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BVetMed3 Alimentary > Pathology Of The Liver And Pancreas > Flashcards

Pathology Of The Liver And Pancreas Flashcards

1
Q

List the key functions of the liver

A

Protein synthesis - clotting factors and albumin

Metabolism - detoxification (e.g. ammonia)

Excretion and digestion - bilirubin and bile

Nutrition - regulation of fat and carbs

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2
Q

Describe the normal level of oxygen of the liver.

A

Poorly oxygenated

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3
Q

Describe the blood supply to the liver

A

75% from Portal vein (w/ nutrients)

25% from Hepatic artery (w/ oxygen)

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4
Q

Describe a liver lobule

A

2mm diameter
Hexagonal
Bounded by several portal tracts - portal vein, hepatic artery, bile duct

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5
Q

Describe the flow of blood in the liver

A

From branch of portal vein and branch of hepatic artery on periphery of lobule

Mix on way to central vein

Blood moves from outside of lobules into the centre

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6
Q

Describe the flow of bile in the liver lobule

A

Bile is produced in canaliculi

Flows in the opposite direction to blood in the bile ducts

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7
Q

What are the three hepatic zones?

A
  1. Periportal (centroacinar)
    - AROUND THE OUTSIDE
  2. Midzonal
    - middle
  3. Centrilobular (periacinar)
    - IN THE MIDDLE
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8
Q

What hepatic zone is where most injuries occur?

A

Centrilobular (periacinar)

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9
Q

Which zone is most poorly oxygenated and is most affected by ischaemia?

A

Centrilobular

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10
Q

Which zone has the highest P450 cytochromes?

A

Centrilobular

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11
Q

Describe the histology of the portal vein.

A

Big, thin walled

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12
Q

Describe the histology of the hepatic artery

A

Smaller, thicker wall

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13
Q

Describe the epithelial lining of the bile duct

A

Tall, cuboidal columnar epithelium

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14
Q

Describe the shunt observed in a congenital PSS.

A

Usually single

To vena cava, azygous vein, renal vein

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15
Q

Describe the shunt observed in an acquired PSS.

A

multiple thin-walled shunts

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16
Q

How can an acquired shunt occur?

A

Secondary to fibrosis in older animals

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17
Q

How can a PSS affect the liver?

A

Causes atrophy

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18
Q

What other effect can a PSS have?

A

HE

Ammonia - neurotoxic

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19
Q

What congenital/developmental disorders can affect the liver?

A 
Congenital cysts 
Displacements
Tension lipidosis 
Capsular fibrosis 
- fibrous tags (e.g. equine liver capsule)
Telangiectasis - focal sinusoidal 
Melanosis

INCIDENTAL LESIONS

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20
Q

Define telangiectasis

A

Dilation of the capillaries causing them to appear as small red or purple clusters, often spidery in appearance

Seen on the skin or the surface of an organ

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21
Q

How can you tell if a liver is enlarged?

A

Rounded edges

Cutting through might tell you why e.g. if congested

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22
Q

What can cause a vacuolar hepatopathy?

A

Anything with swelling and vacuolation of the hepatocytes.

Water- hydropic, Fat - lipidosis, glycogen - glycogenosis

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23
Q

Describe the typical distribution seen with a vacuolar hepatopathy

A

Usually zonal or diffuse

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24
Q

Describe the features of hydropic change.

A

Common

Non specific

Reversible

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25
Q

What can cause vacuolar hepatopathy?

A

Hypoxia
mild toxic damage
Metabolic stress

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26
Q

What can cause glycogenosis?

A

Hyperadrenocorticism

Steroids

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27
Q

What dietary factors can result in lipidosis?

A

Obesity

Starvation

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28
Q

What physiological factors can cause lipidosis?

A

Increased energy demand e.g. lactation and pregnancy

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29
Q

What diseases can cause hepatic lipidosis?

A

Diabetes mellitus
Ketosis
Pregnancy toxaemia

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30
Q

How can abnormal hepatocyte function result in lipidosis?

A

Decreased FA complexing

Decreases LDLs

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31
Q

Describe the appearance of a liver with amyloidosis

A

Pale orange

Friable

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32
Q

Describe the histology of a liver with amyloidosis

A

Homogenous acidophilus material

Special stain - Congo red - fluorescence (green birefringence)

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33
Q

What animals are predisposed to hepatic amyloidosis?

A

Abyssinian/ oriental cats

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34
Q

What can cause amyloidosis?

A

Primary or secondary liver disease

Endocrinopathy

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35
Q

What can cause centrilobular necrosis?

A

Ischaemia/anaemia

Metabolic/toxic damage

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36
Q

What would a zonal necrosis pattern suggest?

A

Ischaemia,

Toxic damage

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37
Q

What would a random pattern of necrosis suggest?

A

Viral/ bacterial

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38
Q

What does a focally extensive pattern of necrosis indicate?

A

Bacterial cause

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39
Q

What does massive necrosis indicate?

A

Severe injury/ toxicity

E.g. hepatosis dietetics

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40
Q

What is hepatosis dietetica?

What species does it typically affect?

A

Selenium/vitamin E deficiency

Presentation: sudden death
PM - large areas of hepatic necrosis and haemorrhage
- gall bladder oedematous

PIGS - young - 3/4 months

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41
Q

What does ascites indicate about oncotic pressure?

A

REDUCED

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42
Q

When is cirrhosis seen?

A

End stage liver disease

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43
Q

How can RCHF affect the liver?

A

Passive venous congestion

44
Q

Describe the gross pathology associated with passive venous congestion.

A

Enlarged,
Rounded edges,
Blood from cut surface

NUTMEG LIVER - enhanced lobular pattern

45
Q

Describe the histology associated with passive venous congestion.

A

Hepatic venules and sinusoids congested

Centrilobular atrophic hepatocytes (DARK RED)

Periportal lipidosis (pale red)

46
Q

What is cholangitis?

A

Inflammation of the bile ducts

Can be immune mediated or associated with infection

47
Q

What species is associated with immune mediated cholangitis ?

48
Q

What affect on the liver can salmonellosis in calves have?

A

Cholangitis

49
Q

What broadly occurs in acute hepatitis?

A

Necrosis followed by inflammation

50
Q

If the animal survives, what progression follows from acute hepatitis?

A
  • Complete resolution by regeneration
  • Repair by fibrosis and scarring
  • Encapsulation by abscessation
  • Persistence by granulomatous disease
51
Q

What can cause viral hepatitis?

What animals are these seen in?

A

Adenoviruses
Herpesviruses
FIP

Young, unvaccinated animals

52
Q

What does adenovirus cause in dogs?

A

Canine infectious hepatitis

53
Q

What herpesvirus is associated with abortions in horses?

54
Q

What (herpes)viral conditions are associated with abortions in cows, cats and pigs?

A

Infectious bovine rhinotracheitis

Feline viral rhinotracheitis

Aujeszky’s disease

55
Q

What liver lesions would you expect to see in an aborted foetus from a herpes virus infection?

A

Pinpoint foci of necrosis

Intranuclear inclusions

Necrosis also seen in lungs, kidneys, spleen, adrenals

56
Q

What are the routes of infection with bacterial hepatitis?

A

Direct extension from adjacent tissues

Haematogenous spread

Abscessation

57
Q

What are the sources of haematogenous bacteria?

A

Portal vein from alimentary tract

Hepatic artery - if a bacteraemia

Umbillicus/umbilical vein

58
Q

What animals tend to get liver abscesses?

59
Q

What is the source of most liver abscesses in cows?

A

Umbilical infections (usually mixed bacteria)

From grain overfeeding - rumenitis

60
Q

What can cause a bacterial hepatitis?

A 
Fusobacterium necrophorum 
Clostridium novyi B
Clostridium haemolyticum 
Clostridium piliformis 
Leptospirosis 
Salmonellosis 
Listeria
61
Q

What causes Tyzzer’s disease?

What animals are particularly susceptible?

A

Clostridium pilformis

Mice (+rats, gerbils)(rodents)

Foals - 1-4 weeks old

Immunosuppressed dogs and cats

62
Q

What causes bacilliary haemoglobinuria?

A

Clostridiumhaemolyticum

63
Q

What causes bacillary necrosis?

A

Fusobacterium necrophorum

64
Q

What causes Black disease (Infectious, necrotic hepatitis)?

A

Clostridium novyi type B

65
Q

What is the source of fusobacterium necrophorum in bacillary necrosis:

  • in neonates?
  • in adults?
A

Neonates - UMBILICAL

Adults - RUMENITIS

66
Q

Describe the gross pathology associated with fusobacterium necrophorum.

A

Multiple pale foci of necrosis throughout the liver

May develop into abscesses if the animal survives

67
Q

What is seen on microscopy with bacillary necrosis?

A

Coagulation necrosis with bacteria at periphery

68
Q

What animals tend to get black disease?

A

Sheep

Rarely horses and pigs

69
Q

What precipitates Clostridium novyi B?

A

LIVER FLUKES

70
Q

What clinical presentation is associated with clostridium novyi B infection ?

A

SUDDEN DEATH

71
Q

What pathology is associated with black disease?

A

Extensive subcutaneous venous congestion and oedema

Fibrinous peritoneal, thoracic and pericardial fluid

Pale foci of liver necrosis (containing bacteria) surrounded by a rim of haemorrhage

72
Q

What species get bacillary haemaglobinuria?

A

Cattle and sheep

73
Q

What clinical sign is associated with bacillary haemaglobinuria?

A

Haemaglobin in urine - ‘red water’

Severe anaemia
Jaundice

74
Q

What can be seen on PM with bacillary haemaglobinuria?

A

Focally extensive hepatic necrosis

Haemaglobin staining of kidneys

75
Q

Describe the lesions seen in tyzzer’s disease

A

Liver filled with nodules of necrosis

76
Q

Describe the histology of tyzzer’s

A

Wheat sheaf appearance of colonies with special stain

77
Q

What infections tend to cause focally extensive/ abscessating lesions?

78
Q

What clinical signs are associated with salmonellosis in calves?

A

Fever, dehydration, diarrhoea
Haemorrhagic ileitis

Pale pinpoint foci of necrosis in liver

Necrosis and mixed mononuclear cells

79
Q

How can the nodules in the liver of a calf with salmonellosis be described?

A

Paratyphoid nodules

80
Q

Which parasites of the liver are NOT incidental?

81
Q

What causes ‘milk spot liver’ ?

A

Ascaris Suum

82
Q

What causes fibrous tags on horse liver?

A

Strongyle migration

tags seen on liver surface and diaphragm

83
Q

How does acute liver intoxication occur?

A

HAEMORRHAGE occurs ->
Increased consumption and decreased synthesis of clotting factors by damaged liver - Jaundice

E.g. blue-green algae, iron and cresols

84
Q

How does chronic liver intoxication occur?

A

Continual low dose toxic compounds

Regeneration and repair - fibrosis and biliary hyperplasia

E.g. ragwort, aflatoxins (produced by moulds), copper
Drugs: primidone, sulphonamides, paracetamol (CATS)

85
Q

What drugs can cause chronic liver intoxication?

A

Primidone - phenobarb analogue (anticonvulsant)

Paracetamol (CATS)

Sulphonamides

86
Q

What infectious conditions cause cholecystitis (Gall bladder + extrahepatic bile duct)?

A

SALMONELLA

INFECTIOUS CANINE HEPATITIS

87
Q

What can occur if the gall bladder /extrahepatic duct ruptures ?

A

BILE PERITONITIS

88
Q

What would make you suspect that a liver nodule is an incidental finding?

A

If they look the same as the rest of the liver

89
Q

In what animals is nodular hyperplasia common?

A

Older dogs

90
Q

How do the cells appear in nodular hyperplasia?

A

Cells are larger. Contain more glycogen

91
Q

Which animals tend to get liver neoplasms?

A

Dogs and cats

92
Q

What primary tumours of hepatocytes can occur?

A

Hepatoma / hepatocellular carcinoma

93
Q

What is the most common neoplasm of the biliary epithelium?

A

Cholangiocellular carcinoma

94
Q

Describe the typical appearance of a cholangiocellular carcinoma.

A

White, firm and umbilicate (depression in the middle)

95
Q

What hepatic neoplasm can be primary or metastatic?

A

Haemangiosarcoma

96
Q

Where are primary haemangiosarcoma usually found?

A

Spleen

Right auricle

97
Q

What tumours tend to metastasise to the liver?

A

Melanoma
Carcinoma
Sarcoma
Lymphoma

98
Q

What breeds are predisposed to haemangiosarcoma?

A

Large dogs

99
Q

What animals tend to get pancreatic hypoplasia?

A

GSDs

Calves

100
Q

When do clinical signs of pancreatic hypoplasia tend to be seen?

A

Around a year old

101
Q

What clinical signs are associated with pancreatic hypoplasia?

A

Diarrhoea + steatorrhaea
Loss of condition despite polyphagia
Pot bellied
Lack of abdominal fat

102
Q

Define the term : steatorrhoea

A

Abnormally high levels of fat in faeces

103
Q

What type of pancreatic neoplasia is most common?

104
Q

Describe a pancreatic carcinoma

A 
Highly invasive 
Infiltrative with mets to:
-liver
-abdominal LNs
- spleen 
- adrenals
105
Q

How does chronic pancreatitis occur in dogs?

A

Acute pancreatitis
Replacement fibrosis and atrophy
EPI - steatorrhoea and loss of condition

106
Q

(LOOK AT PICTURES)

A

LOOK AT PICTURES DESCRIPTIONS ARE USELESS

BVetMed3 Alimentary (16 decks)

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