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GI > Liver pathology & histology > Flashcards

Liver pathology & histology Flashcards

1
Q

Name the 3 zones of the liver

A

1 - Peri portal
2 - Mid acinar
3 - Peri central

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2
Q

Which cells in the liver are most vulnerable to injury?

A

Zone 3 cells

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3
Q

Does liver have large functional reserve?

A

Yes

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4
Q

Meaning of functional reserve?

A

Remaining capacity of organ to fulfil its physiological activity especially in context of disease

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5
Q

What are 3 outcomes of liver injury?

A

Severe parenchymal necrosis which heals entirely by restitution
Permanent damage
Production of predictable pathological patterns

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6
Q

Pathogenesis of liver disease?

A

Insult to hepatocytes -> Inflammation -> Fibrosis -> Cirrhosis

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7
Q

Confluent necrosis?

A

Necrosis involving multiple lobules

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8
Q

Jaundice?

A

Yellowing of the skin or whites of the eyes, arising from excess of the pigment bilirubin

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9
Q

Classifications of jaundice? (Site and type)

A

Pre-hepatic
Hepatic
Post hepatic

Conjugated
Unconjugated

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10
Q

Conjugated bilirubin?

A

In the liver, bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase, making it soluble in water

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11
Q

Pre-hepatic jaundice?

A

Excess red cell break down overwhelms liver
Too much haem to break down
Unconjugated bilirubin

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12
Q

Hepatic jaundice?

A

Liver cells are injured/ dead -> loses conjugating ability
Cirrhosis compresses biliary tress
Can be mixed conjugated and unconjugated

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13
Q

Post-hepatic jaundice?

A

Bile cannot escape into bowel

Obstruction biliary drainage, but bilirubin still conjugated in liver

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14
Q

Examples of when pre-hepatic jaundice may occur?

A

Haemolytic anaemias

Gilbert’s syndrome

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15
Q

Examples of when hepatic jaundice may occur?

A 
Acute liver failure
Alcoholic hepatitis
Cirrhosis (decompensated)
Bile duct loss (atresia, PBC, PSC)
Pregnancy
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16
Q

Examples of when post hepatic jaundice may occur?

A

Congenital bowel atresia
Gallstones block CBD
Strictures of CBD
Tumours

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17
Q

Cirrhosis of liver?

A

Irreversible
Bands of fibrosis separating regenerative nodules of hepatocytes
Macronodular or micro nodular
alteration of hepatic microvasculature & loss of hepatic function

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18
Q

Causes of cirrhosis?

A 
Alcohol
Hep B & C viruses
Iron overload
AI liver disease
Gallstones
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19
Q

Complications of cirrhosis?

A

Portal hypertension -> oesophageal varices, caput medusa, haemorrhoids

Ascites
Liver failure

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20
Q

What is portal hypertension?

A

Inc pressure in portal vein which carries blood from digestive organs to liver, caused by blockage in blood flow through liver

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21
Q

Steatosis?

A

Abnormal retention of fat (lipids)/ accumulation of fat in hepatic cells in the liver

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22
Q

Steatosis histology?

A

Fat vacuoles appear clearly in hepatocytes

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23
Q

Alcoholic fatty liver disease - weekend binge outcome and differentials?

A

Outcome - reversible

Dx - NASH, pregnancy, drugs, nutritional, diabetes, Hep C virus

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24
Q

Alcoholic hepatitis - weeks to month heavy drinking outcomes and features?

A

Reversible if stops

Hepatocyte necrosis, neutrophils, mallory bodies and pericellular fibrosis

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25
Q

Mallory bodies?

A

Large irregular masses abnormally located in hepatocytes of liver
Cytoplasmic hyaline incusions

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26
Q

Pericellular fibrosis?

A

Connective tissue strands that extend along the sinusoids to surround single or small groups of hepatocytes

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27
Q

Alcoholic fibrosis - heavy drinking from months to years?

A

Collagen (stains blue) is laid down around cells

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28
Q

Alcoholic cirrhosis?

A

Irreversible

Bands of fibrosis separating regenerative nodules Micronodular cirrhosis with abundant white scarring

29
Q

Alcoholic liver disease outcomes?

A 
Cirrhosis
Portal hypertension (varices, ascites)
Malnutrition
Hepatocellular carcinoma
Social disintegration
30
Q

Non-alcoholic steatohepatitis (NASH)?

A

Non-drinkers
Pathologically identical to alcoholic liver disease
Occurs in pts with diabetes, obesity, hyperlipidaemia
May lead to fibrosis, cirrhosis

31
Q

Viral hepatitis?

A

May cause acute or chronic liver injury

32
Q

Common cause of viral hepatitis?

A

Hep A, B, C, E

33
Q

Rare causes of viral hepatitis?

A 
Delta agent
Ebstein- Barr virus
Yellow fever virus
Herpes simplex virus
Cytomegalovirus
34
Q

Hepatitis A?

A 
Faecal- oral
Short incubation period
Directly cytopathic
No carrier state
Mild illness, usually full recovery
35
Q

Hepatitis B?

A

Blood, blood products, sex, vertically (in utero)
Long incubation period
Liver damage by antiviral immune response
Carriers
Variable outcomes

36
Q

Hepatitis C?

A 
Blood, blood products, sexually?
Short incubation
Often assymptomatic
Cases inc and dec
Tends to become chronic
37
Q

Features of chronic viral hepatitis?

A 
Dense portal chronic inflammation
Interface hepatitis (piecemeal necrosis)
Lobular inflammation
Councilman body
Fibrosis
Cirrhosis
38
Q

Interface hepatitis (piecemeal necrosis)?

A

Necrosis of the limiting plates, by inflammatory cells.

39
Q

Councilman body?

A

In pathology, is an acidophilic (eosinophilic / pink-staining on H&E) globule of cells that represents a dying hepatocyte often surrounded by normal parenchyma.

40
Q

Outcomes of Hep B?

A 
Fulminant acute infection (death)
Chronic hepatitis
Cirrhosis
Hepatocellular carcinoma
Asymptomatic (carrier)
41
Q

Outcomes of Hep C?

A

Chronic hepatitis

Cirrhosis

42
Q

Primary biliary cirrhosis/ cholangitis?

A 
AI disease, rare
Slow, progressive destruction of the small bile ducts of the liver, causing bile and other toxins to build up in the liver, a condition called cholestasis
Autoantibodies to mitochondria (assoc)
Females
Granulomas & BD loss
43
Q

Pathology of PBC?

A

Chronic portal inflammation
Bile duct inflammation
Granuloma around duct
Cirrhosis

44
Q

Outcomes of PBC?

A

If untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis & cirrhosis

45
Q

Autoimmune hepatitis?

A 
>females
Assoc w/ other AI diseases
Chronic hepatitis pattern
Numerous plasma cells
Autoantibodies to smooth muscle, nuclear or LKM, raised IgG
Triggers - inc drugs
46
Q

Chronic drug-induced hepatitis?

A

Similiar features to all other types of chronic hepatitis
May trigger AI hep
Chronic active process
Many causes

47
Q

Primary sclerosing cholangitis? (PSC)

A

Chronic inflammatory process affects intra & extra-hepatic bile ducts
Assoc with UC
Males
Inc risk of malignancy in bile ducts & colon

48
Q

What does PSC lead to?

A

Periductal fibrosis
Duct destruction
Jaundice
Fibrosis

49
Q

Pathology of PSC?

A

Periductal onion-skinning fibrosis

50
Q

Haemochromatosis?

A

Excess iron within the liver

Primary & secondary

51
Q

Primary haemochromatosis?

A

Genetic condition
Increased absorption of iron
Men

52
Q

Secondary haemochromatosis?

A

Iron overload from diet
Transfusions
Iron therapy

53
Q

More information on primary haemochromatosis?

A

Iron deposited in liver, asymptomatic for years
–> eventually deposited in portal connective tissue –> fibrosis
–> Cirrhosis if untreated
Predisposes to carcinoma

54
Q

Pathology of haemochormatosis?

A

Iron accumulates in hepatocytes - confirmed by Perls stain

55
Q

Outcome of haemochromatosis?

A

Depends on genetics, therapy & cofactors e.g. alcohol
Cirrhosis
Hepatocellular carcinoma

56
Q

Wilson’s disease?

A

Inherited autosomal recessive disorder of copper metabolism

Copper accumulates in liver and brain (basal ganglia)

57
Q

Features of Wilson’s disease?

A

Kayser-Fleischer rings at corneal limbus (dark rings circle iris of eye)
Low serum ceruloplasmin (Copper carrying protein)

58
Q

Outcomes of Wilson’s disease?

A

Causes chronic hepatitis & neurological deterioration

59
Q

Alpha-1-antitrypsin deficiency?

A

Inherited autosomal recessive disorder of production of enzyme inhibitor
AAT is produced in liver and meant to protect lungs

60
Q

What can alpha-1-antitrypsin deficiency cause?

A

Emphysema & cirrhosis

61
Q

Features of AAT deficiency ?

A

Cytoplasmic globules of unsecreted globules of protein in liver cells

62
Q

Tumours of liver?

A

Primary (rare) & secondary (common)

63
Q

Primary tumours of the liver?

A

RARE
Hepatocellular adenoma
Hepatocellular carcinoma (hepatoma)

64
Q

Secondary tumours of the liver?

A

COMMON
Multiple
Metastases from colon, pancreas, stomach, breast, lung etc.

65
Q

Hepatocellular adenoma?

A

Benign
Females
May become large -> can rupture or bleed
Most assymptomatc

66
Q

Hepatocellular carcinoma?

A 
RARE (in Europe)
Assoc with HBV, HCV, cirrhosis
Presents as mass, pain, obstruction
Usually advanced
Poor prognosis
67
Q

Histopatholical types of hepatocellular carcinoma?

A

Hepatocytic

Cholangio-

68
Q

Treatment for metastatic carcinoma?

A

Usually incurable disease unless single solitary metastasis

69
Q

Cholangiocarcinoma?

A

Cancer that forms in the bile ducts

GI (9 decks)

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