Pathology of the Liver Flashcards
Describe the pathogenesis of liver disease?
Insult to hepatocytes, viral, drug, toxin, antibody
Grading…. degree of inflammation
Staging… degree of fibrosis
Cirrhosis
What could be the consequences of acute liver failure?
Complete recovery
Chronic liver disease
Death from liver failure
Describe pre-hepatic jaundice?
Too much haem to break down (increased bilirubin entering the liver)
Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin
What is heamolysis?
the rupture or destruction of red blood cells.
Describe intra-hepatic jaundice?
Liver cells are injured or dead - hepatocellular damage
caused by hepatitis, drugs, cirrhosis, pregnancy
Describe post hepatic jaundice?
Bile cannot escape into the bowel - obstruction of bile flow out of the liver (cholestasis)
(cause by, gallstones, biliary stricture, cardonima, sclerosing cholangitis)
What is cirrhosis of the liver?
The final common endpoint for liver disease
Irreversible
Alteration of hepatic microvasculature
Loss of hepatic function
What is cirrhosis of the liver usually defined by?
Defined by bands of fibrosis separating regenerative nodules of hepatocytes
What are some of the causes of liver cirrhosis?
Alcohol Iron overload Hepatitis Autoimmune disease Gallstones
What are some complications of liver cirrhosis?
Portal hypertension - leading to varices, caput medusa, haemorrhoids
Ascites
Liver failure
Describe roughly the 4 stages of what happens to the liver depending how long you drink for?
Few days - fatty liver (Reversible)
Weeks - hepatitis (reversible)
Months - Fibrosis (irreversible)
Years - Cirrhosis (irreversible)
What might you see in an alcoholic fatty liver?
Fat vacuoles appears clear in hepatocytes
What might you see in alcoholic hepatitis?
Hepatocyte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis
What might you see in alcoholic fibrosis?
Collagen layed down around cells
What might you see in alcoholic cirrhosis?
Micronodular cirrhosis with abundant white scarring
What can be the complications of alcoholic liver disease?
Cirrhosis
Portal hypertension
Malnutrition
Hepatocellular carinoma
Describe non alcoholic steatohepatitis?
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.
Describe Hep A - the transmission?
Face oral spread
Describe hep A?
Short incubation period Common in gay men/IV drug users Sporadic or endemic Directly cytopathic No carrier state
Mild illness usually full recovery
How is Hep B spread?
By blood products, sexually, vertically (in utero)
Describe Hep B?
Long incubation period
Liver damage is by antiviral immune response
Carriers exist
Outcome is variable
How is hep C spread?
Blood, sexual intercourse
Describe Hep C?
Short incubation period
Often asymptomatic
Tends to become chronic
What might be the outcome of hep B?
Fulminant acute infection (death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma Asymptomatic (Carrier)
What might be the outcome of hep C?
Chronic hepatits
Cirrhosis
What is primary biliary cirrhosis?
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
What is primary biliary cirrhosis associated with?
Autoantibodies to mitochondria
itch without a rash
Describe primary biliary cirrhosis - who gets it more etc?
Females (90%) - middle aged
Indication for biopsy - to stage disease
May see granulomas and bile duct loss
Outcome - unpredictable
What is autoimmune hepatitis?
Chronic condition, more common in females
Describe chronic drug induced hepatitis?
Similar features to all other types of chronic hepatitis
May trigger an autoimmune hepatitis
Chronic active process
What is primary sclerosing cholangitis?
Chronic inflammatory process affecting intra and extra-hepatic bile ducts
(progressive fibrosis and obliteration of the biliary tracts)
Describe who is more likely to get primary sclerosing cholangitis?
Males
Associated with UC
What does the chronic inflammation affecting the bile ducts in PSC cause?
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
What are the 3 storage diseases?
Haemochromatosis
Wilsons disease
Alpha-1-antitrypsiin deficiency
What is haemochromatosis?
Excess iron within the liver
Primary: Genetic condition, increased absorption of iron
Secondary: Iron overload from diet, transfusions, iron therapy
Describe primary haemochormatosis?
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
What is wilsons disease?
Inherited autosomal recessvie disorder of copper metabolism
Copper accumulates in the liver and brain
What might you find on investigation of wilsons disease?
Kayser-fleischer rings
Low serum caeruoplasmin
What is alpha-1-antitrypsin deficieny?
Inherited autosomal recessive disorder of production of an enzyme inhibitor
What does A1AD cause?
Emphysema and cirrhosis
Describe hepatocellular adenoma?
BENIGN
Females
May become larger - can rupture or bleed
Most asymptomatic
Describe hepatocullular carcinoma?
Rare
Associated with HBV, HCV and cirrhosis
Usually presents as a mass, pain, obstruction
Usually advanced unless discovered incidentally
Poor prognosis
