Liver Pathology

Question 1

What are the broad causes of liver injury?

Answer 1

Drugs or toxins including alcohol
Abnormal nutrition/metabolism
Infection
Obstruction to bile or blood flow
Autoimmune liver disease
Genetic/deposition disease
Neoplasia

Question 2

What is ‘fulminant’ inflammation of the liver?

Answer 2

Severe, acute inflammation and rapidly progressing towards liver failure

Question 3

What part of the liver is usually affected by liver injury?

Answer 3

Parenchyma

Question 4

Define cirrhosis

Answer 4

It is a diffuse process with fibrosis and nodule formation

Question 5

What is the main aim of treatment of chronic liver disease?

Answer 5

Avoid progression to cirrhosis

Question 6

What investigations should be conducted in chronic liver disease?

Answer 6

LFTs
Haematological
Viral and autoimmune serology
Metabolic tests
Ultrasound
Biopsy

Question 7

What are the histological features of acute hepatitis?

Answer 7

Swelling with ‘spotty’ necrosis
Inflammatory cell infiltrate in all areas
Dying hepatocytes
Plasma cells prominent

Question 8

What are the histological features of acute cholestasis?

Answer 8

Presence of brown bile pigment (bilirubin), possibly alongside acute hepatitis

Question 9

What can cause acute cholestasis?

Answer 9

Extra hepatic biliary obstruction

Drug injury e.g. antibiotics

Question 10

What are the histological features of hepatitis B?

Answer 10

Acute hepatitis plus fibrosis

Ground glass cytoplasm in hepatocytes due to the accumulation of surface antigen

Question 11

What can cause chronic biliary/cholestatic disease?

Answer 11

Primary biliary cholangitis

Primary sclerosis cholangitis

Question 12

What are the histological features of chronic biliary/cholestatic disease?

Answer 12

There is local, portal-predominant inflammation and fibrosis with bile duct injury and granulomas in primary biliary cholangitis

Question 13

What are the different types of depositional/genetic liver disease?

Answer 13

Haemachromatosis (excess iron)
Wilson’s disease (excess copper)
Alpha 1 antitrypsin deficiency

Question 14

What are the specific causes of diffuse liver disease?

Answer 14

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

Question 15

Most drug hepatotoxicity is idiosyncratic. T/F?

Answer 15

True

Question 16

Give an example of a drug which can cause predictable liver damage

Answer 16

Paracetamol overdose

Question 17

What is the normal origin of liver cysts?

Answer 17

Developmental and degenerative

Question 18

What is the most common liver cyst?

Answer 18

Von meyenberg complexes

Question 19

Describe the importance of Von Meyenberg liver cysts?

Answer 19

These can resemble metastases to the naked eye at operation and are often submitted for pathology including urgent intra-operative. frozen section

Question 20

Liver cysts require surgical removal. T/F?

Answer 20

False - there is no treatment required

Question 21

What is the most common benign liver neoplasm?

Answer 21

Hepatocellular adenoma

Question 22

What is the most common malignant liver neoplasm?

Answer 22

Hepatocellular carcinoma

Question 23

Biopsy is required for the diagnosis of haemangiomas. T/F?

Answer 23

False - biopsy is avoided due to the risk of bleeding

Question 24

In what group of patients do hepatic adenomas typically occur?

Answer 24

Young women

Question 25

Which liver neoplasm is associated with hormonal therapy?

Answer 25

Hepatic adenomas

Question 26

Hepatic adenomas should be surgically excised. T/F?

Answer 26

True - as they are at risk of bleeding and rupture

Question 27

Which liver neoplasm is associated with elevated serum alpha fetoprotein?

Answer 27

Hepatocellular carcinomas