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Systemic Pathology II > Pathology of the Hepatobiliary System #1 > Flashcards

Pathology of the Hepatobiliary System #1 Flashcards

1
Q

What can be seen in the image below?

A

Dorsal aspect on right
The liver represents 1-4% of the body weight. Depends on animal you are looking at.
Carnivores = 3-4.5%
it is important for us to measure the weight of the liver during post-mortem exam b/c we want to know whether there is a true hepatomegaly vs. liver is normal in size vs. liver is smaller in size.
Neonates = Liver is much larger compared to adult, it can be more than 5% of the body weight. If you do BW on neonates, you may notice elevated ALP due to neonate so liver is larger and it is growing.

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2
Q

Describe the arrangement of the Canine Liver.

A

Normal Canine Liver – 6 lobes
* Left lateral (LL)
* Left medial (LM)
* Quadrate (Q)
* Right medial (RM)
* Right lateral (RL)
* Caudate lobes. The caudate lobe
has a caudate process (CC) and
a papillary process (PC).
* The gall bladder (GB) lies
between the quadrate and right
medial liver lobes

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3
Q

Name the ligaments in the liver.

A
  • Coronary = attaches liver to diaphragm
  • Falciform = attaches to the midline of the abdomen
  • Round = imbedded within the falciform ligament; remnant of umbilical vein.
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4
Q

Label this image accordingly

A
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5
Q

Hepatocytes are in charge of _______ and _______ of proteins, __________ of drugs/any sort of toxin.

A

Production and metabolism of proteins, detoxification of drugs/any sort of toxin.

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6
Q

Biliary epithelium controls bile _______ and _______.

A

Bile transport and production.

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7
Q

Kupfer cells are the resident __________ and function to __________ material

A

Kupfer cells are the resident macrophages and function to phagocytize material

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8
Q

Stellate cells store ______ and vitamin ___ and work to ______ (_______).

A

Stellate cells store lipids and vitamin A and work to repair (fibrosis).

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9
Q

Leukocytes are apart of the _______ immune response. E.g: ___ cells

A

Leukocytes are apart of the innate immune response. E.g: NK cells

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10
Q

Label this image accordiingly.
Is this a sample from a normal liver? Or an abnormal liver?

A
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11
Q

Label this image accordingly.

A

Portal vein (PV), hepatic artery (HA), and bile ductule (BD)
The center of the classic lobule is the central vein.

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12
Q

What can be seen below?

A

Classic lobule
Hexagon shape, very prominent in pigs but NOT other animals.
The hole is where the CV is.
The center of this lobule is the central vein.

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13
Q
A

The portal triad is at the center of the hepatic acinus

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14
Q

Which zone contains the highest cytochromc P450?

A

Zone 3/Centrilobular region

This is the first area you will see necrosis. B/c receives less blood supply + Cytochrome p450 enzyme

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15
Q

Name the following zones:
Zone 1
Zone 2
Zone 3

A

Zone 1 = periportal
Zone 2 = midzona
Zone 3 - Centriloblar.

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16
Q
A
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17
Q
A
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18
Q

What can be seen in this image below?

A

Centrilobular Necrosis, Zonal Hepatocellular Injury, Liver, Pig

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19
Q

Describe the flow of the bile duct system.

A
  • Biliary canaliculi → Intrahepatic ductules → Interlobular ducts → Hepatic ducts → Hepatic duct + cystic duct of gallbladder
    → Common bile duct → duodenum
  • Bile flows in same direction as lymph and opposite direction of blood
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20
Q

How does the bile duct system differ in cats?

A

The common bile duct merges with the pancreatic duct before entering the duodenum. As opposed to dogs where it merges later so you won’t see Triaditis in dogs. This difference may predispose cats to Tridaitis, which is concurrent inflammation of the pancreas, liver, and small intestine.

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21
Q

Describe the liver’s blood supply

A
  • Portal vein: 70-80% of blood
    supply to liver from GI, pancreas,
    and spleen.
  • Hepatic artery supply for the
    remainder (20-30%)
  • Portal blood and hepatic arterial
    blood mix in the sinusoids →
    hepatic vein→ caudal vena cava

Whenever you have shunts that bypass hepatic artery?–> atrophy

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22
Q

Label this image accordingly.

A
23
Q

Space of Disse is?

A

A space composed of ECM where the stellate cells live. The stellate cells produce collagen when there is injury so when we see cerosis, that is the work of stellate cells. Stellate cells also store lipids and Vitamin A

24
Q

In bet. hepatic plates there are ________, ________ cells, and there is a place in between the ________ which we call the Space of ______ composed of ECM where _______ cells live. Stellate cells produce ________ when there is injury. They also store ______ and vitamin ____.

A

In bet. hepatic plates there are sinusoids, Kupffer cells, and there is a place in between the sinusoids which we call the Space of Disse composed of ECM where stellate cells live. Stellate cells produce collagen when there is injury. They also store lipids and vitamin A

25
Q

What can be seen below?

A

Ito cells, more commonly known as Stellate cells.
Location:
* Reside in space of Disse

Function:
* Store lipid and vitamin A
* Produce collagen in response to
hepatic injury

Arrows = lipid vacuoles

26
Q

If you are suspecting liver disease, what diagnostics should you do?

A
  1. Blood work:
    * CBC
    * Serum biochemistry
    * Coagulation panel
    * Total serum bile acid
    * Ammonia
  2. Urinalysis
    * Imaging - Ultrasound (nodules, heterogenecity)
  3. Biopsy (diagnose dz such as copper toxicity, or copper hepatopathy.

^ ALT = indicates hepatocyte damage
^ ALP = indicate that there is injury to hepatocytes but also bile canuliciu so interrupt bile flow (look into obstruction, primary liver disease).

Bile acid and ammonia levels in blood can be tested. If there are increases in serum ammonia, that is usually indicative of liver dysfunction.
Serum enzyme but also albumin, if low, if there is something that causes loss of protein or there is a liver dz producing less protein, must look into it.

Elevated ammonia –> crystal formation in bladder —> cysto to see.

27
Q

List the indications of liver biopsy.

A

PUGS Eat Pringles

  • Persistently increased liver enzyme activities and/or abnormal results of function tests
  • Unexplained hepatomegaly
  • Generalized changes in hepatic ultrasonographic echogenicity
  • Presence of solitary or multiple lesions within the hepatic parenchyma
  • Staging of neoplastic disease (soemtimes we aspirate LN to see if there is local invasion; also biopsy liver to check for neoplastic cells to see if there is visceal involvement in tumor).
  • Evaluation of response to therapy (works really well in copper hepatopathy; can chelate copper in dogs)
28
Q

What should you do before doing a liver biopsy?

A

The liver produces coag factors so if you don’t have a good liver, decreased coag factors –> bleeding –> won’t stop bleeding –> died. Can check for this via blood work, coag test, buccal mucosal time, etc.

29
Q

How do you perform a liver biopsy?

A
  • Method:
  • Wedge biopsies or laparoscopic cup forcep
  • 14-16G percutaneous ultrasound-guided needle biopsies
30
Q

List some tips to perform a successful liver biopsy.

A
  • Sample multiple lobes (at least 3 samples)
  • Avoid areas of fibrosis or regenerative nodules
  • Save liver samples for aerobic/anaerobic
    bacterial culture (1 sample) and copper
    quantification (1 sample).
  • Save bile for aerobic/anaerobic bacterial culture
31
Q

How do you stain your liver biopsy sample?

A
  1. H&E
    –> Special stains
    * Copper (Rhodanine or rubeanic acid)
    * Iron (Prussian blue)
    * Bile (Hall’s stain)
    * Collagen (Masson’s trichrome)
    * Sinusoid basement membrane components (Reticulin)
    * Amyloid (Congo red)
    26
32
Q

What can be seen here?

A

Hepatocytes
the red colored pigmented cells = ?
The browner ones = kupffer cells

33
Q

What can be seen here

A

Copper staining (rhodanine) in the liver of a West Highland White Terrier

animal has copper hepatopathy
Pigments within hepatocytes = copper accumulation

34
Q

What can be seen here?

A

Cirrhosis, Liver, Dog. Iron stain (Prussian blue)

hemosidderin will stain blue in color b/c it contains iron
These are kupffer cells,

35
Q

What can be seen here?

A

Cirrhosis, Liver, Dog. Bile stain (Hall’s stain

Bile stasis in this animal due to bile accumulation

36
Q

What can be seen here?

A

Reticulin Fibers (Reticulin Stain), Hepatic Extracellular Matrix, Liver, Normal Dog

Fibers are in the Space of Disse. Reticulin fibers stains the collagen, so in a normal liver you see the central vein in the center and the plates are very well defined. But in certain diseases, may see destruction of this fiber.

37
Q

What can be seen here?

A

Cirrhosis, Liver, Dog. Collagen stain (Masson’s’ Trichrome)

Stains the collagen blue in color.
The stringy blue material is collagen produced by the stellate cells. We see this in cirrhosis (a lot of nodules) b/c fibrous CT surrounds hepatocytes and forms nodule appearance.

38
Q

What should you do during a Postmortem Evaluation of the Liver & Biliary System?

A

–> Examine the patency of common bile duct
* Open duodenum at the level of
duodenal papilla
* Compress the gallbladder and check for bile flow
* Weigh the liver (small animals)
* Recognize incidental and
insignificant findings
* Bread loafing
* Sample all lobes, including the
gallbladder
* The thickness of the section should be < 0.5 cm.

39
Q

Anything greater than 4.5% is considered?

A

Hepatomegaly

40
Q
A

Thin section for proper fixation!
* Red = Unfixed
* Brown = Fixed

Make sure samples are thin enough

41
Q

What are some post-mortem changes you may see in the liver?

A

Postmortem change:
* Bile imbibition
* Pseudomelanosis

42
Q

What are some incidental findings you may see in the liver?

A

Incidental findings:
* Nodular hyperplasia in dogs
* Fibrin tags in horses
* Telangiectasia in cattle

43
Q

What can be seen here?

A

Bile staining (imbibition) of the omental fat in a cat

If tissue comes into contact with gallbladder –> bile staining
May see greenish color on the skin due to bilirubin.

44
Q
A

Pseudomelanosis. Loops of intestine in contact with the liver during the postmortem period will discolor the surface grey to black

No necrosis, or other changes. Just a certain area gets darker. Producing more H2S –> black discoloration

45
Q
A

Fibrous tags, Liver, Horse
Seen typically in horses.
Looking at surface of the liver.
An incidental finding

46
Q
A

Hepatic Nodular Hyperplasia, Liver, Dog

This is very common, especially in older dogs. Does not result in any clinical disease unless it is very large, which is rare.
Intervening portal tracts occur.
When you do surgery and find a nodule like this, do a biopsy to be sure that this is what it is. (b/c could be adenoma or carcinoma, but this well demarcated thing is hepatic nodule)

47
Q
A

Telangiectasia, Liver, Cut Surface, Cow.
Multifocal areas of hemorrhage.
Well demarcated.
Incidental finding
Very dilated hepatic sinusoids. this is where blood enters
does not have clinical implications
seen in cows and cats

48
Q

How do you conduct a Gross Pathology of Liver Lesions?

A
  1. Size
    * Big vs small (often based on the weight)
  2. Sharp or rounded edges
  3. Lesion Gross Pattern
    * Nodular – cirrhosis, neoplasia
    * Random – hepatitis, necrosis
    * Lobar – torsion
    * Diffuse
  4. Color Change
    * Yellow-tan: lipidosis or glycogen accumulation
    * Dark red (reticular or lobular pattern): congestion
    * Orange/Pink: amyloidosis
    * Pale: anemia
49
Q
A

Focal hepatic nodule

50
Q
A

Lobar
One lobe being affected due to torsion (vascular)

51
Q
A

Multifocal random (milliary)

52
Q
A

Diffuse

53
Q

Describe the color in the image below:

A

Yellow-tan: lipidosis, glycogen accumulation, amyloidosi

54
Q
A

Dark red (reticular or lobular pattern): congestion

nutmeg liver
think about hepatic congestion here

Systemic Pathology II (22 decks)

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