wk 6 5 pathology of liver 1/2 Flashcards
microanatomy can be divided into 3 structures
1 - periportal
2- mid acinar
3 - pericental
(used to describe the patterns of liver injury)
‘grading’ is a degree of……
‘staging’ is a degree of….
.. inflammation
…fibrosis
acute causes of jaundice 4
virus
alcohol
drugs
bile duct obstruction
acetoaminophen toxicity is seen in suicide of paracetamol consumption, what happens to liver
confluent necrossis
acute liver failure
how can jaundice be classified
pre-hepatic (uncomplicated)
hepatic
post-hepatic (complicated)
3 ways pre-hepatic jaundice can occur (too much haem)
haemolysis (incr in RBC breakdown = incr in bilirubin production)
haemolytic anaemias
unconjugated bilirubin ]
5 ways hepatic jaundice can occur
death of liver cells
acute liver failure alcoholic hepatitis cirrhossi bile duct loss pregnancy
4 ways post-hepatic jaundice (bile cannot escape into bowel)
conginetal biliary atresia
gallstonesblock
stricutres of CB Duct
Tumours (head of pancrea)
t/f cirrhosis iss reversible
true
define cirrhosis
bands of fibrosis separated by regenerative nodules of hepatocytes
if cirrhosis is said to be ‘micronodular’ this indicates
alcoholism
6 common causes of cirrhosis
alcohol viral disease iron overload autoimmune obstructive liver disease
histologically cirrhosis is
nodules of hepatocytes separatyed by fibrotic bands
main complication of cirrhosis
portal hypertension - porto-caval anastimoses
lead to oesophageal varices, caput medusa, haemorrhoids
sites of porto-caval anastimoses
around rectum, paraumbilical and oesophagus
clinical features of chronic liver disease
oedema ascites haematemesis spider naevi gnaecomastia purpura and bleeding infection coma
duration of drinking to turn liver into fatty liver? into hepatitis? into fibrotic? into cirrhotic?
2-3days (reversible)
4-6weeks (reversible)
mths-years
years
how does the liver look histologically after 2 days
steatosis
lighter shade, more holes (fat vacuoles)
other than alcohol, give 6 examples how a fatty liver can be produced
NASH pregnaancy drugs nutritional diabetes (type 2 2nd commonest cause) HCV (type 3)
4 features of alcoholic hepatitis in heavy drinkin (wks - months)
hepatocyte necrosis
neutrophils
mallory bodies
pericellular fibrossi
t/f collagen found in alcoholic fibrosis
true
this separates cells from blood supply - leading to death
t/f metabolic syndrome can produce the same pathology of alcoholic hepatitis
true
non-alcoholic steatohepatitis (NASH)
commonest cause of liver cancer
NASH
Hep A - E are the common causes of virla hepatitis, what are some rare causes
ebstein-barr virus
yellow fever
herpes
which of the commonest viral hepatitis is spread via faecal-oral
Hep A and E
5 likely outcomes of Hep B infection
death chronic hepatitis cirrhosis hepatocellular carcinoma assymptomatic
6 causes of chronic hepatitis
Hep B Hep C PBC PSC Autoimmune Drug induced `
what is seen histologically in PBC
chronic portal inlfammation/ bile inflammation
portal = bile = biliary
granuloma around duct
outline the steps to cirrhosis if the patient has PBC
untreated leads to bile duct loss
cholestasis
inflammation - fibrosis
cirrhosis
PSC is chronic inflammatory process affecting intra hepatic bile ducts alone t/f
false
intra and extra hepatic bile ducts
which inflammatory disease is PSC related to
UC
PSC or PBC has an increased risk of malignancy in bile ducts and colon
PSC
what is used to test for haemochromatosis
perls stain
treatment of haemochromatosis
venesection
wilsons disease is due to an inherited autosomal recessive disorder of copper metabolism, where does it accumulate? serology would show low levels of…..
liver and brain
low serum caeruloplasmin
what does alpha-1-1antitrypsin defiency cause
emphysema and cirrhosis
how does alpha-1-antitrypsin cause emphsysema
used to protect against elastase neutrophils (similar protection for hepatocytes)
hepatocellular adenoma are usually tumours which are benign, assymptomatic and found in women, however what can cause complications
enlargen - rupture or bleed
hepatocellular carcinoma is associated with 3
Hep B
Hep C
Cirrhosis
t/f multifocal hepatocellular carcinomas are common due to the circulation in liver
false
completely bawed yourself rory
