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Week A13 - GI & Liver > Pathology of the Liver > Flashcards

Pathology of the Liver Flashcards

1
Q

Describe the basic structure of the liver [8]

A
  1. vasculature
    • incoming portal vein and hepatic artery
    • outgoing hepatic vein
  2. parenchymal liver cells
  3. biliary system
  4. connective tissue matrix
  5. all arranged as portal tracts and parenchyma
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2
Q

What are the broad causes of injury to the liver? [7]

A
  1. drugs (e.g. alcohol)
  2. abnormal nutrition
  3. infection
  4. obstruction to bile/blood flow
  5. autoimmune liver disease
  6. genetic/deposition disease
  7. neoplasia
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3
Q

What are the 4 main parts of the liver all of which are inter-connected with damage to one being damage to all? [4]

A
  1. parenchyma,
  2. blood vessels,
  3. connective tissue,
  4. bile ducts
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4
Q

Define acute-on-chronic inflammation in association with liver disease [1]

A

chronic liver disease that often presents with acute exacerbation plus evidence of underlying chronicity (e.g. fibrosis)

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5
Q

Define cirrhosis [4]

A
  • end stage liver disease, defined by:
    • diffuse process
    • fibrosis
    • nodule formation
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6
Q

What are the histological patterns/causes of diffuse liver disease? [7]

A
  1. acute hepatitis
  2. acute cholestasis or cholestatic hepatitis
  3. fatty liver disease (steatosis and steatohepatitis)
  4. chronic hepatitis
  5. chronic biliary/cholestatic disease
  6. genetic/deposition disease
  7. hepatic vascular disease
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7
Q

What are the 3 main causes of acute hepatitis? [3]

A
  1. autoimmune,
  2. viral
  3. drug (paracetamol overdose)
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8
Q

Describe the histological patterns of acute hepatitis [3]

A
  1. diffuse hepatocyte injury seen as swelling
  2. spotty necrosis
  3. inflammatory cell infiltrate in all areas: portal tracts, interface and parenchyma
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9
Q

What are the clinical signs and symptoms of acute hepatitis?

A
  1. right upper quadrant (RUQ) pain,
  2. malaise,
  3. ↑AST/ALT
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10
Q

What are the causes of acute cholestasis (cholestatic) hepatitis? [2]

A
  1. extra-hepatic biliary obstruction
  2. drug injury e.g. antibiotics (augmentin)
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11
Q

What are the histological features of acute cholestasis (cholestatic) hepatitis? [4]

A
  1. brown bile
  2. +/- acute hepatitis (swelling/spotty necrosis)
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12
Q

Which chronic liver diseases may develop fibrosis and progress to cirrhosis? [4]

A
  1. fatty liver disease (steatosis and steatohepatitis)
  2. chronic hepatitis
  3. chronic biliary/cholestatic disease
  4. genetic/deposition disease
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13
Q

What are the histological features of Hepatitis B pathology? [4]

A
  1. may look like acute hepatitis + fibrosis
  2. ground glass cytoplasm in hepatocytes → accumulation of “surface antigens” for Hep B
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14
Q

What are the causes of chronic biliary/cholestatic disease? [2]

A
  1. primary biliary cirrhosis (PBC)
  2. primary sclerosing cholangitis (PSC)
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15
Q

What are the histological features of chronic biliary/cholestatic disease? [4]

A
  1. focal
  2. portal inflammation
  3. fibrosis with bile duct injury
  4. (granulomas in PBC)
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16
Q

Name 3 genetic conditions associated with deposition in the liver and state the deposit in each [5]

A
  1. haemochromatosis → iron
  2. Wilson’s disease → copper
  3. α-1-anti trypsin deficiency
17
Q

Name the causes of the following types of diffuse liver disease

  1. acute hepatitis? [4]
  2. acute cholestasis/cholestatic hepatitis? [3]
  3. fatty liver disease (steatosis + steatohepatitis)? [3]
  4. chronic hepatitis? [3]
  5. chronic biliary/cholestatic disease? [3]
  6. genetic/deposition disease? [1]
  7. hepatic vascular disease? [2]
A
  1. acute hepatitis
    • hepatitis viruses A & E
    • hepatitis viruses B & C
    • drug injury
    • autoimmune liver disease
  2. acute cholestasis/cholestatic hepatitis
    • hepatitis viruses A & E
    • drug injury
    • extrahepatic biliary obstruction
  3. fatty liver disease (steatosis + steatohepatitis)
    • ​drug injury​
    • alcohol
    • metabolic syndrome (e.g. obesity)
  4. chronic hepatitis
    • hepatitis viruses B & C​​
    • autoimmune liver disease
    • genetic/deposition (e.g haemochromatosis, Wilson’s)
  5. chronic biliary/cholestatic disease
    • ​extrahepatic biliary obstruction​
    • chronic biliary disease (e.g. PBC)
    • genetic/deposition (e.g haemochromatosis, Wilson’s)
  6. genetic/deposition disease
    • ​genetic/deposition (e.g haemochromatosis, Wilson’s)​
  7. hepatic vascular disease
    • ​drug injury​
    • vascular disease (e.g. venous obstruction)
18
Q

What are the 3 aims of management of diffuse liver disease? [3]

A
  1. ↓ symptoms
  2. ↓ inflammation
  3. prevent fibrosis
19
Q

What are the treatment options for diffuse liver disease? [6]

A
  1. specific treatment against cause, e.g.
    • removal of alcohol or drug
    • weight loss
    • optimal diabetic control
    • specific antivirals
    • immunosuppression
  2. supportive treatment
    • for severe acute hepatitis or cirrhosis
20
Q

Name the categories of focal liver lesions [6]

A
  1. non-neoplastic
    • developmental/degenerative e.g. cysts
    • inflammatory e.g. abscesses
  2. neoplastic
    • benign
    • malignant
21
Q

What is the most common type of liver cyst? [1]

A

Von Meyenberg complex (simple biliary hamartoma)

22
Q

What is a hamartoma? [1]

A

benign focal malformation which is not malignant and grows at the same rate as the surrounding tissues

23
Q

Name the following liver neoplasms depending on their location:

  1. hepatocyte: benign? [1]
  2. hepatocyte: malignant? [1]
  3. bile duct: benign? [1]
  4. bile duct: malignant? [1]
  5. blood vessel: benign? [1]
  6. blood vessel: malignant? [1]
A
  1. hepatocellular adenoma
  2. hepatocellular carcinoma (HCC)
  3. bile duct adenoma (rare)
  4. cholangiocarcinoma
  5. haemangioma
  6. angiosarcoma
24
Q

What are the normal liver functions? [6]

A

DIP SPP

  1. Detoxification
  2. Immune functions
  3. Production of bile
  4. Storage of proteins, glycogen, vitamins and metals
  5. Protein, carbohydrate and fat metabolism
  6. Plasma protein & enzyme synthesis
25
Q

What are the signs and symptoms of liver disease? [7]

A
  1. from liver itself → hepatomegaly
  2. from portal hypertension → ascites
  3. from chronic liver dysfunction → pruritis and spider naevi
  4. non-specific → nausea, falls and tremor
26
Q

What signs and symptoms arise from:

  1. abnormal biliary system? [2]
  2. abnormal parenchyma? [3]
  3. abnormal vasculature and connective tissue matrix? [1]
A
  1. abnormal biliary system:
    • accumulation of bilirubin (esp. acute cholestasis) → jaundice
    • accumulation of bile acids (esp. chronic cholestasis) → pruritis
  2. abnormal parenchyma:
    • right upper quadrant pain
    • in chronic disease → hormonal changes
    • liver failure only once <25% function
  3. abnormal vasculature and connective tissue matrix:
    • together, results in portal hypertension
27
Q

What investigations would you carry out on a patient with a liver problem? [8]

A
  1. LFTs
    • AST/ALT
    • Alk Phos
    • GGT
    • Bilirubin
    • Albumin
  2. Liver-related haematology tests
    • Prothrombin time (PTT)
  3. Synthetic function
    • PTT
    • Albumin
  4. Viral serology
  5. Autoimmune serology
  6. Tests for liver metabolic/genetic diseases
    • iron
    • copper
    • alpha-1 antitrypsin
  7. Radiology (esp. for masses)
    • ultrasound of abdomen
    • CT scan of abdomen
    • ERCP/MRCP
  8. Biopsy
28
Q

What is the clinical presentation of fatty liver disease (steatosis/steatohepatitis)? [2]

A
  1. Acute or chronic “hepatitis”
  2. Asymptomatic abnormal LFTs
29
Q

What are the causes of fatty liver disease? [6]

A
  1. alcohol
  2. non alcoholic:
    • NAFLD (made up of NASH and NAS),
    • type 2 diabetes
    • obesity
    • hyperlipidaemia
  3. drugs e.g. methotrexate, amiodarone, steroids
30
Q

Where is hepatitis C pathology often found and what is seen there? [2]

A
  1. portal tracts
  2. inflammation with lymphoid aggregates
31
Q

What is the clinical definition of chronic hepatitis? [1]

A

liver inflammation for at least 6 months

32
Q

What are the causes of liver abscess? [2]

A
  1. ascending cholangitis
  2. hydatid and other parasitic disease

Week A13 - GI & Liver (11 decks)

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