Pathology of Liver Disease Flashcards
What are liver biospsies useful for? How are they done?
They are useful for making a primary diagnosis or if this has already been done then can be useful for looking at fibrosis and guiding treatment options.
It is done by inserting a needle between the ribs and is important the person isnt breathing to reduce risk of pneumothorax
What is the structure of the liver internally and what are the three zones that the lobule can be divided into?
The liver is made up of hepatid lobules. Majority of the liver is made up of hepatocytes lining the sinusoids passing from blood vessels to the portal outflow tracts.
- Zone one is the periportal area
- Zone two is the mid-zonal area
- Zone three is the centrilobular area. This zone is furthest from the blood supply and has the highest concentration of P450 enzymes. This is the most vunerable to injury.
What type of virus is Hep A and how is it transmitted?
It is an RNA virus with a short incubation period. It is transmitted by the fecal oral route.
What type of virus is Hep B and how is it transmitted?
It is a DNA virus with a long incubation. It is transmitted through blood and bodily fluids
What type of virus is Hep C and how is it transmitted?
It is an RNA virus with a variable incubation period. It is transmitted through blood and bodily fluids.
What type of virus is Hep D and how is it transmitted?
It is an RNA virus and can only replicate where Hep B is present
What type of virus is Hep E and how is it transmitted?
It is an RNA virus that has high mortality in pregnant women. It is water bourne
What type of virus is Hep G and how is it transmitted?
It is a blood bourne RNA virus that causes acute and chronic hepatitis
How does a liver biopsy with acute hepatitis appear?
There will always be hepatocyte death. There will be spotty lymphocytic inflammation. The whole liver appears shrunken due to panacinar necrosis.
What is the definition of chronic hepatitis?
Inflammation of the liver continuing without improvement for 6 months
What are some of the causes?
Viral, Autoimmune, biliary (PBC, sclerosing cholangitis), metabolic, fatty liver disease, drug induced (nitrofurantoin)
What are the two forms of fatty liver disease?
Alcoholic and non alcoholic
Non alcoholic is mainly caused by metabolic syndrome (apple shaped body) however can be caused by secondary to drugs and surgical procedures
What are the three main stages of fatty liver disease?
Fatty change (steatosis) which is largely reversible
Fibrosis
Cirrhosis
What are the histological findings in fatty liver disease?
There will be balooning of the hepatocytes and cell death. Most pronounced around the central vein. When cirrhosis develops there is often no longer any fat visible.
What are the two main examples of chronic autoimmune biliary disease?
Primary biliary cholangitis
Primary sclerosing cholangitis
