Liver pathology I Flashcards
Review normal liver anatomy below
Review the slide below on hepatic microarchitecture
____ is a space that houses ___ cells that initiate fibrosis when the liver is injured
How is the liver divided into zones? Which zone is the most prone to ischemia and why?
The Space of Disse is the space that has stellate cells (become activated when liver is injured and initiate fibrosis >> cirrhosis)
The liver is divided into zones based on oxygenation: Zone 1 being the most oxygenated (closest to portal tract) and Zone 3 being the least oxygenated (and thus the most affected by ischemia)
Label the liver below. Is this normal or diseased liver?
*see slide*
Normal liver, no fibrosis
Hepatic cords: sinusoid >> hepatocytes >> sinusoid (should be no thicker than 1-2 cells If thicker, worry about neoplasm)
Limiting plate: the fibrous tissue at the end of the portal tract (according to Wikipedia: ring of hepatocytes abutting connective tissue of portal triad)
**refer to lecture ppt for slide on portal triad**
There are different stains used to visualize the liver.
Which stain is used to detect liver fibrosis?
Which stain is also used to detect fibrosis, but detecting type 3 collagen?
Which stain would be used to detect conditions involving iron, e.g. hemochromatosis?
Trichome stain is used to detect fibrosis (type I collagen)
Reticulin stain detects fibrosis by looking at type III collagen
Iron stain is used to stain for iron (e.g. hemochromatosis or iron overload)
What are the pathologies below? (label and define each)
Top left: steatosis (fat accumulation in liver cells)
Top right: cholestasis (literally bile stasis)
Bottom: ballooning degenaration - hepatocyte swelling
What is the pathology below?
Necrosis (lots of uncontrolled release of cell contents >> redness)
Apoptosis: apoptotic bodies
Hepatitis is characterized by infiltration of which inflammatory cells?
Inflammation of the liver is characterized by lymphocyte infiltrate (not neutrophils like everywhere else)
What is the pathology below?
Left: liver cirrhosis
Characterized by nodules surrounded by fibrous bands
Also has bile ductules - fake bile ducts, w/ advanced disease
Fill in the blanks below
Remember that injury involving the bile ducts will result in elevated bilirubin + alk phos, injury involving the hepatocytes results in elevated AST/ALT
Fill in the table of non-neoplastic liver diseases
*see below*
Acute hepatitis primarily affects what unit of the liver?
What are 4 characteristics of this disease?
Chronic hepatitis mainly affects the ___ and is characterized by interface activity, inflammation (+/-), apoptotic bodies and ___ (hint: leads to cirrhosis)
Acute hepatitis mainly affects lobules
Characterized by: lymphocytes, lobular disarray + ballooning degeneration, apoptotic bodies, +/- necrosis in severe cases
Chronic hepatitis mainly affects the portal tract and is characterized by interface activity, inflammation (+/-), apoptotic bodies and fibrosis
What is the pathology on the left?
Acute hepatitis
*notice the apoptotic body - black arrow, and the lymphocyte infiltrate*
What is the pathology below?
Submassive hepatic necrosis
Describe the difference between staging and grading in chronic hepatitis. Which is reversible and which is not?
Grade is a measure of how much inflammation there is and is therefore reversible w/ treatment
Stage is a measure of how much fibrosis there is and is therefore irreversible (generally)
Study the slide below on staging in chronic hepatitis
Long standing chronic hepatitis increases risk of ___
Long standing chronic hepatitis increases risk of hepatocellular carcinoma
**long standing bile duct injury increases risk of cholangiocarcinoma**
**cirrhosis in general increases the risk of hepatocellular carcinoma**
A pt comes in with suspicion of viral hepatits. You do a biopsy and you notice ground glass hepatocytes. You also do serology and you confirm the presence of anti-HBc IgM and HBs Ag.
Which hepatitis virus is on your differential?
Hepatitis B
A different pt comes to you presenting with jaundice and scleral icterus and is suspected to have viral hepatitis. You do a biopsy and you observe lymphoid follicles in the portal tract + mild steatosis. You later learn that the pt is also an IV drug user.
Which hepatitis virus is on your differential?
Hepatitis C
A 33 year old female pt comes in w/ severe chronic hepatitis. On biopsy, you observe extensive interface activity, bridging necrosis and the presence of plasma cells. You later treat the pt w/ prednisone and she responds well.
Which hepatitis category is in your differential?
Autoimmune hepatitis
(note the pix below w/ plasma cells)
What is the pathology below?
Autoimmune hepatitis
A patient presents with elevated liver enzymes on routine physical exam. Serology is performed and the patient is found to have Hepatitis C. Which of the following histologic features is most compatible with chronic HCV infection?
A.Ground glass hepatocytes
B.Inflammatory portal based infiltrate composed of mostly plasma cells
C.Lobular inflammation without significant portal inflammation
D.Portal and periportal fibrosis
D. Portal and periportal fibrosis
Unlike in hepatitis, fibrosis in fatty liver disease occurs around ___ and results in a “chicken-wire fence” pattern
Steatosis is characterized by __ in liver cells
Steatohepatitis is characterized by steatosis, ___, +/- ___
Unlike in hepatitis, fibrosis in fatty liver disease occurs around the central vein and results in a “chicken-wire fence” pattern
Steatosis is characterized by fat in liver cells (pushed nucleus aside)
Steatohepatitis is characterized by steatosis, ballooning, +/- inflammation
What is the pathology below?
Fatty liver
The slide below indicates what pathology?
Steatohepatitis (inflammation, ballooning, fat droplets + Mallory bodies but don’t necessarily have to see these. if present, suggests alcholic fatty liver)
A patient undergoing bariatric surgery is noted to have a nodular liver. Biopsy is taken which shows marked steatosis with inflammation and Mallory body formation. Trichrome stain shows pericellular “chicken-wire” fibrosis. What is likely to occur as he loses weight following surgery?
A.The fat and fibrosis will decrease
B.The fat will decrease, but the fibrosis will stay the same
C.Both the fat and fibrosis will stay the same
D.The fat and fibrosis will get worse
B. Fat decreases but since fibrosis is irreversible, it won’t change
Hemochromatosis is caused by excessive ___ deposition in parenchymal organs and involves cirrhosis, diabetes, “bronze diabetes” (skin pigmentation) and cardiomyopathy
How is this disease treated?
Hemochromatosis is caused by excessive iron deposition in parenchymal organs and involves cirrhosis, diabetes, “bronze diabetes” (skin pigmentation) and cardiomyopathy
Treatment: phlebotomy, chelation
Review this slide on normal iron absorption
In hemochromatosis, iron overload is due to reduced hepcidin caused by the mutation ___
In hemochromatosis, iron overload is due to reduced hepcidin caused by the mutation C282Y in HFE3
**reduced hepcidin = more iron leaving the enterocyte via ferroportin >> systemic iron overload
What is the pathology below?
Hemochromatosis (all the blue is iron)
___ is synthesized in the liver and normally inhibits proteases. A mutation in this protein (most common = __) results in a misfolded protein that accumulates in the ER of hepatocytes
alpha 1 antitrypsin is synthesized in the liver and normally inhibits proteases. A mutation in this protein (most common = PiZ) results in a misfolded protein that accumulates in the ER of hepatocytes
**increased risk of liver disease due to other causes, and increased risk of panlobular emphysema - lack of alpha 1 antitrypsin in the lungs**
