Pathology of the liver Flashcards
What are the 3 zones of the liver?
Pericentral, Periportal and mid acinar
How does Cirrhosis manifest?
Insult to hepatocytes ..viral, drug, toxin, antibody
Grading -> degree of inflammation
Staging -> degree of fibrosis
Cirrhosis
What are the causes of Acute liver failure?
viruses
alcohol
drugs
bile duct obstruction
What is the clinical sign of Acute liver failure?
acute onset of jaundice
What is Acetoaminophen Toxicity?
Confluent necrosis produces massive acute necrosis and liver failure
- caused by overdose of drugs (mainly in suicidal patients)
What are the consequences of acute liver failure?
complete recovery
chronic liver disease
death from liver failure
What can cause pre-hepatic jaundice?
Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin
i.e. too much haem to break down
What can cause hepatic jaundice?
Acute liver failure (virus,drugs,alcohol) Alcoholic hepatitis Cirrhosis (decompensated) Bile duct loss (atresia, PBC, PSC) Pregnancy
i.e. liver cells injured of dead
What can cause post-hepatic jaundice?
Congenital biliary atresia
Gallstones block CB Duct
Strictures of CB Duct
Tumours (Ca head of pancreas)
i.e. bile cannot escape into the bowel - deadly
What are the characteristics of cirrhosis?
Irreversible
Defined by bands of fibrosis separating regenerative nodules of hepatocytes
Macronodular or micronodular (alcoholic)
Alteration of hepatic microvasculature - blood leaving the liver is different to that of a normal person ->
Loss of hepatic function
What can cause Cirrhosis?
alcohol drugs too much iron gallstones autoimmune liver disease
What are the complications of Cirrhosis?
Portal hypertension
Ascites - no albumin so fluid is not drawn back in
Liver Failure
What happens when ethanol enters the body?
Ethanol -> acetaldehyde -> acetate
What is the effect of acetaldehyde on the body?
toxic and causes liver cell injury
What occurs in the liver after 2-3 days of heavy drinking?
Fatty liver
Reversible
What occurs in the liver after 4-6 weeks of heavy drinking?
Hepatitis
Reversible
What occurs in the liver after months of heavy drinking?
Fibrosis
Irreversible
What occurs in the liver after years of heavy drinking?
Cirrhosis
Irreversible
What is a fatty liver called?
Steatosis
Apart from alcohol, what can also cause fatty liver disease?
NASH - Non-alcoholic steatohepatitis Pregnancy Drugs Nutritional Diabetes HCV (type 3)
What are the consequences of alcoholic liver disease?
Cirrhosis Portal hypertension… varices and ascites Malnutrition Hepatocellular carcinoma Social disintegration
Describe NASH?
Non-drinkers
Pathologically identical to alcoholic liver disease
Occurs in patients with diabetes,obesity, hyperlipidaemia
May lead to fibrosis, cirrhosis and very common cause of carcinoma
What are the rare causes of viral hepatitis?
Ebstein-Barr virus Yellow fever virus Herpes Simplex virus Cytomegalovirus Delta agent
What are the common causes of viral hepatitis?
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E
What are the characteristics of Hep A?
Faecal-oral spread
Short incubation period
Mild illness, usually full recovery
No carrier state
What are the chracteristics of Hep B?
Spread by blood, blood products, sexually, vertically (in utero)
Long incubation period
Liver damage is by antiviral immune response
Carriers exist
Outcome is variable
What are the characteristics of Hep C?
Spread by blood, blood products, possibly sexually Short incubation period Often asymptomatic Disease waxes and wanes Tends to become chronic or cirrhosis
What are the outcomes of Hep B?
Fulminant acute infection (Death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma Assymptomatic (Carrier)
What can cause chronic hepatitis?
Hepatitis B Hepatitis C Primary Biliary Cirrhosis (PBC) Autoimmune hepatitis Drug induced hepatitis Primary Sclerosing Cholangitis (PSC)
What is a key indicator of Primary Biliary Cirrhosis?
High anti mitochondria antibodies
May see granulomas and bile duct loss
Describe the characteristics of autoimmune hepatitis?
Commoner in females Associated with other AI diseases Chronic hepatitis pattern Numerous plasma cells Autoantibodies to smooth muscle, nuclear or LKM, raised IgG May have triggers, including some drugs
What may trigger an autoimmune hepatitis?
chronic drug induced hepatitis
Describe Primary Sclerosing Cholongitis?
Chronic inflammatory process affecting intra - and extra-hepatic bile ducts
Leads to periductal fibrosis, duct destruction, jaundice and fibrosis
Associated with Ulcerative Colitis
Males
Increased risk of malignancy in bile ducts and colon
Name some storage diseases?
Haemochromatosis
Wilsons disease
Alpha-1-antitrypsin deficiency
What is the cause of primary Haemochromatosis?
Genetic condition - excess absorbtion of iron from intestine, abnormal iron metabolism
What are the causes of secondary Haemochromatosis?
Iron overload from diet, transfusions, iron therapy
What are the consequences of primary haemochromatosis?
Iron deposited in liver, assymptomatic for years
Eventually deposited in portal connective tissue and stimulates fibrosis
Cirrhosis if not treated and predisposes to carcinoma
Also causes diabetes, cardiac failure and impotence
What is the therapy for haemochromatosis?
venesection
What is Wilsons Disease?
Inherited autosomal recessive disorder of copper metabolism
Copper accumulates in liver and brain (basal ganglia)
What are the signs and outcomes of Wilsons Disease?
Kayser-Fleischer rings at corneal limbus
Low serum caeruloplasmin
Causes chronic hepatitis and neurological deterioration
What is Alpha-1-antitrypsin deficiency?
Inherited autosomal recessive disorder of production of an enzyme inhibitor
Causes empysema and cirrhosis
Cytoplasmic globules of unsecreted globules of protein in liver cells
