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Histopathology - Path > Liver Pathology > Flashcards

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
Q

What is haemosiderosis?

A
  • Accumulation of iron in macrophages
  • Can occur after repeated blood transfusions
26
Q

What is Wilson’s disease?

  1. What is it?
  2. What genes are affected?
  3. Assessment
A
  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
Q

What does this image show?

A

Rhodanine stain for copper in the liver

Test used on liver biopsies, where Wilson’s disease is suspected

28
Q

Describe autoimmune hepatitis.

  1. Aetiology
  2. What is it?
  3. Antibodies
  4. Treatment
A
  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
Q

Describe alpha-one antitrypsin deficiency

A
  • Failure to secrete alpha-one antitrypsin
  • Intra-cytoplasmic inclusions due to misfolded protein
  • Leads to hepatitis and cirrhosis
30
Q

Any drug can cause damage to the liver.

What areas of the liver will be affected by an overdose of paracetamol?

A

Zone 2 adnd zone 3

31
Q

What are the

  1. specific and
  2. general

causes of hepatic granulomas?

A

Specific

  1. PBC and drugs

General

  1. TB and sarcoid etc.
32
Q

Name 3 benign liver tumors

A
  • Liver cell adenoma
  • Bile duct adenoma
  • haemangioma
33
Q

Describe secondary malignant liver tumors

A

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
Q

Name 4 primary malignant liver tumors

A
  • Heptaocellular carcinoma
  • Hepatoblastoma
  • Cholangiocarcinoma
  • Haemangiosarcoma
35
Q

Describe a cholangiocarcinoma

  1. What is it associated with?
  2. Where can they arise from?
A
  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
Q
A

Histopathology - Path (14 decks)

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