Microscopic anatomy of liver disease Flashcards
The image below shows normal liver microanatomy. What do each of the numbers labelled relate to?

1 - hepatocytes
2 - bile canaliculi
3 - bile duct
4 - branch of hepatic vein
5 - portal triad
6 - hepatic artery
7 - sinusoids
8 - central vein
What are the sinusoids of the liver?
- vascular spaces between hepatic plates
- blood flows from portal triad to central vein

What are the bile cannaliculi of the liver?
- sit between hepatocyes as these produce bile
- bile oves from central vein to portal triad

What are hepatic nodules?
- hexagon shapes of liver organisation
- central vein is in the middle

Acinar zones 1,2,3 are zones within the hepatic lodules. What is the relevence of the acinar zones?
- receiving blood progressively poorer in oxygen and nutrients close to central vein
- zone 3 will recieve blood that has been extracted of O2 and nutrients from zones 1 and 2

Acinar zones 1,2,3 are zones within the hepatic lodules. The acinar zones receive blood progressively poorer in oxygen and nutrients close to central vein. For example, zone 3 will recieve blood that has been extracted of O2 and nutrients from zones 1 and 2. Out of the 3 zones which is likley to suffer from ischemia and become damaged?
- zone 3

In the liver histology section image below, what do the colour arrows depict?

- red = hepatic artery
- green = bile duct
- blue = portal bein
In the liver histology section image below, what do the darker spots around the sinusoids depict?

- inflammatory cells
What is the space of Disse?
- a location in the liver between a hepatocyte and a sinusoid
- contains blood plasma
- can only been seen in pathophysiology

The sinusoidals of the liver are lined by a specific type or endothelial cell, what is this cell and what is the importance of this?
- fenestrated (like a sink hole with little holes)
- allows transfer of nutrients and plasma between hepatocytes and blood vessels

What are the immune cells of the liver?
- kupffer cells (macrophages)

Stellate cells of the liver, sit in the space of disse and are important for storage. What do they store?
- vitamin A

Hepatocytes contain a fine granuler eosinophilic cytoplasm. What colour does this stain on H&E staining?
- protein stain pink
- nucleus stains blue
Do hepatocytes contain glycogen?
- yes and can be stained for
- important for energy and blood glucose of liver
The image below is H&E stain of hepatocytes. What do the numbers 1, 2 and 3 denote?

1 - sinusoids
2 - nuclei of hepaticytes
3 - kupffer cells
In addition to storing and metabolising vitamin A, what else do stellate cells do?
- play a leading role in fibrogenesis
- cells transform into myofibroblasts that can lay down collagen
- reticulin fibers lay down collagen III, fibrous collagen can cause liver dysfunction
What is the white space in the image below of hepatocytes?

- central vein
In the image of the bilary tree below, what do the numbers 1-8 denote?

1 - right hepatic duct
2 - cystic duct
3 - gall bladder
4 - ampulla
5 - pancreatic duct
6 - bile duct
7 - common hepatic duct
8 - left hepatic duct
What cells line the bilary tree intrahepatically?
- cholangiocytes
- intrahepatic has small ducts and large ducts
- small = portal tracts (columnar) and surface epithelium (cuboidal)
- large ducts = surface epithelium surrounded by fibrous duct wall (columnar)

What cells line the bilary tree extrahepatically?
- cholangiocytes
- all columnar surface epithelium surrounded by fibrous duct wall
- contain a Muscle layer but not well defined until distal common bile duct (lower 1/3 of extrahepatic bile duct)

In ALD and NAFLD where does fat accumulate?
- in the cytoplasm of hepatocytes
The fat that gathers in the cytoplasm of hepatocytes in ALD and NAFLD can be classed as Macro and Microvesicular steatosis, what does this mean?
- macrovesicular steatosis = fat vacuoles larger than the nucleus, displace nucleus
- microvesicular steatosis = fat vacuoles smaller than the nucleus and mostly a foamy appearance with central nucleus

To confirm a diagnosis of steatosis, what other changes are needed to be classified as steatohepatitis?
- hepatocellular ballooning degeneration.
- mallory-denk bodies (intermediate cytoskeleton)
- necroinflammation
- fibrosis
What causes a hepatocyte to balloon?
- hepatocytes are filled with fat
- cells are unable to regulate the cell size
- cytoskeleton, specifically intermediate filaments then clump together




