W3 - Liver pathology

Question 1

liver has a ______ blood supply, which are? What is the significance of this?

Answer 1

dual, portal vein, hepatic artery

If you tie off one of the vessels, you wont produce too much ischaemia. Both bring oxygenated blood, but of course the hepatic artery will have a bit more oxygen

Question 2

which vessel carries blood with a higher oxygen content to the liver?

Answer 2

hepatic artery

Question 3

Name 6 cell types found in the liver

Answer 3

CELLS OF THE LIVER

1. Hepatocytes
2. Bile ducts
3. Blood vessels
4. Endothelial cells - 2 types: those lining sinusoids, those lining blood vessels
5. Kupffer cells
6. Stellate cells

Question 4

Function of kupffer cells

Answer 4

Liver resident macrophages

Question 5

Function of stellate cells

Answer 5

aka eater cells - store Vitamin A

in damaged liver, stellate cells differentiate into an active phenotype, making collagen and causing fibrosis

Question 6

3 changes in damaged liver that prevents blood in sinusoids from reaching hepatocytes

Answer 6

1. Hepatocytes lost their microvilli
2. Activated stellate cells lay down collagen
3. Loss of fenestratae between the endothelial cells (normally discontinuous)

Question 7

The 4 key histological features of cirrhosis

Answer 7

1. whole liver involved
2. fibrosis
3. nodules of regenerating hepatocytes
4. distortion of liver vascular architecture:
   intra- and extra- hepatic (e.g. gastro-oesophageal) shunting of blood

Question 8

Explain what intra- and extra- hepatic shunting of blood is

Answer 8

In intrahepatic shunt, the blood will come to the liver but will just pass through and leave, unfiltered

In extrahepatic shunts, the blood will find a diff way to bypass the liver, good example of this are oesophageal varices

Question 9

2 classification systems of cirrhosis

Answer 9

1. According to nodule size = micronodular or macronodular
2. According to aetiology = alcohol/insulin resistance, viral hepatitis

Question 10

What type of cirrhosis does viral hepatitis usually cause?

Answer 10

macronodular

Question 11

Name 3 complications of cirrhosis

Answer 11

1. Portal hypertension
2. Hepatic encephalopathy
3. Liver cell cancer

Question 12

Timeline difference between acute and chronic hepatitis

Answer 12

Acute hepatitis – less than 6 months
Chronic hepatitis – more than 6 months

Question 13

Histology of acute hepatitis

Answer 13

spotty necrosis = necrosis of minute clusters of hepatocytes, usually in association with lymphocytes

Question 14

Acute hepatitis aetiology

Answer 14

1. Viruses
2. Drugs

Question 15

Chronic hepatitis aetiology

Answer 15

1. Viral
2. Drugs
3. Auto-immune

Question 16

In histology of chronic hepatitis, what do grade and stage mean?

Answer 16

severity of inflammation = grade

severity of fibrosis = stage

Question 17

Histology of chronic hepatitis

Answer 17

1. Portal inflammation (not crossed limiting plate)
2. Piecemeal necrosis/interface hepatitis (has crossed limiting plate)
3. Lobular inflammation (similar to spotty necrosis seen in acute hepatitis)
4. Fibrosis

Question 18

Alcoholic liver disease - name 3, from least extreme to most.

Answer 18

1. Fatty liver
2. Alcoholic hepatitis
3. Cirrhosis

Question 19

Histological features of fatty liver

Answer 19

• Round spaces of fat/ large droplet fatty change
• The liver will also be more yellow (not the typical dark, beefy liver)

In alcoholics, it’s a reversible change

Question 20

In which zone chronic hepatitis due to viruses and those due to alcohol take place?

Answer 20

Alcoholic = zone 3

Viral = zone 1

Question 21

MOA of primary biliary cholangitis

Answer 21

Bile duct loss associated with chronic inflammation (with granulomas), which may end in cirrhosis

Question 22

Diagnostic test for Primary biliary cholangitis

Answer 22

anti-mitochondrial antibodies

Question 23

MOA of primary sclerosing cholangitis

Answer 23

Periductal bile duct fibrosis leading to bile duct loss, which may lead to liver damage, cirrhosis, and an increased risk of developing cholangiocarcinoma

Question 24

In PBC, you get loss of bile duct due to ____________, whereas in PSC it is due to ____________.

Answer 24

inflammation
sclerosis/fibrosis

Question 25

Diagnostic test for Primary sclerosing cholangitis

Answer 25

bile duct imaging

Question 26

Male:Female distribution of PBC and PSC Any associations with an autoimmune condition

Answer 26

PBC F\>M (9:1) PSC M\>F (3:1) PSC associated with UC

Question 27

Histological features of PBC and PSC

Answer 27

PBC = inflammatory changes around bile duct PSC = concentric fibrosis (onion skin) around bile duct

Question 28

What is haemochromatosis? Which gene is implicated? MOA of damage + which organs are affected?

Answer 28

- Genetically determined increased gut iron absorption - Gene on chromosome 6 (HFe) - Parenchymal damage to organs secondary to iron deposition - Organs include: pancreas, heart, testes, liver

Question 29

Bronzed diabetes describes _______ patient

Answer 29

haemochromatosis

Question 30

Why does haemochromatosis show up earlier in men?

Answer 30

possibly due to the iron loss in menstruation that women experience

Question 31

What is haemosiderosis?

Answer 31

Accumulation of iron in macrophages, caused by blood transfusions.

Question 32

In haemochromatosis iron deposits in the _________ of the liver, whereas in haemosiderosis iron deposits in the \_\_\_\_\_\_\_\_\_.

Answer 32

hepatocytes macrophages (Kupffer cells)

Question 33

What is Wilson's disease? MOA of disease? Which gene is implicated? Which organs are affected?

Answer 33

- Accumulation of copper due to failure of excretion by hepatocytes into the bile - Genes on chromosome 13 - Accumulates in the liver and CNS (hepato-lenticular degeneration) including Kayser-Fleishcer rings

Question 34

Which stain is used for copper?

Answer 34

Rhodanine stain

Question 35

- Autoimmune hepatitis? - Male : female ratio? - ab test used? - Treatment?

Answer 35

- F\>M - Active chronic hepatitis with plasma cells - Anti-smooth muscle actin antibodies - Responds to steroids

Question 36

Alpha-one antitrypsin deficiency - MOA of disease in liver

Answer 36

Failure to secrete alpha-one antitrypsin --\> Intra-cytoplasmic inclusions due to misfolded protein --\> Hepatitis and cirrhosis \* usually a disease you'll see in paediatrics and in respiratory medicine, as it will cause COPD/emphysema in the lungs

Question 37

Give 2 specific causes and 2 general causes of hepatic granulomas

Answer 37

Specific causes: - PBC - Drugs General causes: - TB - Sarcoid

Question 38

Name 3 benign liver tumours

Answer 38

1) liver cell adenoma 2) bile duct adenoma 3) haemangioma

Question 39

Liver cell adenoma - male : female ratio?

Answer 39

F\>M, usually in women taking oestrogen-containing OCP

Question 40

Malignant liver tumours; primary or secondary more common? why?

Answer 40

2ndary more common Liver sees all the blood in the circulation (via portal vein) and so malignant cells will spread first to the liver!

Question 41

Name 4 malignant liver tumours (primary)

Answer 41

1. hepatocellular carcinoma 2. hepatoblastoma (related to blastomas of the childhood) 3. cholangiocarcinoma 4. haemangiosarcoma

Question 42

Cholangiocarcinoma associations?

Answer 42

- PSC - Worm infections - Cirrhosis

Question 43

Which of these is the commonest carcinoma of the liver? 1. Liver cell carcinoma 2. Cholangiocarcinoma 3. Metastatic adenocarcinoma

Answer 43

3

Question 44

Which of these is NOT associated with fatty change in the liver? 1. Diabetes 2. Hepatitis B 3. Hepatitis C 4. Alcohol

Answer 44

2 but 3 is also accepted \*diabetes - if well-controlled, less likely to have fatty liver change

Question 45

Which of these is not associated with genetic haemochromatosis? 1. Cirrhosis 2. Diabetes 3. Kayser-Fleischer rings 4. Myocardial damage

Answer 45

3