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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
Mallory bodies?
Large irregular masses abnormally located in hepatocytes of liver Cytoplasmic hyaline incusions
26
Pericellular fibrosis?
Connective tissue strands that extend along the sinusoids to surround single or small groups of hepatocytes
27
Alcoholic fibrosis - heavy drinking from months to years?
Collagen (stains blue) is laid down around cells
28
Alcoholic cirrhosis?
Irreversible | Bands of fibrosis separating regenerative nodules Micronodular cirrhosis with abundant white scarring
29
Alcoholic liver disease outcomes?
``` Cirrhosis Portal hypertension (varices, ascites) Malnutrition Hepatocellular carcinoma Social disintegration ```
30
Non-alcoholic steatohepatitis (NASH)?
Non-drinkers Pathologically identical to alcoholic liver disease Occurs in pts with diabetes, obesity, hyperlipidaemia May lead to fibrosis, cirrhosis
31
Viral hepatitis?
May cause acute or chronic liver injury
32
Common cause of viral hepatitis?
Hep A, B, C, E
33
Rare causes of viral hepatitis?
``` Delta agent Ebstein- Barr virus Yellow fever virus Herpes simplex virus Cytomegalovirus ```
34
Hepatitis A?
``` Faecal- oral Short incubation period Directly cytopathic No carrier state Mild illness, usually full recovery ```
35
Hepatitis B?
Blood, blood products, sex, vertically (in utero) Long incubation period Liver damage by antiviral immune response Carriers Variable outcomes
36
Hepatitis C?
``` Blood, blood products, sexually? Short incubation Often assymptomatic Cases inc and dec Tends to become chronic ```
37
Features of chronic viral hepatitis?
``` Dense portal chronic inflammation Interface hepatitis (piecemeal necrosis) Lobular inflammation Councilman body Fibrosis Cirrhosis ```
38
Interface hepatitis (piecemeal necrosis)?
Necrosis of the limiting plates, by inflammatory cells.
39
Councilman body?
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
Outcomes of Hep B?
``` Fulminant acute infection (death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma Asymptomatic (carrier) ```
41
Outcomes of Hep C?
Chronic hepatitis | Cirrhosis
42
Primary biliary cirrhosis/ cholangitis?
``` 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
Pathology of PBC?
Chronic portal inflammation Bile duct inflammation Granuloma around duct Cirrhosis
44
Outcomes of PBC?
If untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis & cirrhosis
45
Autoimmune hepatitis?
``` >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
Chronic drug-induced hepatitis?
Similiar features to all other types of chronic hepatitis May trigger AI hep Chronic active process Many causes
47
Primary sclerosing cholangitis? (PSC)
Chronic inflammatory process affects intra & extra-hepatic bile ducts Assoc with UC Males Inc risk of malignancy in bile ducts & colon
48
What does PSC lead to?
Periductal fibrosis Duct destruction Jaundice Fibrosis
49
Pathology of PSC?
Periductal onion-skinning fibrosis
50
Haemochromatosis?
Excess iron within the liver | Primary & secondary
51
Primary haemochromatosis?
Genetic condition Increased absorption of iron Men
52
Secondary haemochromatosis?
Iron overload from diet Transfusions Iron therapy
53
More information on primary haemochromatosis?
Iron deposited in liver, asymptomatic for years --> eventually deposited in portal connective tissue --> fibrosis --> Cirrhosis if untreated Predisposes to carcinoma
54
Pathology of haemochormatosis?
Iron accumulates in hepatocytes - confirmed by Perls stain
55
Outcome of haemochromatosis?
Depends on genetics, therapy & cofactors e.g. alcohol Cirrhosis Hepatocellular carcinoma
56
Wilson's disease?
Inherited autosomal recessive disorder of copper metabolism | Copper accumulates in liver and brain (basal ganglia)
57
Features of Wilson's disease?
Kayser-Fleischer rings at corneal limbus (dark rings circle iris of eye) Low serum ceruloplasmin (Copper carrying protein)
58
Outcomes of Wilson's disease?
Causes chronic hepatitis & neurological deterioration
59
Alpha-1-antitrypsin deficiency?
Inherited autosomal recessive disorder of production of enzyme inhibitor AAT is produced in liver and meant to protect lungs
60
What can alpha-1-antitrypsin deficiency cause?
Emphysema & cirrhosis
61
Features of AAT deficiency ?
Cytoplasmic globules of unsecreted globules of protein in liver cells
62
Tumours of liver?
Primary (rare) & secondary (common)
63
Primary tumours of the liver?
RARE Hepatocellular adenoma Hepatocellular carcinoma (hepatoma)
64
Secondary tumours of the liver?
COMMON Multiple Metastases from colon, pancreas, stomach, breast, lung etc.
65
Hepatocellular adenoma?
Benign Females May become large -> can rupture or bleed Most assymptomatc
66
Hepatocellular carcinoma?
``` RARE (in Europe) Assoc with HBV, HCV, cirrhosis Presents as mass, pain, obstruction Usually advanced Poor prognosis ```
67
Histopatholical types of hepatocellular carcinoma?
Hepatocytic | Cholangio-
68
Treatment for metastatic carcinoma?
Usually incurable disease unless single solitary metastasis
69
Cholangiocarcinoma?
Cancer that forms in the bile ducts

GI (9 decks)

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