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GI > Pathology of liver > Flashcards

Pathology of liver Flashcards

1
Q

True or False.
The liver is very resistant to injury?
Explain

A

= true

Because it has a large functional reserve

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2
Q

What are 3 possible consequences from liver injury?

A

1) severe parenchymal necrosis but heal entirely by restitution
2) Whereas some types of injury leave permanent damage
3) some types of injury produce predictable pathological patterns

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3
Q

describe the pathogenesis of liver disease?

A

1) insult to hepatocytes via viral, drugs, toxins or antibody
2) grading = degrees of inflammation
3) staging = degree of fibrosis
4) cirrhosis

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4
Q

what happens when there is acute liver failure?

A

= acute onset of jaundice

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5
Q

what are 4 causes of acute liver failure?

A
  • viruses
  • alcohol
  • drugs
  • bile duct obstruction
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6
Q

what is a leading cause of acute liver failure and what does this cause?

A

acetaminophen toxicity

  • confluent necrosis producing massive acute necrosis and liver failure
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7
Q

what are 3 possible outcomes of acute liver failure?

A
  • complete recovery
  • chronic liver disease
  • death from liver disease
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8
Q

how do you classify jaundice?

A
  • pre-hepatic
  • hepatic
  • post-hepatic
  • conjugated
  • un-conjugated
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9
Q

what is the cause of pre-hepatic jaundice?

A

= too much haem to break down

  • haemolysis of all causes
  • haemolytic anaemias
  • un-conjugated bilirubin
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10
Q

what is the cause of hepatic jaundice?

A

= liver cells are injured or dead

  • acute liver failure
  • alcoholic hepatitis
  • cirrhosis (decompensated)
  • bile duct loss (atresia, PBC, PSC)
  • pregnancy
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11
Q

what is the cause of post-hepatic jaundice?

A

= bile cannot escape into the bowel

  • congenital biliary atresia
  • gallstones block CBDuct
  • strictures of CBDuct
  • tumours (Ca head of pancreas)
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12
Q

what is cirrhosis?

A

= final common end point for liver disease

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13
Q

Is cirrhosis reversible or irreversible?

A

= irreversible

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14
Q

what is cirrhosis defined by?

A

= bands of fibrosis separating regenerative nodules of hepatocytes
- macro nodular or micro-nodular (alcoholic)

= alteration of hepatic micro-vasculature
= loss of hepatic function

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15
Q

what are 3 complications of cirrhosis?

A

1) portal hypertension (porto-caval anastimoses)
- oesophageal varices
- caput medusa
- haemorrhoids

2) ascites
3) liver failure
4) hepatocellular carcinoma
5) malnutrition

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16
Q

what does the pathology of alcoholic liver disease depend on?

A

= extent of alcohol abuse

= depends upon individual factors

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17
Q

describe the duration of drinking and whether alcoholic liver disease is reversible or irreversible.

A

2-3days = fatty liver
= reversible

4-6weeks = hepatitis
= reversible if drinking stops

Months/years = fibrosis
= irreversible

Years = cirrhosis
= irreversible

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18
Q

in alcoholic fatty liver, i.e. after a weekend bindge, what is the histological appearance of cells?

A

= fat vacuoles appear clear in hepatocytes

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19
Q

in alcoholic hepatitis, i.e. heavy drinking for weeks or months, what is the histological appearance?

A

= hepatocyte necrosis
= neutrophills
= mallory bodies
= pericellular fibrosis

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20
Q

in alcoholic fibrosis, i.e. drinking heavy for months or years, what is the histological appearance?

A

= collagen is layer down around cells

= collagen is stained blue

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21
Q

what is the histological appearance in alcoholic cirrhosis?

A
  • micro-nodular cirrhosis with abundant white scarring
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22
Q

describe non-alcoholic steatohepatitis (NASH)?

A

= non-drinkers but pathology is identical to alcoholic liver disease

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23
Q

who most commonly gets NASH?

A
  • diabetics
  • obese patiens
  • hyperlipidaemia
24
Q

what can NASH lead to?

A
  • fibrosis

- cirrhosis

25
Q

what common virus leads to acute or chronic liver injury?

A

= viral hepatitis

26
Q

describe hepatitis A-E.

A

Hep A
= Epstein Barr virus

Hep B
= yellow fever virus

Hep C
= herpes simplex virus

Hep e
= cytomegalovirus

27
Q

what is seen histologically with chronic viral hepatitis?

A

= dense portal chronic inflammation

= piecemeal necrosis

= lobular inflammation

  • councilman body
  • small amounts of steatosis present
  • fibrosis
28
Q

what are 5 outcomes of hep B?

A
  • fulminant acute infection (death)
  • chronic hepatitis
  • cirrhosis
  • hepato-cellular carcinoma
  • asymptomatic (carrier)
29
Q

what are 2 outcomes of hep C?

A
  • chronic hepatitis

- cirrhosis

30
Q

what is primary biliary cirrhosis?

A

= rare auto-immune disease,e unknown cause

31
Q

what is primary biliary cirrhosis associated with?

A

= auto-antibodies to mitochondria

32
Q

who is most likely to get primary biliary cirrhosis?

A

= females

33
Q

what is histologically seen in primary biliary cirrhosis?

A
  • chronic portal inflammation
  • bile ducts inflamed
  • granuloma around duct
34
Q

describe auto-immune hepatitis?

A
  • more common in females
  • associated with other AI disease
  • chronic hepatitis pattern
  • numerous plasma cells
  • auto-antibodies to smooth muscle, nuclear or LKM, raised IgG
  • may have triggers, including some drugs
35
Q

describe chronic drug-induce hepatitis?

A
  • similar to all other chronic hepatitis
  • may trigger an auto-immune hepatitis
  • chronic active process
36
Q

what is primary sclerosing cholangitis?

A

= chronic inflammatory process affecting intra and extra hepatic bile ducts

37
Q

what does primary sclerosing cholangitis lead to?

A
  • leads to peri-ductal fibrosis, duct destruction, jaundice and fibrosis
38
Q

what is primary sclerosing cholangitis associated with?

A

ulcerative collisi and males

39
Q

what does primary sclerosing cholangittis increase the risk of?

A

= malignancy in bile ducts and colon

40
Q

what are 3 storage diseases

A
  • haemochromatosis
  • Wilsons disease
  • alpha 1 antitrypsin deficiency
41
Q

what is haemochormatosis?

A

= excess iron within the liver

- iron accumulates in hepatocytes

42
Q

describe primary and secondary haemochormatosis?

A

primary
= genetic condition
= increased absorption of iron from small intestine, abnormal iron metabolism

secondary
= iron overload from diet
= transfusions
= iron therapy

43
Q

describe the genetics behind primary haemochormatosis?

A

= inherited autosomal recessive condition

  • genetic defect v. complex

= worse in homozygotes, men

44
Q

describe what happens in primary haemochormatosis?

A

= iron is deposited into the liver, asymptomatic for years

= eventually deposited in portal connective tissue, stimulating fibrosis

= cirrhosis if not teated
= predisposes to carcinoma
= also causes diabetes, cardiac failure and impotence

45
Q

how is the presence of iron confirmed in haemochormatosis?

A

= Perls stain

46
Q

what is the outcome of haemochormatosis?

A

= depends on genetics, therapy (venesection) and co-factors like alcohol

= cirrhosis
= hepatocellular carcinoma

47
Q

what is Wilsons disease?

A

= inherited autosomal recessive disorder of copper metabolism
= copper accumulates in liver and brain (basal ganglia)

  • low serum caeruuloplasmin
48
Q

what rings appear at Corneal limbus as a result of Wilsons disease?

A

= Kayser-fleischer

49
Q

what does Wilsons disease cause?

A

= chronic hepatitis

= neurological deterioration

50
Q

what is alpha-1 antitrypsin deficiency?

A

= inherited autosomal recessive disorder of production of an enzyme inhibitor

= cytoplasmic globules of un-secreted globules of protein in liver cells

51
Q

what does alpha-1 antitrypsin deficiency cause?

A

= emphysema

= cirrhosis

52
Q

what are 2 types of tumour of the liver?

A

1) primary (rare)
- hepato-cellular adenoma
hepato-cellular carcinoma (hepatoma)

2) secondary (common)
- multiple
= metastases from colon, pancreas, stomach, breast, lung and others

53
Q

is hepatocellular adenoma benign or malignant?

A

= benign

  • more common in females
54
Q

what can happen in hepatocellular adenoma?

A

= may become large and rupture and bleed

  • most remain asymptomatic
55
Q

what is hepato-cellular carcinoma associated with?

A

= HBV, HCV and cirrhosis

56
Q

what does hepato-ceellular carcinoma usually present with?

A

= mass
= pain
= obstruction

GI (43 decks)

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