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NME Emma copy and edit > Microscopic anatomy of liver disease > Flashcards

Microscopic anatomy of liver disease Flashcards

1
Q

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

A

1 - hepatocytes

2 - bile canaliculi

3 - bile duct

4 - branch of hepatic vein

5 - portal triad

6 - hepatic artery

7 - sinusoids

8 - central vein

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2
Q

What are the sinusoids of the liver?

A
  • vascular spaces between hepatic plates
  • blood flows from portal triad to central vein
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3
Q

What are the bile cannaliculi of the liver?

A
  • sit between hepatocyes as these produce bile
  • bile oves from central vein to portal triad
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4
Q

What are hepatic nodules?

A
  • hexagon shapes of liver organisation
  • central vein is in the middle
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5
Q

Acinar zones 1,2,3 are zones within the hepatic lodules. What is the relevence of the acinar zones?

A
  • 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
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6
Q

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?

A
  • zone 3
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7
Q

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

A
  • red = hepatic artery
  • green = bile duct
  • blue = portal bein
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8
Q

In the liver histology section image below, what do the darker spots around the sinusoids depict?

A
  • inflammatory cells
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9
Q

What is the space of Disse?

A
  • a location in the liver between a hepatocyte and a sinusoid
  • contains blood plasma
  • can only been seen in pathophysiology
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10
Q

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?

A
  • fenestrated (like a sink hole with little holes)
  • allows transfer of nutrients and plasma between hepatocytes and blood vessels
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11
Q

What are the immune cells of the liver?

A
  • kupffer cells (macrophages)
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12
Q

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

A
  • vitamin A
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13
Q

Hepatocytes contain a fine granuler eosinophilic cytoplasm. What colour does this stain on H&E staining?

A
  • protein stain pink
  • nucleus stains blue
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14
Q

Do hepatocytes contain glycogen?

A
  • yes and can be stained for
  • important for energy and blood glucose of liver
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15
Q

The image below is H&E stain of hepatocytes. What do the numbers 1, 2 and 3 denote?

A

1 - sinusoids

2 - nuclei of hepaticytes

3 - kupffer cells

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16
Q

In addition to storing and metabolising vitamin A, what else do stellate cells do?

A
  • 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
17
Q

What is the white space in the image below of hepatocytes?

A
  • central vein
18
Q

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

A

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

19
Q

What cells line the bilary tree intrahepatically?

A
  • 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)
20
Q

What cells line the bilary tree extrahepatically?

A
  • 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)
21
Q

In ALD and NAFLD where does fat accumulate?

A
  • in the cytoplasm of hepatocytes
22
Q

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?

A
  • 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
23
Q

To confirm a diagnosis of steatosis, what other changes are needed to be classified as steatohepatitis?

A
  • hepatocellular ballooning degeneration.
  • mallory-denk bodies (intermediate cytoskeleton)
  • necroinflammation
  • fibrosis
24
Q

What causes a hepatocyte to balloon?

A
  • hepatocytes are filled with fat
  • cells are unable to regulate the cell size
  • cytoskeleton, specifically intermediate filaments then clump together
25
Q

When hepatocytes balloon, why do they appear clear?

A
  • cytoskeleton is not able to maintain cells and so collapses
26
Q

In normal liver tissue there should be no gaps between hepatocytes, except for at the sinusoidals. However, in the image below of H&E staining there are empty spaces. What does this image show, identified by the arrows?

A
  • spaces where inflammatory cells have destroyed hepatocytes
  • neutrophils are present
  • this is called necroinflammation
27
Q

The liver should have no collagen in the parenchyme, howeverm in inflammation, what is parenchyme tissue replaced with?

A
  • collagen and fibrosis
  • called chicken wire fibrosis
  • liver cells are yellow and fibrosis is red
28
Q

In NADLD, where can be reveressed?

A
  • liver fibrosis
29
Q

In NADLD, once a patient has fibrosis and cirrhosis, what is the risk of increased?

A
  • hepatocarcinoma
  • liver cancer
30
Q

What does cirrhosis refer to in liver disease?

A
  • yellow nodules form on the liver
  • end stage diffuse scarring process
  • nodularity can be macronodular or micronodular (depends on the size)

NME Emma copy and edit (61 decks)

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