
Q

What cells are responsible for liver regeneration?

A

Oval (stem) cells –> differentiate into hepatocytes or bile duct epithelium

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10
Q

What are the pre-requisites for liver regeneration?

A

Intact framework

Good blood supply

Patent bile ducts

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11
Q

How does hepatocellular regeneration appear histologically?

A

Nodular

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12
Q

What are the 3 general reponses of the liver to injury?

A

Regeneration of the parenchyma

Replacement by fibrosis

Biliary hyperplasia

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13
Q

What cells are responsible for liver fibrosis ?

A

Ito (stellate cells)

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14
Q

What causes milk spot liver in pigs?

A

Ascaris suis -> fibrosis due to parasitic migration

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15
Q

What do you call chronic injury and regeneration that results in hepatocellular nodular proliferation, fibrosis, and impaired blood or bile flow ??

A

Cirrhosis

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16
Q

T/F: in cirrhosis you have nodular regeneration and post-neurotic scarring making the liver increased in size

A

False

–> the liver is usually reduced in size

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17
Q

Capsular fibrosis in a horse. What do you do?

A

Nothing- incidental finding

Usually the end result of inflammation

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18
Q

Capsular fibrosis is AKA

A

Perihepatitis filamentosisa

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19
Q

Cattle..

Focal area of pale discolouration with attachment to the mesentery

A

Incidental lesions

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20
Q

Dog..
Enlarged liver
Multiple linear laceration of the hepatic capsule

A

Trauma

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21
Q

Liver with..
Pale irregular foci
Greenish black discolouration near the intestine
Emphysema

A

Liver autolysis -PM change

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22
Q

Yellow discolouration on surface of liver? What is this ?

A

Biliary inhibiton–> PM change

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23
Q

What are the random patterns of liver degeneration and necrosis

A

Single cell

Multifocal

Piecemeal

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24
Q

Etiology of multifocal liver necrosis with pale zones on the capsule of the liver

A

Bacterial
Viral
Parasitic

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25
What pattern of necrosis is with a defined area like a lobule or acini?
Zonal Every uniform pale discolouration
26
Centrilobular necrosis is commonly due to _________
Hypoxia --> around the central vein
27
T/F: Mid zonal necrosis is a pattern that is rarely seen
True Yellow fever can cause this
28
Periportal necrosis is often associated with what etiology?
Toxic
29
What do you call a liver that has necrosis of an entire lobule
Massive hepatic necrosis | Usually severe, but not always
30
What is the most common causes of massive hepatic necroissi in pigs?
Hepatosis dietetica --> associated with generation of free radicals and deficiency of vitE/Selenium
31
T/F: Cysts that have a thin wall.lined by a single layer of biliary epithelium may result in mortality due to liver or renal failure
False--> Congenital biliary cysts usually incidental finding
32
What breeds are predisposed to congenital polycystic liver disease? What can these cysts caused?
Cair terriers, West highland white terriers Persian cat Mortality due to liver or renal failure
33
A ventral hernia or diaphragmatic hernia are an example of what type of anomalies ?
Developmental -> displacement Traumatic
34
What are the circulatory disturbances that can affect the liver?
``` Congestion Infarction (RARE) Thrombosis Congenital portosystemic shunt Telagiectasis ```
35
Right sided congestive heart failure leads to what disease of the liver?
Nutmeg liver Caused by chronic passive congestion (of central vein)
36
Histology of a liver.. Congestion around central vein Hepatocytes around portal area are normal Midzonal fatty change
Congestion (nutmeg liver)
37
PM of large animal Hepatomegaly Ascities Abnormal pain (history of)
Hepatic vein thrombosis
38
What are probable causes of hepatic vein thrombosis ?
Myeloproliferative disorders-> sluggish blood flow Infection Trauma Neoplasia
39
Condition where blood bypasses the liver and drains into the posterior vena cava or the azygous vein
Portosystemic shunt
40
What are two manifestations that can be seen in congenital cages of portosystemic shunt in dog and cats?
Hepatic encephalopathy | Ascities
41
T/F: in portosystemic shunts, the liver can be very small?
True Liver is deprived of primary perfusion and other growth factors
42
How can you differentiate acquired and congenital portosystemic shunts?
Acquired are due to chronic portal hypertension--> multiple thin walled and tortuous blood vessels
43
_______________ is the presence of focal areas in which sinusoids are dilated and filled with blood
Telangiectasis
44
Liver appears irregular, circumscribed, dark-red foci of cavernous ectasia of sinusoids
Telangiectasis
45
What is the significance of telangiectasis ?
Nothing clinically Except ppl dont want to eat this cause it looks gross
46
Liver.. Pale discolouration Round edges Friable Uniform Yellow discoloured Tissue will float in water
Hepatic lipidosis
47
What is the pathogenesis of hepatic lipidosis ?
1. Excessive entry of fat to liver 2. Decreased oxidation of fatty acid 3. Increased esterification of fatty acid to triglycerides 4. Decreased apoprotein synthesis 5. Impaired secretion of lipoprotein
48
Hepatocytes with marked hepatocellular vacuolation that pushes nucleus to peripheral of cell?
Hepatic lipidosis
49
What stain can you use to determine hepatic lipidosis ?
Oil red O Osmium tetroxide
50
T/F: hepatic lipidosis is reversible
True -> in mild cases Can lead to necrosis, fatty cysts, fat embolism, and liver rupture :(
51
When can you see physiological fatty liver?
Late pregnancy Heavy lactation Dietary excess
52
What can occur following excessive fat metabolism during peak lactation in cattle
Ketoisis | --> vacuolation in cells
53
When do we see bovine fatty liver syndrome?
Few days after parturition Precipitated by event that cow goes off feed (eg retained placenta or metritis, ect)
54
Obese cat .. Icterus Hepatic failure followed by subsequent hepatic encephalopathy .. what could be the cause
Feline fatty liver syndrome
55
What breed of horses do we see hyperlipemia ?
Shetaland breed (unknown pathogenesis)
56
What endocrine disorders can lead to fatty liver
Diabetes -> lack of insulin-> no glucose uptake -> lipolysis-> increase fatty acid Hypothyroidism
57
How is liver injury associated with hepatic lipidosis?
Hepatocyte injury-> decreased formation and/or export of lipoproteins by hepatocytes and decreased oxidation of fatty acids =>fatty degeneration
58
Glycogen accumulation can occur in what disease?
Diabetes Hyperadrenocortisim Glycogen storage disease
59
Excessive levels of _________ cause excessive swelling of hepatocytes leading to glycogen accumulation
Glucocorticoids
60
What is the DDX to a liver that is enlarged and pale due to swollen hepatocytes? How can these be differentiated?
Hepatic lipidosis Steroid induced hepatopathy --> glycogen accumulation PAS stain
61
_________________ usually occurs as a consequence to prolonged antigenic stimulation such as chronic infection
Hepatic amyloidosis
62
What breeds are genetically predisposed to hepatic amyloidosis?
Cat- Abyssinian and Siamese | Dog- Chinese shar-pei
63
What special stain can be used to detect amyloid?
Congo red
64
What are sources of copper toxicosis ?
Dietary excess in ruminants Pasture low in molybdenum Hepatic disease Chronic liver disease Hereditary disorders
65
What stains can be used to detect copper toxicosis?
Rhodanine or Rubeanic acid
66
Hereditary copper toxicosis is seen in what dog breeds?
Bedlington and west highland terriers | Dalmatian
67
Owl with of-white multifocal hepatitis | EDX?
Viral hepatitis
68
What do you call inflammation of the liver affecting primarily the hepatocytes?
Hepatitis
69
What do you call inflammation of the bile ductules and liver parenchyma
Cholangiohepatitis
70
What are the routes by which agents can cause hepatitis?
Hematogenous Ascending -> through biliary system Direct extension from peritoneum
71
Necrotic hepatocytes caused by a herpes virus infection often contains ____________
Intranuclear inclusion bodies
72
Infectious canine hepatitis is caused by???
Canine adenovirus !
73
What is the pathogenesis of infectious canine hepatitis?
Oral exposure to urine-> tonsillitis-> viremia -> tropism for liver
74
Dog Vomiting Diarrhea Petechiation in mucosal surface Hemorrhagic diathesis
Infectous canine hepatitis | Canine adenovirus 1
75
Dog Enlarged, congested friable liver Serosa petechia and ecchymosis I Gall bladder edema Corneal edema "blue eye"
Infectous canine hepatitis
76
Infectous feline peritonitis is caused by what virus?
Feline coronavirus
77
What is Theiler's disease?
Equine serum hepatitis -> flavivirus Icterus, ascities, petechiae, and hepatic encephalopathy (fatty degeneration and necrosis), fibrosis and regeneration
78
What disease is the gross liver referee to as "dish rag liver"?
Equine serum hepatitis | Theiler's disease
79
Bacterial infections of the liver appears in what pattern?
Multifocal necrotizing hepatitis
80
Bacilliary hemoglobinuria in cattle and sheep is caused by??
Clostridum haemolyticus -> produce B toxin Secondary infection of liver damage by flukes
81
Cattle History of dark coloured urine PM-> single large area of focal necrosis
Bacillary hemoglobinuria
82
Sheep Dark colouration of skin Liver with multiple small areas of necrosisi EDX?
Black disease -> C.novyi type B
83
What is the agent causing Tyzzer's disease?
Clostridium piliforme
84
Rodents with ... Multifocal necroitic hepatitis and colitis
Tyzzer's disease Can occur in foal, calves, kittens, and puppies (YOUNG animals)
85
What stain is useful to observed clostridium piliforme
Warthin Starry (Silver stain )
86
What is the pathogenesis of leptospirosis?
Varies dependent on sp. Lesions due to ischemic injury following hemolytic anemia Cholestatis Disease characterized by jaundice
87
Liver abscesses are often a result of what??
Hematogenous infection or secondary to omphalophelbitis -cattle most common due to chemical rumentitis or traumatic reticulitis
88
What are common bacteria isolated from liver abcess?
Fusobacterium necrophorus Trueperella Streptococci Staphylococci
89
Is the right of left lobe of the liver more commonly affected by abscess?
Left
90
What are the most significant concerns of hepatic abscesses?
Focal adhesive peritonitis or diaphragmatic adhesions Rupture --> into hepatic vein or vena cava causing throbmophlebitis, endocarditis, pulmonary abscess or massive endotoxic shock
91
Liver from a bird... Isolated mycobacterium avium. What lesions are present?
Granulomatous Avian tuberculosis
92
T/F: mycobacterium avium can be found in dog and cause hepatic granulomas
True
93
Mycotoxin infection of the liver is usually secondary to???
Mycotic rumenitis
94
What are EDX of mycotic hepatitis?
``` Aspergillus Histoplasma Crytoococcus Coccidioides Sporothrix ```
95
Milk spot in pig liver is caused by??
Ascaris suum
96
What will you see histologically in an ascaris suum infection?
Liver Nematodes causes tunnels followed by hemorrhage Eosinophilic infiltration Healing by fibrosis
97
Trematode that lives in the lumen of the bile duct
Fasciola hepatica Causes chronic cholangitis
98
What trematode causes necrosis and cystic liver
Fascioloides magna
99
Hydatid cysts are caused by??
Ecchinococcus granulosus Cystercercus tenuicollis
100
Where are the intermediate and adult stages of Ecchinococcus granulosus?
Intermediate - moose, camel, sheep Adult- carnivores
101
Rabbit... Multiple raised, off-white nodules in liver Histology shows: proliferative cholangitis with intraleionsal organisms
Coccidiosis
102
What is the cause of black head in turkeys?
Histomoniasis | Histomonas meleagridis
103
Turkey with... Multifocal granulomatous hepatic and diffused granulomatous typhilits "Target lesions" Intralesional organism
Histomonas melegridis
104
Why is the liver the most common site of toxic injury?
Any toxin ingested --> GI tract --> liver Capable of biotransformation for various endogenous and exogenous substances for excretion (product may be toxic)
105
What is the main toxin from blue-green algae?
Microcystin Algae grows in blooms - late summer or early fall
106
Lesions caused by ingestion of blue-green algae?
Acute hemorrhagic gastroenteritis Acute centrilobular to massive hepatic necrosis Survivors-> chronic liver disease
107
Pyrrolizidine alkaoids toxicity affects what animals?
``` Pig Cattle Horse Goat Sheep ```
108
What is covered in the liver to a toxin by hepatic cytochrome p450 system?
Pyrrolizidine alkaloid --> pyrrlolic esters (toxic)
109
What type of lesions does a pyrrolizine alkaloid toxicity cause?
Acute- periacinar necrosis Chronic- fribosis Hepatic veno-occlusive disease
110
Megalocytosis is characteristic of what disease?
AKA seneciosis Pyrrolizidine alkaloid toxicity Giant hypertrophic hepatocytes due to the antimitotic effects of the toxin
111
Histilogically what can be seen in pyrrolizidine alkaloid toxicity
Portal fibrosis Biliary hyperplasia Megalocytosis
112
Alsike clover causes chronic liver disease and photodynamic dermatitis in what species
Horse
113
Horse with Liver fibrosis Bile duct hyperplasia Portal hetaptits No megalocytosis
Alsike clover toxicity
114
What are common mycotoxins?
Aflatoxin Sporidesmin Phomopsin Poisonous mushrooms
115
What is the most common aflatoxin?
B1 Also most potent (carcinogen)
116
How are animals exposed to aflatoxin ?
Ingest moldy feed (eg corn, peanut, cottonseed) --> converted to toxic intermediate in hepatocytes
117
Aflatoxin toxicity is most common in what animals?
Pig Poultry Cattle Dog
118
Aflatoxin can be an acute or chronic intoxication, what are the differences?
Acute - periacinar to massive hepatic lipidosis - hemorrhage diathesis - periportal necrosis in duckling Chronic - severe fatty degeneration - fibrosis - biliary hyperplasia - megalocytosis
119
Aflatoxins are carcinogenic and predispose to the formation of???
Hepatoma | Cholangiocellular tumors
120
What toxin is from pithomyces chartarum fungus? Where is it found?
Sporidesmin Dead ryegrass in warm climate
121
Sporidesmin is toxic to ?? What lesions do you see?
Bile duct epithelium Acute to chronic cholamgiohepatitis Photosensitization/facial eczema (in sheep)
122
What grows on lupins and produces chronic liver damage in herbivores?
Phomopsin
123
T/F: Amanita mushroom is edible
False Poisonous Causes fatal acute periacinar to massive hepatocellular necrosis Toxicity seen in dog
124
What are the hepatotoxic chemicals?
Phosphorus Carbon tetrachloride Cresols Metals
125
In ___________ toxicosis, stress causes the release of this agent causing lipid peroxidation and massive hepatic necrosis. Most commonly seen in sheep
Copper
126
In a cat Centrilobular Hepatocellular necrosis What drug can cause this??
Acetaminophen
127
T/F: hepatic failure indicates a massive reduction in the amount of liver cells or a decrease in their functionality
True
128
What are the clinical manifestations of hepatic failure?
``` Hepatic encephalopathy Disturbance of bile flow-> icterus Metabolic disturbances Vascular and hemodynamic alteration Cutaneous lesions Impaired immune function ```
129
Clinical signs in a dog are.. | depression, behavioral change, mania, and convulsions... what manifestation of hepatic failure is this?
Hepatic encephalopathy
130
Hepatic encephalopathy can result from ___________ in cats and dogs, and ___________ in horse and ruminants
Portosystemic shunt; acute liver disease PS- chronic liver disease in any animal can cause hepatic encephalopathy
131
What is the pathogenesis of hepatic encephalopathy ?
Blood accumulates toxin (mainly ammonia) --> bypass liver and reach brain
132
Yellow discolouration of tissues and body fluids due to hyperbilirubinemia
Icterus/jaundice
133
How is bilirubin metabolized?
Bilirubin-> albumin bound -> hepatocellular uptake -> conjugate with glucuronic acid--> secrete to intestine --> deconjugate to urobilogen in gut by bacteria -> excretion
134
What are causes of hyperbilirubemia?
Over production (pre-hepatic) Decreased uptake/conjugation/secretion at liver (hepatic) Reduced outflow in bile (post-hepatic)
135
Hemolysis is a ___________ jaundice
Prehepatic
136
Grossly - generalized yellow discolouration - yellow-greenish brown liver Microscopic -bile pigement in canaliculi and hepatocytes MDx?
Icterus and cholestasis
137
Leptospirosis will produce liver disease and abortion, what type of icterus is here?
Hepatic icterus -damage to the liver
138
Cholelithiasis will cause a _______________ jaundice
Post-hepatic -obstruction of bile duct
139
T/F: infection with babesiosis can lead to canaliculi that are distended with bilirubin
True --> prehepatic jaundice
140
How does hepatic failure contribute to hemorrhagic diathesis or bleeding tendencies??
``` Impaired synthesis of clotting factors Reduced clearance of clotting cascade Impaired platelet function Impaired absorption of vitK DIC ```
141
How does the liver failure contribute to hypoalbuminemia
Decreased synthesis Loss in ascities or via GI tract
142
What are vascular and hemodynamics alterations found in liver dysfunction and failure?
Portal hypertension Acquired portosystemic shunt Ascities (most common in dogs and cats)
143
Ascities can be secondary to???
Portal hypertension Decreased colloid osmotic pressure Retention of sodium and water Systemic venous congestion of right heart failure Hypoproteinemia ->reduced albumin or globulin
144
What cutaneous problems are associated with liver disease??
Photosensitization Hepatocutaneous syndrome (superficial necrolytic dermatitis)
145
What are the three types of photosensitization?
Primary (ingestion of toxic plants) Secondary (herbivores with impaired excretion of phylloeruthrin) Congenital (abnormal metabolism of heme-> retain porphyrins)
146
What is the most common form of photosensitization ?
Secondary (hepatogenous) Herbivores with impaired excretion of phylloerythrin
147
What is hepatocutaenous syndrome
Crusting erosions and scaling (esp at mucocutaneous junctions)
148
What are the non-neoplasic growth disturbances of the liver?
Hepatocellular nodular hyperplasia Regenerative nodules Bile duct hyperplasia
149
Nodular hyperplasia is common in ?
Dogs | Age related change
150
T/F: most malignant tumors of the liver originate form other organs
True
151
Where do primary tumors of the liver arise from?
Hepatocytes Bile duct Mesenchymal tissue
152
What is a benign neoplasm of hepatocytes seen in young ruminants Single, non-encapsulated, red to brown nodule
Hepatocellular adenoma
153
What malignant tumor of the liver is usually solitary and involved an entire lobe and on the cut surface will be multilobulated and grey-white to yellow-brown?
Hepatocellular carcinoma
154
Histology of a nodule from liver of a dog.. Cells arranged in a trabecular pattern Atypical hepatocytes
Hepatocellular carcinoma
155
A benign tumor arising for the bile duct
Cholangiocellular adenoma | Often cystic
156
A multilobulated, firm, raised mass with central areas of depression in the bile ducts
Cholangiocellular carcinoma
157
What type of liver metastasis can be found in the liver? What are they grossly characterized by?
Multifocal nodules resembling primary neoplastic site Hemangiosarcoma sarcoma a Metastatic melanoma

RUSVM Pathology 2 (16 decks)

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