Liver Pathology and CPC Flashcards
Which area gets the most oxygen, the periportal or the centrilobular areas?
periportal (portal tract includes the hepatic artery)
centrilobular/ zone 3 is more susceptible to injury as it receives less oxygenated blood and is exposed to higher levels of toxic electrophilic metabolites generated by CYP450
Describe what ballooning degeneration looks like and when you might observe it.
cellular swelling due to accumulation of water and protein which cannot be exported, cell becomes round with a foamy cytoplasm
seen in alcoholic steatohepatitis or acute hepatitis of any cause, drugs/toxins
(grossly liver is swollen, pale due to compression of capillaries and turgid with hepatomegaly)
Describe how steatosis appear and in what conditions it appears.
hepatocytes accumulate fat droplets inside their cytoplasm, becoming round with the nucleus pushed to the side
seen in alcoholic liver, drug toxicity (Reye’s syndrome), viral hepatitis c (+/-), Wilson’s disease +/-
grossly the liver is soft, yellow, swollen and greasy on cut surface
Contrast the brown accumulations that can occur in hepatocytes.
with cholestasis, bile will be visible in the hepatocytes and canalicular spaces
iron overload in HH is seen within hepatocytes and can be differentiated from bile or lipofucsin with Prussian blue stain
accumulation of Cu in Wilson’s disease can be distinguished with a Copper stain
Contrast coagulative necrosis with spotty necrosis, the two main morphological patterns of necrosis in the liver.
coagulative: outlines of cells persist, nuclei drop out- occurs in ischemia and infarction
spotty: individual cells undergo lytic necrosis usually following severe ballooning degeneration, hepatocytes drop out and are quickly filled with inflammatory cells, appearing as ‘spots’ of inflammatory cells as in viral hepatitis or alcohol
Describe the appearance of apoptotic bodies/councilman bodies.
single hepatocyte having a dense shrunken cytoplasm with or without a pyknotic nucleus, unaccompanied by inflammation; is usually due to viral hepatitis and drugs
Contrast focal or diffuse necrosis.
focal involves a particular area (zone 3 necrosis or bridging necrosis)
diffuse: extensive, pan lobar or multi lobar necrosis
What situations might you expect Zone 3 necrosis?
acetaminophen toxicity, venous outflow obstruction or with ischemic injury
confluent necrosis around the central vein can extend to involve all the hepatocytes at the periphery of the acinus (which can lead to bridging fibrosis)
Mushroom toxicity may lead to what pattern of liver injury?
massive necrosis
often with wrinkled shrunken gross-appearance
How might you differentiate the inflammation in chronic hepatitis from acute hepatitis.
acute is more diffuse, in chronic, inflammatory cells are more concentrated around the portal tracts
pericellular occurs in alcoholic
What pathologic changes would you expect in alcoholic steatosis?
steatosis- fat accumulations ballooning mallory bodies (pink-clumpy rope like inclusions of degenerating cytokeratin intermediate filaments) inflammation (neutrophils) fibrosis
Non-alcoholic steatosis would be expected to be lacking which features of steatohepatits?
no ballooning or inflammation
with steatohepatitis you would expect ballooning, inflammation but mallory bodies would be less likely in fatty liver disease
What are cellular features of chronic viral hepatitis?
portal nodular lymphoid aggregates, interface inflammation and ground glass hepatocytes (HBV)
Autoimmune hepatitis has varied presentation and can resemble ____ _____ or _______ hepatitis; with severe pan lobular necrosis, fulminant failure is likely.
autoimmune hepatits can present like acute viral hepatitis, chronic hepatitis
**distinguished really by plasma cells in the portal tracks and parenchyma
What extra hepatic systems are effected in HH?
pancreases- DM1
heart failure
arthritic joints
skin (tan due to increased melanin)