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Pathology by week > W3 - Liver pathology > Flashcards

W3 - Liver pathology Flashcards

1
Q

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

A

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

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2
Q

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

A

hepatic artery

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3
Q

Name 6 cell types found in the liver

A

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
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4
Q

Function of kupffer cells

A

Liver resident macrophages

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5
Q

Function of stellate cells

A

aka eater cells - store Vitamin A

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

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6
Q

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

A
  1. Hepatocytes lost their microvilli
  2. Activated stellate cells lay down collagen
  3. Loss of fenestratae between the endothelial cells (normally discontinuous)
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7
Q

The 4 key histological features of cirrhosis

A
  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
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8
Q

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

A

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

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9
Q

2 classification systems of cirrhosis

A
  1. According to nodule size = micronodular or macronodular
  2. According to aetiology = alcohol/insulin resistance, viral hepatitis
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10
Q

What type of cirrhosis does viral hepatitis usually cause?

A

macronodular

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11
Q

Name 3 complications of cirrhosis

A
  1. Portal hypertension
  2. Hepatic encephalopathy
  3. Liver cell cancer
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12
Q

Timeline difference between acute and chronic hepatitis

A

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

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13
Q

Histology of acute hepatitis

A

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

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14
Q

Acute hepatitis aetiology

A
  1. Viruses
  2. Drugs
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15
Q

Chronic hepatitis aetiology

A
  1. Viral
  2. Drugs
  3. Auto-immune
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16
Q

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

A

severity of inflammation = grade

severity of fibrosis = stage

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17
Q

Histology of chronic hepatitis

A
  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
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18
Q

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

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
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19
Q

Histological features of fatty liver

A
  • 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

20
Q

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

A

Alcoholic = zone 3

Viral = zone 1

21
Q

MOA of primary biliary cholangitis

A

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

22
Q

Diagnostic test for Primary biliary cholangitis

A

anti-mitochondrial antibodies

23
Q

MOA of primary sclerosing cholangitis

A

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

24
Q

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

A

inflammation
sclerosis/fibrosis

25
Q

Diagnostic test for Primary sclerosing cholangitis

A

bile duct imaging

26
Q

Male:Female distribution of PBC and PSC

Any associations with an autoimmune condition

A

PBC F>M (9:1)

PSC M>F (3:1)

PSC associated with UC

27
Q

Histological features of PBC and PSC

A

PBC = inflammatory changes around bile duct

PSC = concentric fibrosis (onion skin) around bile duct

28
Q

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

A
  • 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
29
Q

Bronzed diabetes describes _______ patient

A

haemochromatosis

30
Q

Why does haemochromatosis show up earlier in men?

A

possibly due to the iron loss in menstruation that women experience

31
Q

What is haemosiderosis?

A

Accumulation of iron in macrophages, caused by blood transfusions.

32
Q

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

A

hepatocytes
macrophages (Kupffer cells)

33
Q

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

A
  • 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
34
Q

Which stain is used for copper?

A

Rhodanine stain

35
Q
  • Autoimmune hepatitis?
  • Male : female ratio?
  • ab test used?
  • Treatment?
A
  • F>M
  • Active chronic hepatitis with plasma cells
  • Anti-smooth muscle actin antibodies
  • Responds to steroids
36
Q

Alpha-one antitrypsin deficiency
- MOA of disease in liver

A

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

37
Q

Give 2 specific causes and 2 general causes of hepatic granulomas

A

Specific causes:

  • PBC
  • Drugs

General causes:

  • TB
  • Sarcoid
38
Q

Name 3 benign liver tumours

A

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

39
Q

Liver cell adenoma - male : female ratio?

A

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

40
Q

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

A

2ndary more common

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

41
Q

Name 4 malignant liver tumours (primary)

A
  1. hepatocellular carcinoma
  2. hepatoblastoma (related to blastomas of the childhood)
  3. cholangiocarcinoma
  4. haemangiosarcoma
42
Q

Cholangiocarcinoma associations?

A
  • PSC
  • Worm infections
  • Cirrhosis
43
Q

Which of these is the commonest carcinoma of the liver?

  1. Liver cell carcinoma
  2. Cholangiocarcinoma
  3. Metastatic adenocarcinoma
A

3

44
Q

Which of these is NOT associated with fatty change in the liver?

  1. Diabetes
  2. Hepatitis B
  3. Hepatitis C
  4. Alcohol
A

2
but 3 is also accepted

*diabetes - if well-controlled, less likely to have fatty liver change

45
Q

Which of these is not associated with genetic haemochromatosis?

  1. Cirrhosis
  2. Diabetes
  3. Kayser-Fleischer rings
  4. Myocardial damage
A

3

Pathology by week (70 decks)

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