Pathology of the Liver

Question 1

Describe the pathogenesis of liver disease?

Answer 1

Insult to hepatocytes, viral, drug, toxin, antibody

Grading…. degree of inflammation

Staging… degree of fibrosis

Cirrhosis

Question 2

What could be the consequences of acute liver failure?

Answer 2

Complete recovery
Chronic liver disease
Death from liver failure

Question 3

Describe pre-hepatic jaundice?

Answer 3

Too much haem to break down (increased bilirubin entering the liver)

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin

Question 4

What is heamolysis?

Answer 4

the rupture or destruction of red blood cells.

Question 5

Describe intra-hepatic jaundice?

Answer 5

Liver cells are injured or dead - hepatocellular damage

caused by hepatitis, drugs, cirrhosis, pregnancy

Question 6

Describe post hepatic jaundice?

Answer 6

Bile cannot escape into the bowel - obstruction of bile flow out of the liver (cholestasis)

(cause by, gallstones, biliary stricture, cardonima, sclerosing cholangitis)

Question 7

What is cirrhosis of the liver?

Answer 7

The final common endpoint for liver disease
Irreversible
Alteration of hepatic microvasculature
Loss of hepatic function

Question 8

What is cirrhosis of the liver usually defined by?

Answer 8

Defined by bands of fibrosis separating regenerative nodules of hepatocytes

Question 9

What are some of the causes of liver cirrhosis?

Answer 9

Alcohol 
Iron overload 
Hepatitis 
Autoimmune disease 
Gallstones

Question 10

What are some complications of liver cirrhosis?

Answer 10

Portal hypertension - leading to varices, caput medusa, haemorrhoids

Ascites

Liver failure

Question 11

Describe roughly the 4 stages of what happens to the liver depending how long you drink for?

Answer 11

Few days - fatty liver (Reversible)
Weeks - hepatitis (reversible)
Months - Fibrosis (irreversible)
Years - Cirrhosis (irreversible)

Question 12

What might you see in an alcoholic fatty liver?

Answer 12

Fat vacuoles appears clear in hepatocytes

Question 13

What might you see in alcoholic hepatitis?

Answer 13

Hepatocyte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis

Question 14

What might you see in alcoholic fibrosis?

Answer 14

Collagen layed down around cells

Question 15

What might you see in alcoholic cirrhosis?

Answer 15

Micronodular cirrhosis with abundant white scarring

Question 16

What can be the complications of alcoholic liver disease?

Answer 16

Cirrhosis
Portal hypertension
Malnutrition
Hepatocellular carinoma

Question 17

Describe non alcoholic steatohepatitis?

Answer 17

Deposition of fat in the liver in non drinkers
Pathologically identical to alcoholic liver disease
Occurs in patients with diabetes, obesity, hyperlipidaemia
May lead to fibrosis and cirrhosis.

Question 18

Describe Hep A - the transmission?

Answer 18

Face oral spread

Question 19

Describe hep A?

Answer 19

Short incubation period
Common in gay men/IV drug users
Sporadic or endemic
Directly cytopathic 
No carrier state

Mild illness usually full recovery

Question 20

How is Hep B spread?

Answer 20

By blood products, sexually, vertically (in utero)

Question 21

Describe Hep B?

Answer 21

Long incubation period
Liver damage is by antiviral immune response
Carriers exist
Outcome is variable

Question 22

How is hep C spread?

Answer 22

Blood, sexual intercourse

Question 23

Describe Hep C?

Answer 23

Short incubation period
Often asymptomatic
Tends to become chronic

Question 24

What might be the outcome of hep B?

Answer 24

Fulminant acute infection (death)
Chronic hepatitis 
Cirrhosis 
Hepatocellular carcinoma 
Asymptomatic (Carrier)

Question 25

What might be the outcome of hep C?

Answer 25

Chronic hepatits | Cirrhosis

Question 26

What is primary biliary cirrhosis?

Answer 26

Rare autoimmune disease - unknown aetiology Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation causes cholestasis (build up of bile in liver) which may lead to fibrosis, cirrhosis and ports hypertension

Question 27

What is primary biliary cirrhosis associated with?

Answer 27

Autoantibodies to mitochondria | itch without a rash

Question 28

Describe primary biliary cirrhosis - who gets it more etc?

Answer 28

Females (90%) - middle aged Indication for biopsy - to stage disease May see granulomas and bile duct loss Outcome - unpredictable

Question 29

What is autoimmune hepatitis?

Answer 29

Chronic condition, more common in females

Question 30

Describe chronic drug induced hepatitis?

Answer 30

Similar features to all other types of chronic hepatitis May trigger an autoimmune hepatitis Chronic active process

Question 31

What is primary sclerosing cholangitis?

Answer 31

Chronic inflammatory process affecting intra and extra-hepatic bile ducts (progressive fibrosis and obliteration of the biliary tracts)

Question 32

Describe who is more likely to get primary sclerosing cholangitis?

Answer 32

Males | Associated with UC

Question 33

What does the chronic inflammation affecting the bile ducts in PSC cause?

Answer 33

Bile building up in the liver due to narrowing of bile ducts, bile can cause damage to the liver, can cause cirrhosis and liver failure Cause jaundice

Question 34

What are the 3 storage diseases?

Answer 34

Haemochromatosis Wilsons disease Alpha-1-antitrypsiin deficiency

Question 35

What is haemochromatosis?

Answer 35

Excess iron within the liver Primary: Genetic condition, increased absorption of iron Secondary: Iron overload from diet, transfusions, iron therapy

Question 36

Describe primary haemochormatosis?

Answer 36

Inherited autosomal recessie condition Excess absorption of iron from intestine, abnormal iron metabolism Worse in men Iron deposited in the liver for years - asymptomatic Eventually deposited in the portal CT and stimulates fibrosis Leads to cirrhosis Predisposes to carcinoma

Question 37

What is wilsons disease?

Answer 37

Inherited autosomal recessvie disorder of copper metabolism Copper accumulates in the liver and brain

Question 38

What might you find on investigation of wilsons disease?

Answer 38

Kayser-fleischer rings | Low serum caeruoplasmin

Question 39

What is alpha-1-antitrypsin deficieny?

Answer 39

Inherited autosomal recessive disorder of production of an enzyme inhibitor

Question 40

What does A1AD cause?

Answer 40

Emphysema and cirrhosis

Question 41

Describe hepatocellular adenoma?

Answer 41

BENIGN Females May become larger - can rupture or bleed Most asymptomatic

Question 42

Describe hepatocullular carcinoma?

Answer 42

Rare Associated with HBV, HCV and cirrhosis Usually presents as a mass, pain, obstruction Usually advanced unless discovered incidentally Poor prognosis