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GI > Pathology of the liver > Flashcards

Pathology of the liver Flashcards

1
Q

What is the pathogenesis of liver disease?

A

Insult to hepatocytes…viral, dug, toxinn, antibody
Grading…degree of inflammation
Staging….degree of fibrosis
Cirrhosis

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2
Q

What can cause an acute onset of jaundice?

A

Viruses
Alcohol
Drugs
Bile duct obstruction

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3
Q

How does acetoaminophen toxicity affect the liver?

A

Confluent necrosis produces massive acute necoriss and liver failure

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4
Q

What are the consequences of acute liver failure?

A

Complete recovery
Chronic liver disease
Death from liver failure

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5
Q

What is jaundice?

A

Yellowing of the skin and/or sclera due to bilirubin

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6
Q

What are the different types of jaundice?

A

Pre-hepatic
Hepatic
Post-hepatic
Conjugated or unconjugated

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7
Q

What causes pre-hepatic jaundice?

A

Haemolysis of all causes, too much haem to break down in the liver
Haemolytic anaemia
Unconjugated bilirubin

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8
Q

What causes hepatic jaundice?

A 
Acute liver failure (virus, drugs, alcohol) 
Alcoholic hepatitis
Cirrhosis
Bile duct loss (atresia, PBC, PSC) 
Pregnancy
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9
Q

What causes post-hepatic jaundice?

A

Congenital biliary atresia
Gallstones block CBD
Stricture of CBD
Tumours (Ca head of pancreas)

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10
Q

What is cirrhosis?

A

Fibrous bands separarting regenrative nodules altering the hepatic microvasculature causing loss of hepatic function

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11
Q

What can cause cirrhosis?

A 
Alcohol
Hep B and C
Iron overload (haemochromatosis) 
Autoimmune liver disease 
Gallstones
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12
Q

What are the complications of cirrhosis?

A

Portal hypertension
Ascites
Liver failure

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13
Q

What are the clinical signs of portal hypertesion?

A

Oesophageal varices
Caput medusa
Haemorrhoids

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14
Q

Why does ascites occur in cirrhosis?

A

Accumulation of fluid within the abdo cavity as the liver is no longer making albumin which is a protein in the plasma that draws fluid back into the circulation and without it the fluid sits in the extracellular space

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15
Q

What is the pathogeneiss of alcoholic liver disease?

A

When alcohol is drank, there is an increased peripheral release of fatty acids and increased synthesis of fatty aids and triglycerides within the liver cells. Acetaldehyde is a product of alcohol metabolism and is resposible for hepatocyte injury

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16
Q

What will occur after 2/3 days of heavy drinking?

A

Fatty liver - reversible

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17
Q

What will occur aftern 4-6 weeks of heavy drinking?

A

Acute alcoholic hepatitis - reversible

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18
Q

What will occur after mnths/yrs of heavy drinking?

A

Fibrosis - irreversible

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19
Q

What will occur after years of heavy drinking?

A

Cirrhosis - irreversible

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20
Q

What is the name for when hepatocytes become fatty?

A

Steatosis

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21
Q

What are the differential diagnosis of fatty liver?

A 
NASH
Pregnancy
Drugs
Nutritional
Diabetes
HCV
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22
Q

What are the histological changes in alcoholic hepatitis?

A

Hepatocyte necorsis
Neutrophils
Mallory bodies
Pericellular fibrosis

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23
Q

What is the outcome of alcoholic liver disease?

A 
Cirrhosis
Portal hypertesion 
Malnutrition 
HCC
Social disintegration
24
Q

Who does NASH affect?

A

Diabeteics
Obese people
People with hyperlipidaemia

25
Q

What are the causes of viral hepatitis?

A 
Hep A 
Hep B 
Hep C
Hep E 
Delta agent
EB virus
Yellow fever virus
Herpers simplex virus
Cytomegalovirus
26
Q

What will chronic viral hepatitis involve?

A

Inflammation of the portal triad
Interface hepatitis - piecemeal necorsis
Lobular inflammation
Fibrosis

27
Q

What is the outcome of hep B?

A 
Fulminant acute infection 
Chronic hepatitis
Cirrhosis
Hepatocellualr carcinoma
Assymptomatic
28
Q

What is the outcome of hep C?

A

Chronic hepatitis

Cirrhosis

29
Q

What are the autoimmune diseases that can cause chronic hepatitis?

A

Primary biliary cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis

30
Q

Who is likely to get primary biliary cirrhosis?

A

Females

31
Q

What can you see on biopsy of primary biliary cirrhosis?

A

Granulomas and bile duct loss

32
Q

What does primary biliary cirrhosis look like histologically?

A

Portal inflammation

Destruction of the bile ducts in PBC which does not happen in chronic hepatitis of other causes

33
Q

What does a granuloma look like histologically?

A

A collection of histocytes with surroinding lymphocytes

34
Q

What colour is the liver in PBC?

A

Green

35
Q

Who is likely to be affected by autoimmune hepatitis?

A

Commoner in younger females

36
Q

What oes autoimmune hepatitis look like histologically?

A

Chronic hepatitis pattern
Numerous plasma cells
Autoantibodies to smooth muslce, nuclear or LKM, raise IgG

37
Q

What is primary sclerosing cholangitis?

A

Chronic inflammatory process affecting intra and extra hepatic bile ducts

38
Q

What does primary sclerosing cholangitis lead to?

A

Periductal fibrosis, duct destruction, jaundice and fibrosis

39
Q

What other disease is primary sclerosing cholangitis associated with?

A

Ulcerative colitis

40
Q

Who s linke to be affected by primary sclerosing cholangitis?

A

Males

41
Q

What does primary sclerosing cholangitis look like histologically?

A

Periductal onion skinning fibrosis

42
Q

What are the 3 most common storage disorders?

A

Haemochromatosis
Wilson’s disease
Alpha-1-antirypsin deficiency

43
Q

Who will get primary haemochromatosis?

A

Genetic condition

Increased absorption of iron from the intestine and abnormal iron metabolism

44
Q

Who will get secondary haemochromatosis?

A

Iron overload from diet
Transfusions
Iron therapy

45
Q

What can primary haemochromatosis lead to?

A

Deposited in portal connective tissue and stimulates fibrosis
Cirrhosis if not treated
Predidposes to cacrinoma
Can cause diabtetes, cardiac failure and impotence

46
Q

What is wilson’s disease?

A

Inherited autosomal recessive disorder of copper metabolism

47
Q

Where does copper accumulate?

A

In the liver and brain (basal ganglia)

48
Q

What can wilson’s disease cause?

A

Chronic hepatitis and neurological deterioration

49
Q

What is alpha-1-antitypsin deficiency?

A

Inherited autosomal recessive disorder of production of an enzyme inhibitor

50
Q

What can alpha-1-antripysin deficiency cause?

A

Emphysema and cirrhosis

51
Q

What are the primary tumours of the liver?

A

Hepatocellular adenoma

Hepatocellular carcinoma

52
Q

Where are common metastases to the liver from?

A

Colon, pancreas, stomach, breast, lung and other

53
Q

Who is hepatocellular adenoma likely to affect?

A

Women on the contraceptive pill

54
Q

What is hepatocellular carcinoma associated with?

A

HBV
HCV
Cirrhosis

55
Q

What does HCC usually present with?

A

Mass, pain and obstruction

GI (42 decks)

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