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Gastro > Pathology of the Liver > Flashcards

Pathology of the Liver Flashcards

1
Q

What ribs cover the liver

A

7-11

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2
Q

What is the normal appearance of the liver?

A

Red brown colour with a smooth outline and contour

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3
Q

What 3 terms are used to describe the patterns of liver injury

A

1) Periportal Zone
2) Mid Acinar
3) Pericentral

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4
Q

What is the zone that is closest to the vascular supply

A

Zone 1

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5
Q

Cells in which zone are most vulnerable to injury?

Why is this the case?

A

Zone 3

They are furthest from the vascular supply - it takes longer for oxygen to reach them

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6
Q

What 4 aspects can cause insult to hepatocytes

A

Viral
Drug
Toxin
Antibody

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7
Q

How can we measure the degree of injury to the liver?

A

Insult
Grading the degree of inflammation
Staging the degree of fibrosis
Cirrhosis

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8
Q

What is cirrhosis

A

A chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis.

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9
Q

What are 4 causes of the acute onset of jaundice

A

Viruses
Alcohol
Drugs (paracetamol
Bile duct obstruction

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10
Q

What is the underlying cause of acute onset of jaundice

A

Hepatic necrosis

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11
Q

What is necrosis?

A

The death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.

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12
Q

What is the chemical name for Paracetamol

A

Acetoaminophen

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13
Q

Describe the structure of the liver which has been damaged by aracetamol

A

not a normal structure
Necrotic hepatocytes are more rounded and not polyhedral
Majority of cells have lost their nuclei

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14
Q

What 3 things can occur as a consequence of acute liver failure?

A

Complete recovery
Chronic liver disease
Death from liver failure

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15
Q

What is jaundice

A

Yellowing of the skin due to excess bilirubin

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16
Q

What are the 3 classifications of jaundice

A

Pre- hepatic
Hepatic and
Post-hepatic

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17
Q

What are the 2 types of jaundice

A

Conjugated or Unconjugated

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18
Q

What is the cause of pre-hepatic jaundice

A

Too much haem to break down

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19
Q

Describe pre-hepatic jaundice

A

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin (uncombined)

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20
Q

What is hepatic jaundice

A

When the liver cells are injured or dead and so we have reduced hepatic function

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21
Q

Describe hepatic jaundice

A 
Acute liver failure (virus, drugs, alcohol)
Alcoholic hepatitis
Cirrhosis (decompensated)
Bile duct loss (atresia, PBC,PSC)
Pregnancy
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22
Q

What is post hepatic jaundice

A

Bile cannot escape into the bowel

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23
Q

Describe post-hepatic jaunice

A

Congenital biliary atresia
Gallstones block CB Duct
Structures of CB duct
Tumours (head of the pancreas)

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24
Q

What does cirrhosis of the liver signify

A

The endpoint of liver disease

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25
Q

Define cirrhosis of the liver

A

Bands of fibrosis separating regenerative nodules of hepatocytes

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26
Q

What does cirrhosis result in

A

Loss of hepatic function

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27
Q

What is the main cause of cirrhosis of the liver

A

Alcohol

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28
Q

Describe the histological appearance of cirrhosis in the liver

A

Islands of hepatocytes have been cut off from eachother by bands of fibrous tissue has been deposited

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29
Q

What is the main complication of Cirrhosis

A

Portal hypertension

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30
Q

What are 2 other complications of cirrhosis

A

Ascites

Liver failure

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31
Q

What is the result of pre hepatic jaundice

A

Obstructive thrombosis and narrowing of the portal vein (

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32
Q

What is the result of hepatic jaundice

A

Cirrhosis

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33
Q

What is the result of post hepatic jaundice

A

Right sided Heart failure

Hepatic outflow obstruction

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34
Q

What are 6 clinical manifestations of liver disease

A 
Oedema 
Ascites
Haematemesis
Spider naevi
Infection
Coma
35
Q

What is the purpose of a biopsy in suspected alcoholic liver disease

A

Usually to rule out another condition

36
Q

What can influence the severity of alcoholic liver disease

A

Duration of alcohol abuse
Genetic factors
Ethnicity

37
Q

What is the metabolite of alcohol metabolism that is responsible for a lot of the cell injury

A

Acetaldehyde (ADH)

38
Q

After what duration of drinking would fibrosis occur?

A

Months to Years

39
Q

After what duration of drinking would cirrhosis occur?

A

Years

40
Q

Describe the appearance of a liver after a weekend binge

A

Normal liver with a smooth outline and countour but a chance in colour to yellow/ orange due to the accumulation of fat within the liver

41
Q

What are some other differentials for for the appearance of fatty liver disease

A 
NASH 
Pregnancy 
Drugs 
Nutritional 
Dibaetes
HPV
42
Q

Describe the histological appearance with alcoholic hepatitis

A

Hepatocte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis

43
Q

Describe the appearance of a liver with alcoholic cirrhosis

A

White areas

Lots of nodules due to not being able to the move bile

44
Q

What is the name of the 3 staining protocol

A

Massons Trichrome

45
Q

What are 5 outcomes of alcoholic liver disease

A 
Cirrhosis 
Portal hypertension: varices and ascites
Malnutrition
Hepatocellular carcinoma 
Social disintegration
46
Q

What appearance would non-alcoholic steatotohepatitis NASH produce?

A

The same morphilogical appearance as alcoholic liver disease

47
Q

Why is Non-alcoholic steatohepatitis on the increase

A

Due to obesity and diabetes

48
Q

What might Non-alcoholic steatohepatitis lead to

A

Fibrosis and cirrhosis

49
Q

What would viral hepatitis cause

A

Acute liver injury or chronic liver injury

50
Q

What are the 4 most common causes of viral hepatitis

A

Hep A,B, C, E

51
Q

What are 5 rare causes of viral hepatitis

A 
Delta agent
Ebstein-Barr virus
Yellow fever virus
Herpes Simplex virus 
Cytomegalovirus
52
Q

What can be seen histologically in chronic viral hepatitis B or C

A

Dense portal chronic inflammation - lots of black dots

53
Q

Name 3 autoimmune diseases related to chronic hepatitis

A

Primary Biliary Cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis

54
Q

What is primary biliary cirrhosis

A

Rare, autoimmune disease with unknown aetiology

55
Q

Who is most likely to get primary biliary cirrhosis

A

Females, post pregnancy, smokers

56
Q

What might be seen histologically in a patient with primary biliary cirrhosis

A

Granulomas and bile duct loss

57
Q

What might happen if primary biliary cirrhosis is left untreated

A

Bile duct loss leads to cholestasis, liver injury, inflammation, fibrosis and cirrhosis

58
Q

Is autoimmune hepatitis more common in men or women

A

Women

59
Q

What is a trigger of autoimmune hepatitis

A

Some drugs

60
Q

What is primary sclerosing cholangitis

A

Chronic inflammatory process affecting intra and extra hepatic bile ducts

61
Q

What does primary sclerosing cholangitis lead to

A

Periductal fibrosis, duct destruction, jaundice and fibrosis

62
Q

What is associated with primary sclerosing cholangitis

A

Ulcerative colitis

63
Q

What are 3 storage diseases of the liver

A

Haemochromatosis
Wilsons disease
Alpha 1- antitrypsin deficiency

64
Q

What is haemochromatosis

A

Excess iron within the liver

65
Q

Describe primary haemochromatosis

A

Genetic condition (autosomal recessive) , increase absorption of iron

66
Q

Describe secondary haemochromatosis

A

Iron overload from the diet, transfusions, iron therapy

67
Q

What does iron deposited in the liver eventually deposit into and what does this stimulate?

A

Into the portal connective tissue and stimulates fibrosis

68
Q

What can primary haemochromatosis cause

A

Diabetes, cardiac failure and impotence

69
Q

How is iron confirmed

A

Perls stain - blue

70
Q

What is dependent of the outcome of haemochromatosis

A

Genetics
Therapy
Cofactors (alcohol etc.)

71
Q

What are the 2 most common outcomes of haemochromatosis

A

Cirrhosis

Heaptocellular carcinoma

72
Q

What is Wilson’s disease

A

Inherited autosomal recessive disorder of copper metabolism

73
Q

Where does cooper accumulate in the body

A

Liver and brain

74
Q

What might Wilson’s disease cause?

A

Chronic hepatitis and neurological deterioration

75
Q

What is alpha 1 antitrypsin deficiency

A

Inherited autosomal recessive disorder of production of an enzyme inhibitor

76
Q

What does alpha 1 antitrypsin deficiency cause

A

EMpyema and cirrhosis

77
Q

What would be seen histologically in alpha 1 antitrypsin deficiency

A

Cytoplasmic globules of unsecreted globules of protein in liver cells

78
Q

What are the two types of liver tumours. What ones are rare and what ones are common

A

Primary (rare) and secondary (common)

79
Q

Name 2 types of primary tumours

A 
Hepatocellular adenoma
Hepatocellular carcinoma (hepatoma)
80
Q

Name the types of secondary liver tumours

A

Metastases from the colon, pnacreas or stomach mainly

81
Q

Describe hepatocellular adenoma

A

Benign mostly in females which can increase in size and rupture or bleed
Most are assymptomatic

82
Q

Describe hepatocellular carcinoma

A

Rare in europe

Associated with HBV,HCV and Cirrhosis

83
Q

What are the common presentations of hepatocellular carcinoma

A

Mass
Pain
Obstruction

84
Q

What is the prognosis of hepatocellular carcinoma

A

Poor prognosis

Gastro (67 decks)

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