Pathology of the liver Flashcards
What are the different types of non-zonal liver necrosis
Single cell
Focal
Bridging
Submassive
Massive
Special type:
- Typical of chronic hepatitis
- Piece meal necrosis
What is meant by the term zonal liver necrosis
In the whole liver all the lobules are involved in a similar way
This pattern is often based on the distribution of cellular enzymes and is most often associated with:
- Poisoning
- Hypoperfusion states: such as prolonged severe shock/left sided failure: This leads to ischaemic necrosis in zone 3
Which virusses are associated with liver injury
Hep A, B, C, D, E
Epstein-Barr virus
Yellow fever virus
Herpes simplex virus
Cytomegalovirus
What are the histological features of viral / other acute hepatitis
- Apoptotic necrosis
- Necrosis varies: single cell, focal, bridging, sub- or massive necrosis
- Portal tract inflammation and/or lobular inflammation
- Cholestasis
- Regeneration - rosettes
How is chronic hepatits defined
Defined as clinical or biopsy evidence of hepatitis lasting more than 6 months
The histological classification of chronic hepatitis involves assessment of:
- The aetiological type of hepatitis
- The grade of severity of the liver cell damage and inflammation
- The stage of the degree of architectural disturbance
- Cirrhosis
Explain Cirrhosis in terms of:
- Characterised by
- Causes
- Complications
Complication of persistent liver disease
* Diffuse and irreversible process
* Characterised by fibrosis and nodular regeneration
- Causes include HBV, HCV, alcohol and haemochromatosis and many others
- Complications are liver failure, portal hypertension and liver cell carcinoma
How is cirrhosis classified morphlogically
It is classified according to the average size of the regenerating nodules:
* micronodular - nodules up to 3mm diameter
* macronodular - nodules greater than 3mm diameter.
* intermediate between these two categories is described as ‘mixed’.
What does the spectrum of alcoholic liver injury observed in biopsies include
- Fatty change in liver cells (reversible)
- Acute hepatitis with Mallory’s hyaline (reversible)
- Focal liver cell necrosis
- Acute inflammation
- Architectural damage ranging from fibrosis to cirrhosis (irreversible)
Describe non-alcoholic steatohepatitis
More common amoung diabetic patients
- Marked fatty change with variable inflammation that leads to liver damage
- May less commonly progress to cirrhosis
What are the causes of iron overload on the liver
Excessive accumulation of iron, as haemosiderin, in the liver causes it to appear dark brown
* Primary haemochromatosis (congenital): excess iron absorption, deposited in liver (cirrhosis) and endocrine glands / skin (e.g. ‘bronze diabetes’)
* Secondary haemochromatosis (acquired): excess dietary iron or parenteral administration (e.g. multiple blood transfusions)
What is Wilsons disease
Inherited disorder of copper metabolism in which there are low serum caeruloplasmin
* Copper accumulates in liver and brain
* Cirrhosis
* Kayser-Fleischer rings at corneal limbus
What is and what are the consequences of Alpha-1-antitrypsin deficiency
Alpha-1 antitrypsin deficiency (sometimes just called “Alpha-1”) is an inherited genetic disorder that causes low levels of a protein (AAT) that protects your lungs
* Hyaline globular inclusions in liver cells
* Risk of emphysema and cirrhosis
What are the findings in autoimmune hepatitis
- Females > males
- Liver biopsy shows chronic hepatitis, often
with plasma cells and liver cell rosettes - Anti-smooth muscle, anti-nuclear or anti-LKM antibodies, raised IgG and transaminases
What are the findings of primary biliary cirrhosis
- Females > males
- Liver biopsy shows bile duct destruction, granulomas, ductular proliferation, fibrosis, and eventual cirrhosis
- Raised IgM and alkaline phosphatase, anti-mitochondrial antibody, pruritus, jaundice, xanthelasmas
What is sclerosing cholangitis
- chronic inflammatory process that affects mainly intrahepatic bile ducts
- fibrosis (sclerosis) and obliteration of bile ducts
- associated with ulcerative colitis
What are the common primary malignant tumours of the liver
- Liver cell carcinoma
- Cholangiocarcinoma
- Angiosarcoma
- Hepatoblastoma
What are the common benign tumours of the liver
- Angioma
- Bile duct hamartoma: von Meyenberg complexes
- Liver cell adenoma
- Focal nodular hyperplasia
Explain what the fibrolamellar variant of liver tumours is
Fibrolamellar variant in which the neoplastic liver cells are arranged in broad bands of lamellae separated by dense fibrous tissue.
This variant occurs most often in young woman, without cirrhosis as a predisposing cause.
What are choledochal cysts
Coledochal cysts are uncommon congenital cysts of the bile ducts which may be intra- or extra-hepatic. Their presence predisposes to cholangitis.
What are hydatid cysts
Hydatid cysts are due to the parasite Echinococcus granulosus.
* They are usually many centimetres in diameter, have a fibrous laminated wall and contain numerous daughter cysts
- NB: Avoid spillage of cyst fluid into abdomen during removal – may precipitate anaphylactic shock (patient sensitized)
