Pathology of liver Flashcards
True or False.
The liver is very resistant to injury?
Explain
= true
Because it has a large functional reserve
What are 3 possible consequences from liver injury?
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
describe the pathogenesis of liver disease?
1) insult to hepatocytes via viral, drugs, toxins or antibody
2) grading = degrees of inflammation
3) staging = degree of fibrosis
4) cirrhosis
what happens when there is acute liver failure?
= acute onset of jaundice
what are 4 causes of acute liver failure?
- viruses
- alcohol
- drugs
- bile duct obstruction
what is a leading cause of acute liver failure and what does this cause?
acetaminophen toxicity
- confluent necrosis producing massive acute necrosis and liver failure
what are 3 possible outcomes of acute liver failure?
- complete recovery
- chronic liver disease
- death from liver disease
how do you classify jaundice?
- pre-hepatic
- hepatic
- post-hepatic
- conjugated
- un-conjugated
what is the cause of pre-hepatic jaundice?
= too much haem to break down
- haemolysis of all causes
- haemolytic anaemias
- un-conjugated bilirubin
what is the cause of hepatic jaundice?
= liver cells are injured or dead
- acute liver failure
- alcoholic hepatitis
- cirrhosis (decompensated)
- bile duct loss (atresia, PBC, PSC)
- pregnancy
what is the cause of post-hepatic jaundice?
= bile cannot escape into the bowel
- congenital biliary atresia
- gallstones block CBDuct
- strictures of CBDuct
- tumours (Ca head of pancreas)
what is cirrhosis?
= final common end point for liver disease
Is cirrhosis reversible or irreversible?
= irreversible
what is cirrhosis defined by?
= bands of fibrosis separating regenerative nodules of hepatocytes
- macro nodular or micro-nodular (alcoholic)
= alteration of hepatic micro-vasculature
= loss of hepatic function
what are 3 complications of cirrhosis?
1) portal hypertension (porto-caval anastimoses)
- oesophageal varices
- caput medusa
- haemorrhoids
2) ascites
3) liver failure
4) hepatocellular carcinoma
5) malnutrition
what does the pathology of alcoholic liver disease depend on?
= extent of alcohol abuse
= depends upon individual factors
describe the duration of drinking and whether alcoholic liver disease is reversible or irreversible.
2-3days = fatty liver
= reversible
4-6weeks = hepatitis
= reversible if drinking stops
Months/years = fibrosis
= irreversible
Years = cirrhosis
= irreversible
in alcoholic fatty liver, i.e. after a weekend bindge, what is the histological appearance of cells?
= fat vacuoles appear clear in hepatocytes
in alcoholic hepatitis, i.e. heavy drinking for weeks or months, what is the histological appearance?
= hepatocyte necrosis
= neutrophills
= mallory bodies
= pericellular fibrosis
in alcoholic fibrosis, i.e. drinking heavy for months or years, what is the histological appearance?
= collagen is layer down around cells
= collagen is stained blue
what is the histological appearance in alcoholic cirrhosis?
- micro-nodular cirrhosis with abundant white scarring
describe non-alcoholic steatohepatitis (NASH)?
= non-drinkers but pathology is identical to alcoholic liver disease
who most commonly gets NASH?
- diabetics
- obese patiens
- hyperlipidaemia
what can NASH lead to?
- fibrosis
- cirrhosis
what common virus leads to acute or chronic liver injury?
= viral hepatitis
describe hepatitis A-E.
Hep A
= Epstein Barr virus
Hep B
= yellow fever virus
Hep C
= herpes simplex virus
Hep e
= cytomegalovirus
what is seen histologically with chronic viral hepatitis?
= dense portal chronic inflammation
= piecemeal necrosis
= lobular inflammation
- councilman body
- small amounts of steatosis present
- fibrosis
what are 5 outcomes of hep B?
- fulminant acute infection (death)
- chronic hepatitis
- cirrhosis
- hepato-cellular carcinoma
- asymptomatic (carrier)
what are 2 outcomes of hep C?
- chronic hepatitis
- cirrhosis
what is primary biliary cirrhosis?
= rare auto-immune disease,e unknown cause
what is primary biliary cirrhosis associated with?
= auto-antibodies to mitochondria
who is most likely to get primary biliary cirrhosis?
= females
what is histologically seen in primary biliary cirrhosis?
- chronic portal inflammation
- bile ducts inflamed
- granuloma around duct
describe auto-immune hepatitis?
- 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
describe chronic drug-induce hepatitis?
- similar to all other chronic hepatitis
- may trigger an auto-immune hepatitis
- chronic active process
what is primary sclerosing cholangitis?
= chronic inflammatory process affecting intra and extra hepatic bile ducts
what does primary sclerosing cholangitis lead to?
- leads to peri-ductal fibrosis, duct destruction, jaundice and fibrosis
what is primary sclerosing cholangitis associated with?
ulcerative collisi and males
what does primary sclerosing cholangittis increase the risk of?
= malignancy in bile ducts and colon
what are 3 storage diseases
- haemochromatosis
- Wilsons disease
- alpha 1 antitrypsin deficiency
what is haemochormatosis?
= excess iron within the liver
- iron accumulates in hepatocytes
describe primary and secondary haemochormatosis?
primary
= genetic condition
= increased absorption of iron from small intestine, abnormal iron metabolism
secondary
= iron overload from diet
= transfusions
= iron therapy
describe the genetics behind primary haemochormatosis?
= inherited autosomal recessive condition
- genetic defect v. complex
= worse in homozygotes, men
describe what happens in primary haemochormatosis?
= 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
how is the presence of iron confirmed in haemochormatosis?
= Perls stain
what is the outcome of haemochormatosis?
= depends on genetics, therapy (venesection) and co-factors like alcohol
= cirrhosis
= hepatocellular carcinoma
what is Wilsons disease?
= inherited autosomal recessive disorder of copper metabolism
= copper accumulates in liver and brain (basal ganglia)
- low serum caeruuloplasmin
what rings appear at Corneal limbus as a result of Wilsons disease?
= Kayser-fleischer
what does Wilsons disease cause?
= chronic hepatitis
= neurological deterioration
what is alpha-1 antitrypsin deficiency?
= inherited autosomal recessive disorder of production of an enzyme inhibitor
= cytoplasmic globules of un-secreted globules of protein in liver cells
what does alpha-1 antitrypsin deficiency cause?
= emphysema
= cirrhosis
what are 2 types of tumour of the liver?
1) primary (rare)
- hepato-cellular adenoma
hepato-cellular carcinoma (hepatoma)
2) secondary (common)
- multiple
= metastases from colon, pancreas, stomach, breast, lung and others
is hepatocellular adenoma benign or malignant?
= benign
- more common in females
what can happen in hepatocellular adenoma?
= may become large and rupture and bleed
- most remain asymptomatic
what is hepato-cellular carcinoma associated with?
= HBV, HCV and cirrhosis
what does hepato-ceellular carcinoma usually present with?
= mass
= pain
= obstruction
