Pathology of the Liver Flashcards
Describe the basic structure of the liver [8]
- vasculature
- incoming portal vein and hepatic artery
- outgoing hepatic vein
- parenchymal liver cells
- biliary system
- connective tissue matrix
- all arranged as portal tracts and parenchyma
What are the broad causes of injury to the liver? [7]
- drugs (e.g. alcohol)
- abnormal nutrition
- infection
- obstruction to bile/blood flow
- autoimmune liver disease
- genetic/deposition disease
- neoplasia
What are the 4 main parts of the liver all of which are inter-connected with damage to one being damage to all? [4]
- parenchyma,
- blood vessels,
- connective tissue,
- bile ducts
Define acute-on-chronic inflammation in association with liver disease [1]
chronic liver disease that often presents with acute exacerbation plus evidence of underlying chronicity (e.g. fibrosis)
Define cirrhosis [4]
- end stage liver disease, defined by:
- diffuse process
- fibrosis
- nodule formation
What are the histological patterns/causes of diffuse liver disease? [7]
- acute hepatitis
- acute cholestasis or cholestatic hepatitis
- fatty liver disease (steatosis and steatohepatitis)
- chronic hepatitis
- chronic biliary/cholestatic disease
- genetic/deposition disease
- hepatic vascular disease
What are the 3 main causes of acute hepatitis? [3]
- autoimmune,
- viral
- drug (paracetamol overdose)
Describe the histological patterns of acute hepatitis [3]
- diffuse hepatocyte injury seen as swelling
- spotty necrosis
- inflammatory cell infiltrate in all areas: portal tracts, interface and parenchyma
What are the clinical signs and symptoms of acute hepatitis?
- right upper quadrant (RUQ) pain,
- malaise,
- ↑AST/ALT
What are the causes of acute cholestasis (cholestatic) hepatitis? [2]
- extra-hepatic biliary obstruction
- drug injury e.g. antibiotics (augmentin)
What are the histological features of acute cholestasis (cholestatic) hepatitis? [4]
- brown bile
- +/- acute hepatitis (swelling/spotty necrosis)
Which chronic liver diseases may develop fibrosis and progress to cirrhosis? [4]
- fatty liver disease (steatosis and steatohepatitis)
- chronic hepatitis
- chronic biliary/cholestatic disease
- genetic/deposition disease
What are the histological features of Hepatitis B pathology? [4]
- may look like acute hepatitis + fibrosis
- ground glass cytoplasm in hepatocytes → accumulation of “surface antigens” for Hep B
What are the causes of chronic biliary/cholestatic disease? [2]
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis (PSC)
What are the histological features of chronic biliary/cholestatic disease? [4]
- focal
- portal inflammation
- fibrosis with bile duct injury
- (granulomas in PBC)
Name 3 genetic conditions associated with deposition in the liver and state the deposit in each [5]
- haemochromatosis → iron
- Wilson’s disease → copper
- α-1-anti trypsin deficiency
Name the causes of the following types of diffuse liver disease
- acute hepatitis? [4]
- acute cholestasis/cholestatic hepatitis? [3]
- fatty liver disease (steatosis + steatohepatitis)? [3]
- chronic hepatitis? [3]
- chronic biliary/cholestatic disease? [3]
- genetic/deposition disease? [1]
- hepatic vascular disease? [2]
-
acute hepatitis
- hepatitis viruses A & E
- hepatitis viruses B & C
- drug injury
- autoimmune liver disease
-
acute cholestasis/cholestatic hepatitis
- hepatitis viruses A & E
- drug injury
- extrahepatic biliary obstruction
-
fatty liver disease (steatosis + steatohepatitis)
- drug injury
- alcohol
- metabolic syndrome (e.g. obesity)
-
chronic hepatitis
- hepatitis viruses B & C
- autoimmune liver disease
- genetic/deposition (e.g haemochromatosis, Wilson’s)
-
chronic biliary/cholestatic disease
- extrahepatic biliary obstruction
- chronic biliary disease (e.g. PBC)
- genetic/deposition (e.g haemochromatosis, Wilson’s)
-
genetic/deposition disease
- genetic/deposition (e.g haemochromatosis, Wilson’s)
-
hepatic vascular disease
- drug injury
- vascular disease (e.g. venous obstruction)
What are the 3 aims of management of diffuse liver disease? [3]
- ↓ symptoms
- ↓ inflammation
- prevent fibrosis
What are the treatment options for diffuse liver disease? [6]
- specific treatment against cause, e.g.
- removal of alcohol or drug
- weight loss
- optimal diabetic control
- specific antivirals
- immunosuppression
- supportive treatment
- for severe acute hepatitis or cirrhosis
Name the categories of focal liver lesions [6]
- non-neoplastic
- developmental/degenerative e.g. cysts
- inflammatory e.g. abscesses
- neoplastic
- benign
- malignant
What is the most common type of liver cyst? [1]
Von Meyenberg complex (simple biliary hamartoma)
What is a hamartoma? [1]
benign focal malformation which is not malignant and grows at the same rate as the surrounding tissues
Name the following liver neoplasms depending on their location:
- hepatocyte: benign? [1]
- hepatocyte: malignant? [1]
- bile duct: benign? [1]
- bile duct: malignant? [1]
- blood vessel: benign? [1]
- blood vessel: malignant? [1]
- hepatocellular adenoma
- hepatocellular carcinoma (HCC)
- bile duct adenoma (rare)
- cholangiocarcinoma
- haemangioma
- angiosarcoma
What are the normal liver functions? [6]
DIP SPP
- Detoxification
- Immune functions
- Production of bile
- Storage of proteins, glycogen, vitamins and metals
- Protein, carbohydrate and fat metabolism
- Plasma protein & enzyme synthesis
