Liver Pathology Flashcards
What are the broad causes of liver injury?
Drugs or toxins including alcohol Abnormal nutrition/metabolism Infection Obstruction to bile or blood flow Autoimmune liver disease Genetic/deposition disease Neoplasia
What is ‘fulminant’ inflammation of the liver?
Severe, acute inflammation and rapidly progressing towards liver failure
What part of the liver is usually affected by liver injury?
Parenchyma
Define cirrhosis
It is a diffuse process with fibrosis and nodule formation
What is the main aim of treatment of chronic liver disease?
Avoid progression to cirrhosis
What investigations should be conducted in chronic liver disease?
LFTs Haematological Viral and autoimmune serology Metabolic tests Ultrasound Biopsy
What are the histological features of acute hepatitis?
Swelling with ‘spotty’ necrosis
Inflammatory cell infiltrate in all areas
Dying hepatocytes
Plasma cells prominent
What are the histological features of acute cholestasis?
Presence of brown bile pigment (bilirubin), possibly alongside acute hepatitis
What can cause acute cholestasis?
Extra hepatic biliary obstruction
Drug injury e.g. antibiotics
What are the histological features of hepatitis B?
Acute hepatitis plus fibrosis
Ground glass cytoplasm in hepatocytes due to the accumulation of surface antigen
What can cause chronic biliary/cholestatic disease?
Primary biliary cholangitis
Primary sclerosis cholangitis
What are the histological features of chronic biliary/cholestatic disease?
There is local, portal-predominant inflammation and fibrosis with bile duct injury and granulomas in primary biliary cholangitis
What are the different types of depositional/genetic liver disease?
Haemachromatosis (excess iron)
Wilson’s disease (excess copper)
Alpha 1 antitrypsin deficiency
What are the specific causes of diffuse liver disease?
Hepatitis A,B,C,D,E Drug injury Autoimmune liver disease Extrahepatic biliary obstruction Alcohol Metabolic syndrome e.g. obesity Chronic biliary disease e.g. PBC Vascular disease e.g. venous obstruction Genetic/deposition e.g. haemachromatosis
Most drug hepatotoxicity is idiosyncratic. T/F?
True
Give an example of a drug which can cause predictable liver damage
Paracetamol overdose
What is the normal origin of liver cysts?
Developmental and degenerative
What is the most common liver cyst?
Von meyenberg complexes
Describe the importance of Von Meyenberg liver cysts?
These can resemble metastases to the naked eye at operation and are often submitted for pathology including urgent intra-operative. frozen section
Liver cysts require surgical removal. T/F?
False - there is no treatment required
What is the most common benign liver neoplasm?
Hepatocellular adenoma
What is the most common malignant liver neoplasm?
Hepatocellular carcinoma
Biopsy is required for the diagnosis of haemangiomas. T/F?
False - biopsy is avoided due to the risk of bleeding
In what group of patients do hepatic adenomas typically occur?
Young women
Which liver neoplasm is associated with hormonal therapy?
Hepatic adenomas
Hepatic adenomas should be surgically excised. T/F?
True - as they are at risk of bleeding and rupture
Which liver neoplasm is associated with elevated serum alpha fetoprotein?
Hepatocellular carcinomas
