Pathology of the liver Flashcards
What is the pathogenesis of liver disease?
Insult to hepatocytes…viral, dug, toxinn, antibody
Grading…degree of inflammation
Staging….degree of fibrosis
Cirrhosis
What can cause an acute onset of jaundice?
Viruses
Alcohol
Drugs
Bile duct obstruction
How does acetoaminophen toxicity affect the liver?
Confluent necrosis produces massive acute necoriss and liver failure
What are the consequences of acute liver failure?
Complete recovery
Chronic liver disease
Death from liver failure
What is jaundice?
Yellowing of the skin and/or sclera due to bilirubin
What are the different types of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
Conjugated or unconjugated
What causes pre-hepatic jaundice?
Haemolysis of all causes, too much haem to break down in the liver
Haemolytic anaemia
Unconjugated bilirubin
What causes hepatic jaundice?
Acute liver failure (virus, drugs, alcohol) Alcoholic hepatitis Cirrhosis Bile duct loss (atresia, PBC, PSC) Pregnancy
What causes post-hepatic jaundice?
Congenital biliary atresia
Gallstones block CBD
Stricture of CBD
Tumours (Ca head of pancreas)
What is cirrhosis?
Fibrous bands separarting regenrative nodules altering the hepatic microvasculature causing loss of hepatic function
What can cause cirrhosis?
Alcohol Hep B and C Iron overload (haemochromatosis) Autoimmune liver disease Gallstones
What are the complications of cirrhosis?
Portal hypertension
Ascites
Liver failure
What are the clinical signs of portal hypertesion?
Oesophageal varices
Caput medusa
Haemorrhoids
Why does ascites occur in cirrhosis?
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
What is the pathogeneiss of alcoholic liver disease?
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
What will occur after 2/3 days of heavy drinking?
Fatty liver - reversible
What will occur aftern 4-6 weeks of heavy drinking?
Acute alcoholic hepatitis - reversible
What will occur after mnths/yrs of heavy drinking?
Fibrosis - irreversible
What will occur after years of heavy drinking?
Cirrhosis - irreversible
What is the name for when hepatocytes become fatty?
Steatosis
What are the differential diagnosis of fatty liver?
NASH Pregnancy Drugs Nutritional Diabetes HCV
What are the histological changes in alcoholic hepatitis?
Hepatocyte necorsis
Neutrophils
Mallory bodies
Pericellular fibrosis
What is the outcome of alcoholic liver disease?
Cirrhosis Portal hypertesion Malnutrition HCC Social disintegration
Who does NASH affect?
Diabeteics
Obese people
People with hyperlipidaemia
What are the causes of viral hepatitis?
Hep A Hep B Hep C Hep E Delta agent EB virus Yellow fever virus Herpers simplex virus Cytomegalovirus
What will chronic viral hepatitis involve?
Inflammation of the portal triad
Interface hepatitis - piecemeal necorsis
Lobular inflammation
Fibrosis
What is the outcome of hep B?
Fulminant acute infection Chronic hepatitis Cirrhosis Hepatocellualr carcinoma Assymptomatic
What is the outcome of hep C?
Chronic hepatitis
Cirrhosis
What are the autoimmune diseases that can cause chronic hepatitis?
Primary biliary cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis
Who is likely to get primary biliary cirrhosis?
Females
What can you see on biopsy of primary biliary cirrhosis?
Granulomas and bile duct loss
What does primary biliary cirrhosis look like histologically?
Portal inflammation
Destruction of the bile ducts in PBC which does not happen in chronic hepatitis of other causes
What does a granuloma look like histologically?
A collection of histocytes with surroinding lymphocytes
What colour is the liver in PBC?
Green
Who is likely to be affected by autoimmune hepatitis?
Commoner in younger females
What oes autoimmune hepatitis look like histologically?
Chronic hepatitis pattern
Numerous plasma cells
Autoantibodies to smooth muslce, nuclear or LKM, raise IgG
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 other disease is primary sclerosing cholangitis associated with?
Ulcerative colitis
Who s linke to be affected by primary sclerosing cholangitis?
Males
What does primary sclerosing cholangitis look like histologically?
Periductal onion skinning fibrosis
What are the 3 most common storage disorders?
Haemochromatosis
Wilson’s disease
Alpha-1-antirypsin deficiency
Who will get primary haemochromatosis?
Genetic condition
Increased absorption of iron from the intestine and abnormal iron metabolism
Who will get secondary haemochromatosis?
Iron overload from diet
Transfusions
Iron therapy
What can primary haemochromatosis lead to?
Deposited in portal connective tissue and stimulates fibrosis
Cirrhosis if not treated
Predidposes to cacrinoma
Can cause diabtetes, cardiac failure and impotence
What is wilson’s disease?
Inherited autosomal recessive disorder of copper metabolism
Where does copper accumulate?
In the liver and brain (basal ganglia)
What can wilson’s disease cause?
Chronic hepatitis and neurological deterioration
What is alpha-1-antitypsin deficiency?
Inherited autosomal recessive disorder of production of an enzyme inhibitor
What can alpha-1-antripysin deficiency cause?
Emphysema and cirrhosis
What are the primary tumours of the liver?
Hepatocellular adenoma
Hepatocellular carcinoma
Where are common metastases to the liver from?
Colon, pancreas, stomach, breast, lung and other
Who is hepatocellular adenoma likely to affect?
Women on the contraceptive pill
What is hepatocellular carcinoma associated with?
HBV
HCV
Cirrhosis
What does HCC usually present with?
Mass, pain and obstruction
