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E 1.2: Histology, Anatomy, Pathology, and Infectious Diseases Lab > Week 4: Liver - Fibrosis/Cirrhosis, Liver Failure, and Hepatitis > Flashcards

Week 4: Liver - Fibrosis/Cirrhosis, Liver Failure, and Hepatitis Flashcards

1
Q

ID

A

Liver Steatosis

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2
Q

ID

A

Ballooned Hepatocytes

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3
Q

ID

A

Cholestasis

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4
Q

ID

A

Normal Liver

Terminal Hepatic Venule (orange arrow) with hepatic sinusoids (yellow arrows). Note the sinusoids between the hepatocytes and the RBCs in each sinusoid with a yellow arrow.

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5
Q

ID

A

Left - Normal Liver cells
Right - Hepatic Necrosis

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6
Q

ID

A

Hepatocyte Apoptosis - black arrows

apoptotic hepatocytes have an “acidophil body”

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7
Q

ID

A

Hepatocellular Necrosis

necrosis in Zone 3 (Pericentral) (black arrow) and normal hepatic tissue (asterisk) - this case is caused by acetaminophen (cytochrome P450 detoxification occurs in Zone 3)

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8
Q

What are examples of reversible changes in liver tissue?

A

Steatosis, Cholestasis, and Ballooned Hepatocytes

CBS

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9
Q

What are examples of “Irreversible” changes in liver tissue?

A

Apoptosis, Necrosis, and Fibrosis

FAN

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10
Q

What is the main function of stellate cells?

A

lipid storage & Vitamin A

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11
Q

ID the organ and staining

A

Normal Liver and Trichrome Stain

collagen stains blue so in normal liver only small amounts around the portal triad is blue.

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12
Q

ID the organ and staining

A

Liver; Stage 4 - Cirrhosis and Trichrome Stain

In liver cirrhosis there is islands of hepatocytes (pink) with lots collagen (blue/purple) replacing hepatocytes and surrounding them

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13
Q

ID the Stage

A

Stage 3 - Bridging Fibrosis

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14
Q

ID the Stage

A

Stage 4 - Cirrhosis

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15
Q

ID the organ and staining

A

Liver; Stage 3 - Bridging Fibrosis and Trichrome Staining

delicate bridging

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16
Q

ID the organ and staining

A

Liver; Stage 3 - Bridging Fibrosis and Trichrome Staining

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17
Q

ID the organ and staining

A

Normal Liver and Trichrome Stain

collagen stains blue so in normal liver only small amounts around the portal triad is blue.

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18
Q

ID

A

Stage 1 - Fibrosis

fibrous tissue starts extending beyond the portal system

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19
Q

ID

A

Stage 2 - Fibrosis

Note the collagen blue is almost connecting two portal triads

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20
Q

ID

A

Stage 3 - Bridging Fibrosis

Note the collagen in blue is connecting between portal triads

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21
Q

ID

A

Stage 4 - Cirrhosis

In liver cirrhosis there is islands of hepatocytes (pink) with lots collagen (blue/purple) replacing hepatocytes and surrounding them

22
Q

ID

A

Cirrhotic Liver

23
Q

ID

A

Stage 4 - Cirrhosis

24
Q

In Acute Liver failure what enzymes are markedly elevated?

A

Liver transaminases (ALT, and AST)

25
What Transaminase is a specific marker for the liver?
A**L**T ## Footnote L for liver
26
# T/F: A decline in transaminases following acute liver failure (ALF) is always an indication of improvement in liver function?
False ## Footnote Decline of serum transaminases is **NOT** an indication of improvement but rather a reflection that there are few viable remaining hepatocytes
27
ID
Hepatic Necrosis
28
What two things must occur for a classification of Acute Liver Failure (ALF)?
* Hepatic Encephalopathy * Coagulopathy
29
Spectrum of altered mental status ranging from subtle behavioral abnormalities to marked confusion/coma/death in ALF
Hepatic Encephalopathy
30
The liver is responsible for production of Vit K dependent and independent clotting factors and for removing activated coagulation factors. Range from easy bruising to more severe (ex: intracranial bleeding)
Hepatic Coagulopathy
31
Renal failure occurring in patients with liver failure. Decreased renal perfusion due to systemic vasodilation, activation of the renal sympathetic nervous system with vasoconstriction of the afferent renal arterioles. Patient has a drop in urine output and a rise in blood urea nitrogen and creatinine levels.
Hepatorenal Syndrome
32
What are the three most common causes of cirrhosis in the United States?
* MAFLD * Alcoholic Liver Disease * Chronic Hepatitis C
33
What are three symptomatic findings in Chronic Liver Disease?
Palmar Erythema Spider angiomas Gynecomastia
34
ID
Palmar Erythema
35
ID
Telangiectasia (Spider Angiomas)
36
Cirrhosis of the the liver indirectly occludes the sinusoids and raises the hydrostatic pressure of the hepatic portal system. What is this termed?
Portal Hypertension
37
Portal Hypertension leads to what 4 things?
* Ascites * Splenomegaly * Hepatic Encephalopathy * Portosystemic Venous Shunts ## Footnote "HEPS A" **H**epatic **E**ncephalopathy **P**ortosystemic Venous Shunts **S**plenomegaly **A**scites
38
**What are the 3 main Portosystemic venous shunts?**
**Esophageal Varices** Hemorrhoids Caput Medusae ## Footnote Gut, But, and Caput
39
ID
Caput Medusae ## Footnote 1/3 Portosystemic Shunts
40
What molecule leads to Hepatic Encephalopathy
Ammonia
41
ID
Portal inflammation with interface activity ## Footnote characteristic – though not specific for – viral hepatitis
42
ID
Large portal lymphoid aggregates/follicles ## Footnote characteristic – though not specific for – Hepatitis C Virus (HCV)
43
ID
Large portal lymphoid aggregates/follicles ## Footnote characteristic – though not specific for – Hepatitis C Virus (HCV)
44
ID
Clusters of Inflammatory cells
45
ID
Apoptotic hepatocytes
46
ID
Hepatitis B Virus (HBV) ## Footnote Ground glass hepatocytes (black arrows) - abundant endoplasmic reticulum full of hepatitis B viral antigens. These have a distinct pale appearance on H/E staining
47
ID
Hepatitis B Virus (HBV) ## Footnote Ground glass hepatocytes - abundant endoplasmic reticulum full of hepatitis B viral antigens. These have a distinct pale appearance on H/E staining
48
Which viruses never cause chronic hepatitis?
HAV and HEV ## Footnote The vowels through the bowels; Hepatitis A and E never cause chronic hepatitis and are transmitted through fecal-oral route
49
What are the three ways Hepatitis B is transmitted?
* Blood * Birth * Banging ## Footnote The 3 B's of HepB
50
Which requires HBV co-infection?
HDV ## Footnote becaue it is D fective
51
Which type of hepatitis is more often chronic and leads to cirrhosis?
HCV ## Footnote "Hepatitis Chronic Virus" - HCV,  80% develop chronic hepatitis, 20% develop cirrhosis.
52
What are the inflammatory cells seen in acute hepatitis? Chronic hepatitis?
the inflammatory cells in both acute and chronic viral hepatitis are mainly T-lymphocytes ## Footnote It is the pattern of injury that changes with acute vs chronic hepatitis

E 1.2: Histology, Anatomy, Pathology, and Infectious Diseases Lab (41 decks)

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