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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
Q

What pattern of necrosis is with a defined area like a lobule or acini?

A

Zonal

Every uniform pale discolouration

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26
Q

Centrilobular necrosis is commonly due to _________

A

Hypoxia

–> around the central vein

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27
Q

T/F: Mid zonal necrosis is a pattern that is rarely seen

A

True

Yellow fever can cause this

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28
Q

Periportal necrosis is often associated with what etiology?

A

Toxic

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29
Q

What do you call a liver that has necrosis of an entire lobule

A

Massive hepatic necrosis

Usually severe, but not always

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30
Q

What is the most common causes of massive hepatic necroissi in pigs?

A

Hepatosis dietetica –> associated with generation of free radicals and deficiency of vitE/Selenium

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31
Q

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

A

False–>

Congenital biliary cysts usually incidental finding

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32
Q

What breeds are predisposed to congenital polycystic liver disease? What can these cysts caused?

A

Cair terriers,
West highland white terriers
Persian cat

Mortality due to liver or renal failure

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33
Q

A ventral hernia or diaphragmatic hernia are an example of what type of anomalies ?

A

Developmental -> displacement

Traumatic

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34
Q

What are the circulatory disturbances that can affect the liver?

A 
Congestion 
Infarction (RARE) 
Thrombosis 
Congenital portosystemic shunt
Telagiectasis
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35
Q

Right sided congestive heart failure leads to what disease of the liver?

A

Nutmeg liver

Caused by chronic passive congestion (of central vein)

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36
Q

Histology of a liver..

Congestion around central vein
Hepatocytes around portal area are normal
Midzonal fatty change

A

Congestion (nutmeg liver)

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37
Q

PM of large animal

Hepatomegaly
Ascities
Abnormal pain (history of)

A

Hepatic vein thrombosis

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38
Q

What are probable causes of hepatic vein thrombosis ?

A

Myeloproliferative disorders-> sluggish blood flow
Infection
Trauma
Neoplasia

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39
Q

Condition where blood bypasses the liver and drains into the posterior vena cava or the azygous vein

A

Portosystemic shunt

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40
Q

What are two manifestations that can be seen in congenital cages of portosystemic shunt in dog and cats?

A

Hepatic encephalopathy

Ascities

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41
Q

T/F: in portosystemic shunts, the liver can be very small?

A

True

Liver is deprived of primary perfusion and other growth factors

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42
Q

How can you differentiate acquired and congenital portosystemic shunts?

A

Acquired are due to chronic portal hypertension–> multiple thin walled and tortuous blood vessels

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43
Q

_______________ is the presence of focal areas in which sinusoids are dilated and filled with blood

A

Telangiectasis

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44
Q

Liver appears irregular, circumscribed, dark-red foci of cavernous ectasia of sinusoids

A

Telangiectasis

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45
Q

What is the significance of telangiectasis ?

A

Nothing clinically

Except ppl dont want to eat this cause it looks gross

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46
Q

Liver..

Pale discolouration
Round edges
Friable
Uniform Yellow discoloured

Tissue will float in water

A

Hepatic lipidosis

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47
Q

What is the pathogenesis of hepatic lipidosis ?

A
  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
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48
Q

Hepatocytes with marked hepatocellular vacuolation that pushes nucleus to peripheral of cell?

A

Hepatic lipidosis

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49
Q

What stain can you use to determine hepatic lipidosis ?

A

Oil red O

Osmium tetroxide

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50
Q

T/F: hepatic lipidosis is reversible

A

True -> in mild cases

Can lead to necrosis, fatty cysts, fat embolism, and liver rupture :(

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51
Q

When can you see physiological fatty liver?

A

Late pregnancy
Heavy lactation
Dietary excess

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52
Q

What can occur following excessive fat metabolism during peak lactation in cattle

A

Ketoisis

–> vacuolation in cells

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53
Q

When do we see bovine fatty liver syndrome?

A

Few days after parturition

Precipitated by event that cow goes off feed (eg retained placenta or metritis, ect)

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54
Q

Obese cat ..

Icterus
Hepatic failure followed by subsequent hepatic encephalopathy .. what could be the cause

A

Feline fatty liver syndrome

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55
Q

What breed of horses do we see hyperlipemia ?

A

Shetaland breed (unknown pathogenesis)

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56
Q

What endocrine disorders can lead to fatty liver

A

Diabetes -> lack of insulin-> no glucose uptake -> lipolysis-> increase fatty acid

Hypothyroidism

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57
Q

How is liver injury associated with hepatic lipidosis?

A

Hepatocyte injury-> decreased formation and/or export of lipoproteins by hepatocytes and decreased oxidation of fatty acids =>fatty degeneration

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58
Q

Glycogen accumulation can occur in what disease?

A

Diabetes
Hyperadrenocortisim
Glycogen storage disease

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59
Q

Excessive levels of _________ cause excessive swelling of hepatocytes leading to glycogen accumulation

A

Glucocorticoids

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60
Q

What is the DDX to a liver that is enlarged and pale due to swollen hepatocytes? How can these be differentiated?

A

Hepatic lipidosis
Steroid induced hepatopathy –> glycogen accumulation

PAS stain

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61
Q

_________________ usually occurs as a consequence to prolonged antigenic stimulation such as chronic infection

A

Hepatic amyloidosis

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62
Q

What breeds are genetically predisposed to hepatic amyloidosis?

A

Cat- Abyssinian and Siamese

Dog- Chinese shar-pei

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63
Q

What special stain can be used to detect amyloid?

A

Congo red

64
Q

What are sources of copper toxicosis ?

A

Dietary excess in ruminants

Pasture low in molybdenum

Hepatic disease

Chronic liver disease

Hereditary disorders

65
Q

What stains can be used to detect copper toxicosis?

A

Rhodanine or Rubeanic acid

66
Q

Hereditary copper toxicosis is seen in what dog breeds?

A

Bedlington and west highland terriers

Dalmatian

67
Q

Owl with of-white multifocal hepatitis

EDX?

A

Viral hepatitis

68
Q

What do you call inflammation of the liver affecting primarily the hepatocytes?

A

Hepatitis

69
Q

What do you call inflammation of the bile ductules and liver parenchyma

A

Cholangiohepatitis

70
Q

What are the routes by which agents can cause hepatitis?

A

Hematogenous
Ascending -> through biliary system
Direct extension from peritoneum

71
Q

Necrotic hepatocytes caused by a herpes virus infection often contains ____________

A

Intranuclear inclusion bodies

72
Q

Infectious canine hepatitis is caused by???

A

Canine adenovirus !

73
Q

What is the pathogenesis of infectious canine hepatitis?

A

Oral exposure to urine-> tonsillitis-> viremia -> tropism for liver

74
Q

Dog

Vomiting
Diarrhea
Petechiation in mucosal surface
Hemorrhagic diathesis

A

Infectous canine hepatitis

Canine adenovirus 1

75
Q

Dog

Enlarged, congested friable liver
Serosa petechia and ecchymosis I
Gall bladder edema
Corneal edema “blue eye”

A

Infectous canine hepatitis

76
Q

Infectous feline peritonitis is caused by what virus?

A

Feline coronavirus

77
Q

What is Theiler’s disease?

A

Equine serum hepatitis
-> flavivirus

Icterus, ascities, petechiae, and hepatic encephalopathy (fatty degeneration and necrosis), fibrosis and regeneration

78
Q

What disease is the gross liver referee to as “dish rag liver”?

A

Equine serum hepatitis

Theiler’s disease

79
Q

Bacterial infections of the liver appears in what pattern?

A

Multifocal necrotizing hepatitis

80
Q

Bacilliary hemoglobinuria in cattle and sheep is caused by??

A

Clostridum haemolyticus -> produce B toxin

Secondary infection of liver damage by flukes

81
Q

Cattle

History of dark coloured urine
PM-> single large area of focal necrosis

A

Bacillary hemoglobinuria

82
Q

Sheep

Dark colouration of skin
Liver with multiple small areas of necrosisi

EDX?

A

Black disease -> C.novyi type B

83
Q

What is the agent causing Tyzzer’s disease?

A

Clostridium piliforme

84
Q

Rodents with …

Multifocal necroitic hepatitis and colitis

A

Tyzzer’s disease

Can occur in foal, calves, kittens, and puppies (YOUNG animals)

85
Q

What stain is useful to observed clostridium piliforme

A

Warthin Starry (Silver stain )

86
Q

What is the pathogenesis of leptospirosis?

A

Varies dependent on sp.

Lesions due to ischemic injury following hemolytic anemia

Cholestatis

Disease characterized by jaundice

87
Q

Liver abscesses are often a result of what??

A

Hematogenous infection or secondary to omphalophelbitis

-cattle most common due to chemical rumentitis or traumatic reticulitis

88
Q

What are common bacteria isolated from liver abcess?

A

Fusobacterium necrophorus

Trueperella

Streptococci
Staphylococci

89
Q

Is the right of left lobe of the liver more commonly affected by abscess?

A

Left

90
Q

What are the most significant concerns of hepatic abscesses?

A

Focal adhesive peritonitis or diaphragmatic adhesions

Rupture –> into hepatic vein or vena cava causing throbmophlebitis, endocarditis, pulmonary abscess or massive endotoxic shock

91
Q

Liver from a bird…

Isolated mycobacterium avium.

What lesions are present?

A

Granulomatous

Avian tuberculosis

92
Q

T/F: mycobacterium avium can be found in dog and cause hepatic granulomas

A

True

93
Q

Mycotoxin infection of the liver is usually secondary to???

A

Mycotic rumenitis

94
Q

What are EDX of mycotic hepatitis?

A 
Aspergillus 
Histoplasma 
Crytoococcus
Coccidioides 
Sporothrix
95
Q

Milk spot in pig liver is caused by??

A

Ascaris suum

96
Q

What will you see histologically in an ascaris suum infection?

A

Liver

Nematodes causes tunnels followed by hemorrhage
Eosinophilic infiltration
Healing by fibrosis

97
Q

Trematode that lives in the lumen of the bile duct

A

Fasciola hepatica

Causes chronic cholangitis

98
Q

What trematode causes necrosis and cystic liver

A

Fascioloides magna

99
Q

Hydatid cysts are caused by??

A

Ecchinococcus granulosus

Cystercercus tenuicollis

100
Q

Where are the intermediate and adult stages of Ecchinococcus granulosus?

A

Intermediate - moose, camel, sheep

Adult- carnivores

101
Q

Rabbit…

Multiple raised, off-white nodules in liver
Histology shows: proliferative cholangitis with intraleionsal organisms

A

Coccidiosis

102
Q

What is the cause of black head in turkeys?

A

Histomoniasis

Histomonas meleagridis

103
Q

Turkey with…

Multifocal granulomatous hepatic and diffused granulomatous typhilits
“Target lesions”

Intralesional organism

A

Histomonas melegridis

104
Q

Why is the liver the most common site of toxic injury?

A

Any toxin ingested –> GI tract –> liver

Capable of biotransformation for various endogenous and exogenous substances for excretion (product may be toxic)

105
Q

What is the main toxin from blue-green algae?

A

Microcystin

Algae grows in blooms - late summer or early fall

106
Q

Lesions caused by ingestion of blue-green algae?

A

Acute hemorrhagic gastroenteritis

Acute centrilobular to massive hepatic necrosis

Survivors-> chronic liver disease

107
Q

Pyrrolizidine alkaoids toxicity affects what animals?

A 
Pig 
Cattle 
Horse
Goat 
Sheep
108
Q

What is covered in the liver to a toxin by hepatic cytochrome p450 system?

A

Pyrrolizidine alkaloid –> pyrrlolic esters (toxic)

109
Q

What type of lesions does a pyrrolizine alkaloid toxicity cause?

A

Acute- periacinar necrosis
Chronic- fribosis

Hepatic veno-occlusive disease

110
Q

Megalocytosis is characteristic of what disease?

A

AKA seneciosis

Pyrrolizidine alkaloid toxicity

Giant hypertrophic hepatocytes due to the antimitotic effects of the toxin

111
Q

Histilogically what can be seen in pyrrolizidine alkaloid toxicity

A

Portal fibrosis
Biliary hyperplasia
Megalocytosis

112
Q

Alsike clover causes chronic liver disease and photodynamic dermatitis in what species

A

Horse

113
Q

Horse with
Liver fibrosis
Bile duct hyperplasia
Portal hetaptits

No megalocytosis

A

Alsike clover toxicity

114
Q

What are common mycotoxins?

A

Aflatoxin
Sporidesmin
Phomopsin
Poisonous mushrooms

115
Q

What is the most common aflatoxin?

A

B1

Also most potent (carcinogen)

116
Q

How are animals exposed to aflatoxin ?

A

Ingest moldy feed (eg corn, peanut, cottonseed)

–> converted to toxic intermediate in hepatocytes

117
Q

Aflatoxin toxicity is most common in what animals?

A

Pig
Poultry
Cattle
Dog

118
Q

Aflatoxin can be an acute or chronic intoxication, what are the differences?

A

Acute

  • periacinar to massive hepatic lipidosis
  • hemorrhage diathesis
  • periportal necrosis in duckling

Chronic

  • severe fatty degeneration
  • fibrosis
  • biliary hyperplasia
  • megalocytosis
119
Q

Aflatoxins are carcinogenic and predispose to the formation of???

A

Hepatoma

Cholangiocellular tumors

120
Q

What toxin is from pithomyces chartarum fungus? Where is it found?

A

Sporidesmin

Dead ryegrass in warm climate

121
Q

Sporidesmin is toxic to ?? What lesions do you see?

A

Bile duct epithelium

Acute to chronic cholamgiohepatitis

Photosensitization/facial eczema (in sheep)

122
Q

What grows on lupins and produces chronic liver damage in herbivores?

A

Phomopsin

123
Q

T/F: Amanita mushroom is edible

A

False

Poisonous
Causes fatal acute periacinar to massive hepatocellular necrosis

Toxicity seen in dog

124
Q

What are the hepatotoxic chemicals?

A

Phosphorus
Carbon tetrachloride
Cresols
Metals

125
Q

In ___________ toxicosis, stress causes the release of this agent causing lipid peroxidation and massive hepatic necrosis. Most commonly seen in sheep

A

Copper

126
Q

In a cat

Centrilobular Hepatocellular necrosis

What drug can cause this??

A

Acetaminophen

127
Q

T/F: hepatic failure indicates a massive reduction in the amount of liver cells or a decrease in their functionality

A

True

128
Q

What are the clinical manifestations of hepatic failure?

A 
Hepatic encephalopathy 
Disturbance of bile flow-> icterus 
Metabolic disturbances 
Vascular and hemodynamic alteration 
Cutaneous lesions 
Impaired immune function
129
Q

Clinical signs in a dog are..

depression, behavioral change, mania, and convulsions… what manifestation of hepatic failure is this?

A

Hepatic encephalopathy

130
Q

Hepatic encephalopathy can result from ___________ in cats and dogs, and ___________ in horse and ruminants

A

Portosystemic shunt; acute liver disease

PS- chronic liver disease in any animal can cause hepatic encephalopathy

131
Q

What is the pathogenesis of hepatic encephalopathy ?

A

Blood accumulates toxin (mainly ammonia) –> bypass liver and reach brain

132
Q

Yellow discolouration of tissues and body fluids due to hyperbilirubinemia

A

Icterus/jaundice

133
Q

How is bilirubin metabolized?

A

Bilirubin-> albumin bound -> hepatocellular uptake -> conjugate with glucuronic acid–> secrete to intestine –> deconjugate to urobilogen in gut by bacteria -> excretion

134
Q

What are causes of hyperbilirubemia?

A

Over production (pre-hepatic)

Decreased uptake/conjugation/secretion at liver (hepatic)

Reduced outflow in bile (post-hepatic)

135
Q

Hemolysis is a ___________ jaundice

A

Prehepatic

136
Q

Grossly

  • generalized yellow discolouration
  • yellow-greenish brown liver

Microscopic
-bile pigement in canaliculi and hepatocytes

MDx?

A

Icterus and cholestasis

137
Q

Leptospirosis will produce liver disease and abortion, what type of icterus is here?

A

Hepatic icterus

-damage to the liver

138
Q

Cholelithiasis will cause a _______________ jaundice

A

Post-hepatic

-obstruction of bile duct

139
Q

T/F: infection with babesiosis can lead to canaliculi that are distended with bilirubin

A

True

–> prehepatic jaundice

140
Q

How does hepatic failure contribute to hemorrhagic diathesis or bleeding tendencies??

A 
Impaired synthesis of clotting factors 
Reduced clearance of clotting cascade 
Impaired platelet function 
Impaired absorption of vitK
DIC
141
Q

How does the liver failure contribute to hypoalbuminemia

A

Decreased synthesis

Loss in ascities or via GI tract

142
Q

What are vascular and hemodynamics alterations found in liver dysfunction and failure?

A

Portal hypertension
Acquired portosystemic shunt
Ascities (most common in dogs and cats)

143
Q

Ascities can be secondary to???

A

Portal hypertension
Decreased colloid osmotic pressure
Retention of sodium and water
Systemic venous congestion of right heart failure
Hypoproteinemia ->reduced albumin or globulin

144
Q

What cutaneous problems are associated with liver disease??

A

Photosensitization

Hepatocutaneous syndrome (superficial necrolytic dermatitis)

145
Q

What are the three types of photosensitization?

A

Primary (ingestion of toxic plants)

Secondary (herbivores with impaired excretion of phylloeruthrin)

Congenital (abnormal metabolism of heme-> retain porphyrins)

146
Q

What is the most common form of photosensitization ?

A

Secondary (hepatogenous)

Herbivores with impaired excretion of phylloerythrin

147
Q

What is hepatocutaenous syndrome

A

Crusting erosions and scaling (esp at mucocutaneous junctions)

148
Q

What are the non-neoplasic growth disturbances of the liver?

A

Hepatocellular nodular hyperplasia

Regenerative nodules

Bile duct hyperplasia

149
Q

Nodular hyperplasia is common in ?

A

Dogs

Age related change

150
Q

T/F: most malignant tumors of the liver originate form other organs

A

True

151
Q

Where do primary tumors of the liver arise from?

A

Hepatocytes
Bile duct
Mesenchymal tissue

152
Q

What is a benign neoplasm of hepatocytes seen in young ruminants

Single, non-encapsulated, red to brown nodule

A

Hepatocellular adenoma

153
Q

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?

A

Hepatocellular carcinoma

154
Q

Histology of a nodule from liver of a dog..

Cells arranged in a trabecular pattern
Atypical hepatocytes

A

Hepatocellular carcinoma

155
Q

A benign tumor arising for the bile duct

A

Cholangiocellular adenoma

Often cystic

156
Q

A multilobulated, firm, raised mass with central areas of depression in the bile ducts

A

Cholangiocellular carcinoma

157
Q

What type of liver metastasis can be found in the liver? What are they grossly characterized by?

A

Multifocal nodules resembling primary neoplastic site

Hemangiosarcoma sarcoma a
Metastatic melanoma

RUSVM Pathology 2 (16 decks)

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