Pathology of the Liver Flashcards
What ribs cover the liver
7-11
What is the normal appearance of the liver?
Red brown colour with a smooth outline and contour
What 3 terms are used to describe the patterns of liver injury
1) Periportal Zone
2) Mid Acinar
3) Pericentral
What is the zone that is closest to the vascular supply
Zone 1
Cells in which zone are most vulnerable to injury?
Why is this the case?
Zone 3
They are furthest from the vascular supply - it takes longer for oxygen to reach them
What 4 aspects can cause insult to hepatocytes
Viral
Drug
Toxin
Antibody
How can we measure the degree of injury to the liver?
Insult
Grading the degree of inflammation
Staging the degree of fibrosis
Cirrhosis
What is cirrhosis
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.
What are 4 causes of the acute onset of jaundice
Viruses
Alcohol
Drugs (paracetamol
Bile duct obstruction
What is the underlying cause of acute onset of jaundice
Hepatic necrosis
What is necrosis?
The death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.
What is the chemical name for Paracetamol
Acetoaminophen
Describe the structure of the liver which has been damaged by aracetamol
not a normal structure
Necrotic hepatocytes are more rounded and not polyhedral
Majority of cells have lost their nuclei
What 3 things can occur as a consequence of acute liver failure?
Complete recovery
Chronic liver disease
Death from liver failure
What is jaundice
Yellowing of the skin due to excess bilirubin
What are the 3 classifications of jaundice
Pre- hepatic
Hepatic and
Post-hepatic
What are the 2 types of jaundice
Conjugated or Unconjugated
What is the cause of pre-hepatic jaundice
Too much haem to break down
Describe pre-hepatic jaundice
Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin (uncombined)
What is hepatic jaundice
When the liver cells are injured or dead and so we have reduced hepatic function
Describe hepatic jaundice
Acute liver failure (virus, drugs, alcohol) Alcoholic hepatitis Cirrhosis (decompensated) Bile duct loss (atresia, PBC,PSC) Pregnancy
What is post hepatic jaundice
Bile cannot escape into the bowel
Describe post-hepatic jaunice
Congenital biliary atresia
Gallstones block CB Duct
Structures of CB duct
Tumours (head of the pancreas)
What does cirrhosis of the liver signify
The endpoint of liver disease
Define cirrhosis of the liver
Bands of fibrosis separating regenerative nodules of hepatocytes
What does cirrhosis result in
Loss of hepatic function
What is the main cause of cirrhosis of the liver
Alcohol
Describe the histological appearance of cirrhosis in the liver
Islands of hepatocytes have been cut off from eachother by bands of fibrous tissue has been deposited
What is the main complication of Cirrhosis
Portal hypertension
What are 2 other complications of cirrhosis
Ascites
Liver failure
What is the result of pre hepatic jaundice
Obstructive thrombosis and narrowing of the portal vein (
What is the result of hepatic jaundice
Cirrhosis
What is the result of post hepatic jaundice
Right sided Heart failure
Hepatic outflow obstruction
What are 6 clinical manifestations of liver disease
Oedema Ascites Haematemesis Spider naevi Infection Coma
What is the purpose of a biopsy in suspected alcoholic liver disease
Usually to rule out another condition
What can influence the severity of alcoholic liver disease
Duration of alcohol abuse
Genetic factors
Ethnicity
What is the metabolite of alcohol metabolism that is responsible for a lot of the cell injury
Acetaldehyde (ADH)
After what duration of drinking would fibrosis occur?
Months to Years
After what duration of drinking would cirrhosis occur?
Years
Describe the appearance of a liver after a weekend binge
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
What are some other differentials for for the appearance of fatty liver disease
NASH Pregnancy Drugs Nutritional Dibaetes HPV
Describe the histological appearance with alcoholic hepatitis
Hepatocte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis
Describe the appearance of a liver with alcoholic cirrhosis
White areas
Lots of nodules due to not being able to the move bile
What is the name of the 3 staining protocol
Massons Trichrome
What are 5 outcomes of alcoholic liver disease
Cirrhosis Portal hypertension: varices and ascites Malnutrition Hepatocellular carcinoma Social disintegration
What appearance would non-alcoholic steatotohepatitis NASH produce?
The same morphilogical appearance as alcoholic liver disease
Why is Non-alcoholic steatohepatitis on the increase
Due to obesity and diabetes
What might Non-alcoholic steatohepatitis lead to
Fibrosis and cirrhosis
What would viral hepatitis cause
Acute liver injury or chronic liver injury
What are the 4 most common causes of viral hepatitis
Hep A,B, C, E
What are 5 rare causes of viral hepatitis
Delta agent Ebstein-Barr virus Yellow fever virus Herpes Simplex virus Cytomegalovirus
What can be seen histologically in chronic viral hepatitis B or C
Dense portal chronic inflammation - lots of black dots
Name 3 autoimmune diseases related to chronic hepatitis
Primary Biliary Cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis
What is primary biliary cirrhosis
Rare, autoimmune disease with unknown aetiology
Who is most likely to get primary biliary cirrhosis
Females, post pregnancy, smokers
What might be seen histologically in a patient with primary biliary cirrhosis
Granulomas and bile duct loss
What might happen if primary biliary cirrhosis is left untreated
Bile duct loss leads to cholestasis, liver injury, inflammation, fibrosis and cirrhosis
Is autoimmune hepatitis more common in men or women
Women
What is a trigger of autoimmune hepatitis
Some drugs
What is primary sclerosing cholangitis
Chronic inflammatory process affecting intra and extra hepatic bile ducts
What does primary sclerosing cholangitis lead to
Periductal fibrosis, duct destruction, jaundice and fibrosis
What is associated with primary sclerosing cholangitis
Ulcerative colitis
What are 3 storage diseases of the liver
Haemochromatosis
Wilsons disease
Alpha 1- antitrypsin deficiency
What is haemochromatosis
Excess iron within the liver
Describe primary haemochromatosis
Genetic condition (autosomal recessive) , increase absorption of iron
Describe secondary haemochromatosis
Iron overload from the diet, transfusions, iron therapy
What does iron deposited in the liver eventually deposit into and what does this stimulate?
Into the portal connective tissue and stimulates fibrosis
What can primary haemochromatosis cause
Diabetes, cardiac failure and impotence
How is iron confirmed
Perls stain - blue
What is dependent of the outcome of haemochromatosis
Genetics
Therapy
Cofactors (alcohol etc.)
What are the 2 most common outcomes of haemochromatosis
Cirrhosis
Heaptocellular carcinoma
What is Wilson’s disease
Inherited autosomal recessive disorder of copper metabolism
Where does cooper accumulate in the body
Liver and brain
What might Wilson’s disease cause?
Chronic hepatitis and neurological deterioration
What is alpha 1 antitrypsin deficiency
Inherited autosomal recessive disorder of production of an enzyme inhibitor
What does alpha 1 antitrypsin deficiency cause
EMpyema and cirrhosis
What would be seen histologically in alpha 1 antitrypsin deficiency
Cytoplasmic globules of unsecreted globules of protein in liver cells
What are the two types of liver tumours. What ones are rare and what ones are common
Primary (rare) and secondary (common)
Name 2 types of primary tumours
Hepatocellular adenoma Hepatocellular carcinoma (hepatoma)
Name the types of secondary liver tumours
Metastases from the colon, pnacreas or stomach mainly
Describe hepatocellular adenoma
Benign mostly in females which can increase in size and rupture or bleed
Most are assymptomatic
Describe hepatocellular carcinoma
Rare in europe
Associated with HBV,HCV and Cirrhosis
What are the common presentations of hepatocellular carcinoma
Mass
Pain
Obstruction
What is the prognosis of hepatocellular carcinoma
Poor prognosis