Liver Pathology Flashcards
zones of the liver
periportal zone
mid acinar zone
pericentral
what are zones of the liver used to describe
describe patterns of liver injury
which zone of the liver is most vulnerable to injury
zone 3 - pericentral
describe the liver and injury
very resistant to injury
large functional reserve
healing of the liver
can produce severe parenchymal necrosis but heal entirely by restitution
some injuries may leave permanent damage
pathogenesis of cirrhosis
insult to hepatocytes
grading - inflammation
staging - fibrosis
cirrhosis
how may the hepatocytes be insulted
viral
drug
toxin
antibodies
describe acute liver failure
the acute onset of jaundice (many patients with severe liver disease are not jaundiced)
causes of acute liver failure
viruses - hepatitis
alcohol
drugs
bile duct obstruction
consequences of acute liver failure
complete recovery
chronic liver disease
death
describe jaundice
yellowing of skin
why does skin turn yellow in jaundice
bilirubin
how is jaundice classified
site and type
classification by site of jaundice
pre-hepatic
hepatic
post-hepatic
classification by type of jaundice
conjugated
unconjugated
describe pre-hepatic jaundice
there is too much haem to break down;
unconjugated bilirubin
causes of pre-hepatic jaundice
Haemolysis of all causes
haemolytic anaemias
describe hepatic jaundice
liver cells injured or dead
causes of hepatic jaundice
acute liver failure alcohol hepatitis cirrhosis bile duct loss pregnancy
how may the bile duct be lost
atresia
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis (PSC)
describe post-hepatic jaundice
bile cannot escape into bowel
causes of post-hepatic jaundice
congenital biliary atresia
gallstones blocking common bile duct
strictures of common bile duct
tumours (carcinoid head of pancreas)
define cirrhosis of the liver
bands of fibrosis sporting regenerative nodules of hepatocytes (massons trichrome stain)
macro nodular or micro nodular (alcoholic)
alteration of hepatic microvasculature
loss of hepatic function
describe cirrhosis of the liver
final common endpoint for liver disease
it is irreversible
causes of cirrhosis of the liver
alcohol !!! hepatitis B and C and other virsuses iron overload autoimmune disease gallstones
complications of cirrhosis
portal hypertension low albumin reduced metabolic capacity shunting of blood by-passing liver ascites liver faillure
features of portal hypertension
oesophageal varices
caput medusa
haemorrhoids
causes of portal hypertension
haemodynamic abnormalities proximal or distal to sinusoids or sinusoidal level
portal vein thrombosis
post-sinusoidal causes of portal hypertension
budd-chiari syndrome
sinusoidal causes of portal hypertension
cirrhosis
pre-sinusoidal causes of portal hypertension
portal fibrosis sarcoidosis schistosomiasis hepatoportal sclerosis cirrhosis
clinical features of cirrhosis and chronic liver failure
oedema ascites haematemesis spider nave gynaecomastia purport and bleeding coma infection
pathology of oedema in cirrhosis and chronic liver failure
reduced albumin synthesis - hypoalbuminaemia
pathology of ascites in cirrhosis and chronic liver failure
hypoalbuminaemia
secondary hyperaldosteronsim
portal hypertension
pathology of haematemesis in cirrhosis and chronic liver failure
ruptured oesophageal varices - portal hypertension
pathology of spider navi gynaecomastia in cirrhosis and chronic liver failure
hyeroestrogenism
pathology of purport and bleeding in cirrhosis and chronic liver failure
reduced clotting factor synthesis
pathology of coma in cirrhosis and chronic liver failure
failure to eliminate toxic gut bacterial metabolites
pathology if infection in cirrhosis and chronic liver failure
reduced Kupffer cell number and function
describe alcoholic liver disease
fatty liver - pathology is dependent on extent of alcohol abuse and individual factors
reversible to an extent
pathogenesis of alcoholic liver disease
increased peripheral release of fatty acids and increased synthesis of fatty acids and triglycerides within liver cells
acetaldehyde causes cell injury, manifested by formation of Mallory’s hyalin
increased collagen synthesis by fibroblasts and perisinusoidal cells of Ito
microscopy of alcoholic fatty liver disease - a weekend binge
fat vacuoles appear clear in hepatocytes
microscopy of alcoholic fatty liver disease - heavy drinking for weeks to months
hepatocyte necrosis
neutrophils
mallory bodies
pericelluar fibrosis
microscopy of alcoholic fatty liver disease - heavy drinking for months to years
collagen is layer down around cells
outcome of alcoholic live disease
cirrhosis portal hypertension - varies, ascites etc. malnutrition hepatocellular carcinoma social disintegration
describe non-alcoholic steatohepatitis (NASH)
pathologically identical to alcoholic liver disease but seen In non-drinkers
who gets NASH
diabetics
obese
hyperlipidaemia
outcomes of NASH
fibrosis
cirrhosis
