Liver Pathology

Question 1

zones of the liver

Answer 1

periportal zone
mid acinar zone
pericentral

Question 2

what are zones of the liver used to describe

Answer 2

describe patterns of liver injury

Question 3

which zone of the liver is most vulnerable to injury

Answer 3

zone 3 - pericentral

Question 4

describe the liver and injury

Answer 4

very resistant to injury

large functional reserve

Question 5

healing of the liver

Answer 5

can produce severe parenchymal necrosis but heal entirely by restitution
some injuries may leave permanent damage

Question 6

pathogenesis of cirrhosis

Answer 6

insult to hepatocytes
grading - inflammation
staging - fibrosis
cirrhosis

Question 7

how may the hepatocytes be insulted

Answer 7

viral
drug
toxin
antibodies

Question 8

describe acute liver failure

Answer 8

the acute onset of jaundice (many patients with severe liver disease are not jaundiced)

Question 9

causes of acute liver failure

Answer 9

viruses - hepatitis
alcohol
drugs
bile duct obstruction

Question 10

consequences of acute liver failure

Answer 10

complete recovery
chronic liver disease
death

Question 11

describe jaundice

Answer 11

yellowing of skin

Question 12

why does skin turn yellow in jaundice

Answer 12

bilirubin

Question 13

how is jaundice classified

Answer 13

site and type

Question 14

classification by site of jaundice

Answer 14

pre-hepatic
hepatic
post-hepatic

Question 15

classification by type of jaundice

Answer 15

conjugated

unconjugated

Question 16

describe pre-hepatic jaundice

Answer 16

there is too much haem to break down;

unconjugated bilirubin

Question 17

causes of pre-hepatic jaundice

Answer 17

Haemolysis of all causes

haemolytic anaemias

Question 18

describe hepatic jaundice

Answer 18

liver cells injured or dead

Question 19

causes of hepatic jaundice

Answer 19

acute liver failure 
alcohol hepatitis 
cirrhosis 
bile duct loss
pregnancy

Question 20

how may the bile duct be lost

Answer 20

atresia
Primary biliary cholangitis (PBC)
Primary sclerosing cholangitis (PSC)

Question 21

describe post-hepatic jaundice

Answer 21

bile cannot escape into bowel

Question 22

causes of post-hepatic jaundice

Answer 22

congenital biliary atresia
gallstones blocking common bile duct
strictures of common bile duct
tumours (carcinoid head of pancreas)

Question 23

define cirrhosis of the liver

Answer 23

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

Question 24

describe cirrhosis of the liver

Answer 24

final common endpoint for liver disease

it is irreversible

Question 25

causes of cirrhosis of the liver

Answer 25

alcohol !!!
hepatitis B and C and other virsuses
iron overload
autoimmune disease
gallstones

Question 26

complications of cirrhosis

Answer 26

portal hypertension
low albumin  
reduced metabolic capacity 
shunting of blood by-passing liver
ascites
liver faillure

Question 27

features of portal hypertension

Answer 27

oesophageal varices
caput medusa
haemorrhoids

Question 28

causes of portal hypertension

Answer 28

haemodynamic abnormalities proximal or distal to sinusoids or sinusoidal level
portal vein thrombosis

Question 29

post-sinusoidal causes of portal hypertension

Answer 29

budd-chiari syndrome

Question 30

sinusoidal causes of portal hypertension

Answer 30

cirrhosis

Question 31

pre-sinusoidal causes of portal hypertension

Answer 31

portal fibrosis 
sarcoidosis 
schistosomiasis 
hepatoportal sclerosis 
cirrhosis

Question 32

clinical features of cirrhosis and chronic liver failure

Answer 32

oedema 
ascites
haematemesis 
spider nave gynaecomastia 
purport and bleeding 
coma 
infection

Question 33

pathology of oedema in cirrhosis and chronic liver failure

Answer 33

reduced albumin synthesis - hypoalbuminaemia

Question 34

pathology of ascites in cirrhosis and chronic liver failure

Answer 34

hypoalbuminaemia
secondary hyperaldosteronsim
portal hypertension

Question 35

pathology of haematemesis in cirrhosis and chronic liver failure

Answer 35

ruptured oesophageal varices - portal hypertension

Question 36

pathology of spider navi gynaecomastia in cirrhosis and chronic liver failure

Answer 36

hyeroestrogenism

Question 37

pathology of purport and bleeding in cirrhosis and chronic liver failure

Answer 37

reduced clotting factor synthesis

Question 38

pathology of coma in cirrhosis and chronic liver failure

Answer 38

failure to eliminate toxic gut bacterial metabolites

Question 39

pathology if infection in cirrhosis and chronic liver failure

Answer 39

reduced Kupffer cell number and function

Question 40

describe alcoholic liver disease

Answer 40

fatty liver - pathology is dependent on extent of alcohol abuse and individual factors
reversible to an extent

Question 41

pathogenesis of alcoholic liver disease

Answer 41

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

Question 42

microscopy of alcoholic fatty liver disease - a weekend binge

Answer 42

fat vacuoles appear clear in hepatocytes

Question 43

microscopy of alcoholic fatty liver disease - heavy drinking for weeks to months

Answer 43

hepatocyte necrosis
neutrophils
mallory bodies
pericelluar fibrosis

Question 44

microscopy of alcoholic fatty liver disease - heavy drinking for months to years

Answer 44

collagen is layer down around cells

Question 45

outcome of alcoholic live disease

Answer 45

cirrhosis 
portal hypertension - varies, ascites etc.
malnutrition 
hepatocellular carcinoma
social disintegration

Question 46

describe non-alcoholic steatohepatitis (NASH)

Answer 46

pathologically identical to alcoholic liver disease but seen In non-drinkers

Question 47

who gets NASH

Answer 47

diabetics
obese
hyperlipidaemia

Question 48

outcomes of NASH

Answer 48

fibrosis

cirrhosis