Liver Pathology Flashcards

1
Q

How much does the liver weight on average?

A

1500g, normally approx 4% of body weight

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2
Q

The liver has a dual blood supply, where do they come from?

A

Portal vein

Hepatic artery

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3
Q

What are the 6 types of cells of the liver?

A
  • Hepatocytes - most metabolically active cell
  • Bile ducts
  • Blood vessels
  • Endothelial cells
  • Kupffer cells - resident macrophages of the liver
  • Stellate cells - store vitamin A - when activated become myofibroblasts and lay down collagen
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4
Q

Describe the development of hepatocytes and where it occurs

A

Liver cells are born in zone 1 near the bile duct

Hepatocytes mature in zone 2

Retire when fully mature in zone 3, here the hepatocytes are the most metabolically active

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5
Q

Describe how and what happens when stellate cells of the liver get activated

A

Stellate cells are activated when the liver is damaged - hepatocyte villi is damaged/lost

Stellate cells are activated and lay down collagen/scar tissue and loss of fenestrae between endothelial cells

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6
Q

Define cirrhosis (4 things)

A
  1. whole liver involved
  2. fibrosis
  3. nodules of regneration hepatocytes
  4. distortion of liver vasculature architecture: both intra and extra hepatic shunting of blood e.g. gastro-oesophageal
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7
Q

How is cirrhosis classified?

A
  1. according to nodule size - micronodular or macronodular

AND

  1. According to aetiology
  • alcohol/insulin resistance
  • viral hepatitis etc.
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8
Q

What are the 3 main complications of liver cirrhosis?

A
  • Portal hypertension
  • Hepatic encephalopathy
  • Liver cell cancer

Also, oesophageal varicies, splenomegaly due to chronic passive congestion

*Cirrhosis may be reversible

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9
Q
  1. What does this picture show?
  2. What is the most common cause?
A
  1. Oesophageal varicies - dilated tortuous vein
  2. Liver cirrhosis
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10
Q

What are the two main causes of acute hepatitis?

A
  1. Viruses
  2. Drugs
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11
Q

What does this slide show?

A

Acute hepatitis

  • spotty necrosis - lots of little spots of inflammation, with lots of lymphocytes and macrophages
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12
Q

What are the 3 main causes of chronic hepatitis?

A
  1. Viral hepatitis
  2. Drugs
  3. Auto-immune
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13
Q

What does grade and stage of chronic hepatitis liver mean in histology?

A
  • Grade = severity of inflammation
  • Stage = severity of fibrosis
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14
Q

What does the picture show?

A

Interface hepatitis

Shows ‘piecemeal necrosis’

Shows the portal tract which has lost the definition as necrosis spreads across the limiting plate. T cell mediated destruction of hepatoyctes

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15
Q

What are the three stages of alcoholic liver disease?

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
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16
Q

What does this image show?

A

Fatty liver

Pale and yellow, suggesting lots of fat droplets

17
Q

What are the histological features of alcoholic hepatitis?

A
  • Ballooning (+/- Mallory Denk bodies)
  • Apoptosis
  • Pericellular fibrosis
  • Mainly see in zone 3 of the liver - where hepatocytes are most metabolically active
18
Q

What does this image show?

A

Alcoholic hepatitis

  • Balloon cells
  • Mallory Denk bodies
  • Neutrophil polymorphs
  • Pericellular fibrosis
19
Q

What does this image show?

A

Liver cirrhosis

Pale due to fatty change, with associated nodules indicative of cirrhosis

20
Q

What is NAFLD and NASH?

A

NAFLD - Non-alcoholic fatty liver disease

NASH - Non-alcoholic steatohepatitis

  • Histologically looks like alcoholic liver disease
  • Due to insulin resistance associated with a raised BMI and diabetes
21
Q

Describe Primary Biliary cholangitis (PBC)

  • Aetiology
  • What it is
  • Antibodies
A
  • Previously known as primary biliary cirrhosis
  • Bile duct loss assoacited with chronic inflammation, with granulomas
  • More common in females then males
  • Diagnostic test is detection of anti-mitochondrial antibodies
22
Q

Describe Primary Sclerosing cholangitis

  • Aetiology
  • What is it
  • Diagnostic test
A
  • Periductal bile duct fibrosis leading to loss
  • Associated with UC, and causes an increased risk of cholangiocarcinoma
  • More common in males than females
  • Diagnostic test is bile duct imaging
23
Q

What is haemochromatosis?

  • What is it?
  • What gene is affected?
A
  • Genetically determined increased gut iron absorption, leading to high levels of iron in the body and iron deposits in different organs. Parenchymal damage to organs occurs secondary to iron deposition - classic is in the pancreas leading to ‘bronzed diabetes’ as pancreas is damaged and change in skin colour due to iron deposition
  • Gene on chromosome 6 - HFe
24
Q

What does this image show?

A

Haemocrhomatosis

Liver full of brown pigments which are iron deposits, causes parenchymal damage in organs leading to reduced/loss of function

25
What is haemosiderosis?
* Accumulation of iron in macrophages * Can occur after repeated blood transfusions
26
What is Wilson's disease? 1. What is it? 2. What genes are affected? 3. Assessment
1. Wilson's disease is the accumulation of copper due to failure of excretion by hepatocytes into the bile. Copper therefore accumulates in the liver, and the CNS leading to hepato-lenticular degeneration and Kayser-Fleischer rings in the eyes 2. Genes affected found on chromosome 13 3. Assessed by biopsy or biochemistry
27
What does this image show?
Rhodanine stain for copper in the liver Test used on liver biopsies, where Wilson's disease is suspected
28
Describe autoimmune hepatitis. 1. Aetiology 2. What is it? 3. Antibodies 4. Treatment
1. More common in females than males 2. Active chronic hepatitis with plasma cells present 3. Anti-smooth muscle actin antibodies in the serum 4. Responds to steroids
29
Describe alpha-one antitrypsin deficiency
* Failure to secrete alpha-one antitrypsin * Intra-cytoplasmic inclusions due to misfolded protein * Leads to hepatitis and cirrhosis
30
Any drug can cause damage to the liver. What areas of the liver will be affected by an overdose of paracetamol?
Zone 2 adnd zone 3
31
What are the 1. specific and 2. general causes of hepatic granulomas?
Specific 1. PBC and drugs General 2. TB and sarcoid etc.
32
Name 3 benign liver tumors
* Liver cell adenoma * Bile duct adenoma * haemangioma
33
Describe secondary malignant liver tumors
Secondary malignant liver tumors usually arise from metastasis from another cancer in the body, commonly GI tract or pancreas. The liver is a hotspot for metastases due to its dual blood supply. In this case, where there are liver metastases, there will be several tumors not just one.
34
Name 4 primary malignant liver tumors
* Heptaocellular carcinoma * Hepatoblastoma * Cholangiocarcinoma * Haemangiosarcoma
35
Describe a cholangiocarcinoma 1. What is it associated with? 2. Where can they arise from?
1. Associated with PSC, Worm infections and liver cirrhosis 2. Can arise from the intra-hepatic ducts (looking like HCC) or the extrahepatic ducts, including the gallbladder
36