Robbins 9th ed - Chapter 18 - Liver and Gallbladder - General features of Hepatic Disease (1) Flashcards
Name the five general pathologic responses to injury that are displayed by hepatocytes.
Intracellular accumulations (e.g. steatosis) Necrosis and Apoptosis Inflammation Regeneration Fibrosis
What are Councilman bodies?
Councilman bodies are the eosinophilic-staining apoptotic bodies of hepatocytes that have shrunken and fragmented into apoptotic bodies during apoptosis. This was originally meant only to describe the apoptotic bodies produced during yellow fever, although there are many diseases that will produce apoptotic bodies in hepatocytes.
In which location is the most common site for necrosis in the liver?
Necrosis typically occurs around the central vein (centrilobular), in the middle of a liver lobule.
What is meant by “bridging necrosis”?
This is when the necrosis in the centre of a liver lobule extends, and eventually bridges between portal tracts, and across several lobules. The central vein may be obliterated by the necrosis.
What is meant by cirrhosis of the liver?
This refers to the diffuse scarring of chronic liver disease. There are fibrous septa (scar tissue) encircling the surviving hepatocytes - this is called parenchymal nodules.
What is the principal cell type involved in liver fibrosis? Into which cell type do they transform during scar tissue formation?
Hepatic stellate cell (also called Ito cell). Upon activation, they transform into myofibroblasts, and deposit scar tissue.
What is a Kupffer cell?
This is the resident macrophage of the liver. It can act as an antigen-presenting cell.
What is the most common cause of acute liver failure?
Paracetamol overdose accounts for 50% of cases of acute liver failure.
What is the major pathological feature of acute liver failure?
Massive hepatic necrosis.
What are the 2nd, 3rd, 4th most common causes of acute liver failure?
Autoimmune hepatitis Acute Hepatitis A Acute Heptatitis B Rifampicin overdose and other toxins Acute cholestasis of pregnancy
What are the 4 most common causes of chronic liver disease worldwide? (And western?)
Chronic Hepatitis B
Chronic Hepatitis C
Non-alcoholic Fatty Liver
Alcoholic Liver Disease (60% of western cases)
Clinical signs of chronic liver disease: Break it down into 6 categories based on pathogenesis.
Impaired oestrogen metabolism Impaired synthesis of clotting factors Hypoalbuminaemia Hyperammoniaemia Portal Hypertension Impaired bile formation and flow
Clinical signs of chronic liver disease: Name as many as you can, remembering the 6 categories.
- (oestrogen) Palmar erythema, Spider naevi, Hypogonadism, Gynaecomastia
- (clotting) Bruising, Bleeding
- (low albumin) Oedema
- (ammonia) Hepatic encephalopathy, Asterixis (liver flap)
- (portal HT) Varices, Caput medusae, Ascites, Splenomegaly
- (bile) Jaundice
What is another name for spider naevi?
Spider angiomas. Spider telangiectasis.
What is hepatorenal syndrome?
This is acute renal failure secondary to liver disease, where there is no other cause for renal failure.
