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pathology 2 > medical conditions of the liver > Flashcards

medical conditions of the liver Flashcards

1
Q

three main histological patterns

A
  • hepatitis - inflammation
  • steatosis - fatty liver
  • cholestasis - retention of bile

there can be overlap

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2
Q

acute liver inflammation

A

<6 months is acute hepatitis
symptoms not always present
- fatigue, anorexia, nausea, jaundice, tenderness

typically lasts 2-4 weeks
minority progress to acute liver failure
- multiple disparate causes

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3
Q

chronic liver inflammation

A
  • greater than 6 months
  • symptoms not always present
  • weakness, tiredness and malaise
  • often identified on screening blood tests
  • aetiology dictates progression rate of damage and development of cirrhosis and carcinoma
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4
Q

causes of acute hepatitis

A

hep A, E, B, C, D
immunosuppressed/transplant - CMV, EBV, HSV
other infections - toxoplasma, Q fever, leptospirosis, brucellosis
alcohol
drugs - parecetomol
toxins - mushrooms, carbon tetrachloride
ischaemia
pregnancy
autoimmune conditions
metabolic

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5
Q

causes of chronic hepatitis

A 
- hep B, C 
alcohol 
drugs 
autoimmune hepatitis 
biliary 
metabolic 
NAFLD - non-alcohol fatty liver disease
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6
Q

biliary causes of chronic hepatitis

A
  • primary biliary cholangitis

primary sclerosis cholangitis

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7
Q

metabolic cause of chronic hepatitis

A

alpha -1 - antitrypsin deficiency
hereditary haemochromatosis
Wilson’s disease

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8
Q

aetiologies of steatosis

A

alcohol
NAFLD/NASH - non alcoholic stet-hepatitis
drugs - methotrexate, amiodarone
hep C

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9
Q

causes of cholestasis

A

primary biliary cholangitis
primary sclerosisg cholangitis
extra hepatic biliary obstruction
drugs

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10
Q

hepatitis and liver inflammation

A

a necro-infalmmatory process comparing inflammation, hepatocyte necoris and repair, involving the portal and lobular regions

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11
Q

histological features of liver inflammation

A

portal tract inflammation
limiting plate - interface hepatitis
lobular inflammation and hepaocyte necrosis - apoptosis of coagulative necrosis
repair - macrophages, hepatocyte regeneration and fibrosis which may progress to cirrhosis

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12
Q

macro vesicular steatosis

A

one vacuole is filling the cytoplasm, variable in size but often large

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13
Q

microvesicular steatosis

A

multiple small vacuoles filling the cytoplasm of a hepatocyte
uncommon

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14
Q

causes of microvessicular steatosis

A

Reye’s syndrome
acute faty liver of pregnancy
drugs - tetracycline, valproic acid
congenital metabolic disorders - urea cycle disorders, Jamaican vomtiting disease

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15
Q

causes of macrovessicular steatosis

A

alcohol
- acute hepatitis - hepatocyte necrosis with a neutrophil infiltrate. Mallory’s hyaline steatosis
- chronic stages - portal tract chronic inflammation and fibrosis, central vein sclerosis, often mild increase in iron
NASH - non alcohol steatohepatitis
- associated with obesity diabetes, GI surgery, TPN, metabolise syndrome features - fat, mallory’s hyaline, inflammation, fibrosis
- drugs - methotrexate, amiodarone
- hep C virus

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16
Q

NASH

A

non alcohol steatohepattitis

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17
Q

NASH causes of macrovessicular hepatitis

A
  • obesity
  • drugs
  • hep C
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18
Q

cholestasis

A

incomplete excretion of bile

19
Q

histology of cholestasis

A 
- feathery degeneration of hepatocytes 
bile plugs 
cell death with inflmaammtion 
bile ductile proliferation at the edge of portal tracts 
fibrosis - cirrhosis
20
Q

pre haptic cholestasis

A

excess production of bilirubin (RBC breakdown)

21
Q

intrahepatic causes of cholestisis

A

inform errors
drugs - flucloxicillin - destroys bile ducts
primary biliary cholangitis
primary sclerosing cholangitis

22
Q

primary biliary cholangitis

A

4 stages

  • duct lesion - duct damage, portal inflammation, granulomata
  • ductular proliferation - expanded portal tracts, interface hepatitis
  • scarring - fibrosis, loss of bile ducts
  • cirrhosis
23
Q

primary sclerosis cholangitis

A

large duct vs small duct

inflammation and concentric fibrosis around ducts resulting in epithelial necrosis and duct loss

24
Q

post hepatic cause of cholestasis

A

extra-hepatic biliary obstruction (gall stones, tumours in the head of the pancreas
- bile plug in ducts - may rupture to form bile likes +/- ascending cholangitis (neutrophils in bile ducts), abscesses

25
Q

biopsy diagnosis

A

asses whether hepatitis, steaotic, cholestatic, fibrotic, overlap or other
rarely make a diagnosis in isolation
always a combination of serological, clinical and/or radiological
not frequently a non-specific pattern
- however, some etiologists can produce characteristic patterns that may be highly suggestive of a particular cause

26
Q

ground glass hepatocytes

A

hepatocytes with ground glass inclusions

hep B surface antigen

27
Q

auto-immune hepatitis

A

florid lobular and portal inflammation, interface hepatitis, hepatocyte rosettes, plasma cells

28
Q

mallory bodies

A

occur in alcoholic hepatitis

29
Q

biliary diseases

A
  • primary biliary cholangitis - cirrhosis
  • primary sclerosis cholangitiss
  • extra hepatic biliary obstruction
30
Q

histopathology of biliary diseases

A 
inflammation/dmaaaage around the bile ducts 
cholestasis 
bile ductile proliferation 
hepatocyte damage 
fibrosis
31
Q

PBC histology

A

jigsaw pattern of fibrosis

32
Q

PSC histology

A

inflammation and fibrposis

sclerosing fibrosis

33
Q

inborn errors

A 
congenital 
- hereditary haemochromatosis - iron overload 
- alpha -1 anti-trypsin 
Wilson's copper storage disease 
cystic fibrosis
34
Q

hereditary haemochromatosis

A

iron granules present in liver cells

35
Q

investigations

A
  • LFTs
  • infective agents
  • serology - autoimmune Ab, iron studies
  • tumour markers, alpha-feto protein
  • imaging for mass lesions
  • liver biopsy
36
Q

cirrhosis

A

diffuse alteration of the normal architecture by fibrous septa separating nodules of regenerating hepatocytes

the end point of many disease processes where there are cycles of necrosis/infalmmation and repair/fibrosis

37
Q

aetiologies of cirrhosis

A 
alcohol/drugs 
viral hepatitis 
auto immune hepatitis 
metabolic diseases 
genetic haemochomatosis 
alpha-1-antitrypsin deficiency 
Wilson's disease 
biliary tract disease 
non-alcoholic steatohepatitis 
idiopathic
38
Q

clinical symptoms and signs of cirrhosis

A
  • no symptoms, abnormal liver function tests
  • non specific symptoms and signs - malaise, abdominal pain, hepatomegaly
  • liver failure signs and symptoms
  • multi organ failure/death
39
Q

treatment of liver cirrhosis

A

remove/treat aetiology

  • anti virals
  • stop drinking
  • Immunosuppressor
  • cease medication
  • remove iron -venesection

support and await repair
transplant

40
Q

acute liver failure

A

rapid deterioration of liver function in a previously healthy individual

  1. coagulopathy - impaired protein synthesis - as measured by the prothrombin time in the blood
  2. hepatic encephalopathy - alteration of mental status

hyper acute is within 1 week - acute is 1-4 weeks and subacute is 4-12 weeks

41
Q

aetiologies of acute liver failure

A 
drugs/alcohol 
hep, EBV, CMV
auto immune hepatitis 
metabolic diseases - Wilson's disease (copper overload) 
idiopathic
42
Q

paracetamol overdose

A

characteristic appearance
nutmeg liver
zones of necrosis

43
Q

liver transplantation

A

the replacement of a disease liver with some or all of a healthy liver from another person
usually the native liver is removes and replaced by the donor organ in some anatomic location
needs a blood group matched donor
multiple anastomoses

44
Q

indications of transplantation

A
  • end stage chronic liver disease
  • acute liver failure
  • hepatic neoplasms

pathology 2 (47 decks)

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