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YR5 Histopathology > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

Describe hepatocyte function in each zone

A
  1. “Born”
  2. “Grow up”
  3. Reach maturity, most metabolically active + eventually die
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2
Q

What occurs in zone 3 of the liver?

A

Hepatocytes metabolise xenobiotics to toxic substances
Thus most alcoholic liver damage occurs in zone 3

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3
Q

Describe the blood flow in the liver

A

Hepatic artery + portal vein bring blood to liver
Blood travels through sinusoids, O2 absorbed by hepatocytes along the way
pO2 much lower when blood reaches zone 3 where cells are most metabolically active - problem in alcoholics

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4
Q

What is shown by each arrow?

A

Blue: Portal triad
Yellow: Central vein

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5
Q

What is shown by each arrow?

A

Blue: Portal vein
Purple: Bile duct
Green: Hepatic artery

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6
Q

What is shown in this picture?

A

Yellow: Hepatocytes
Red: Bile duct canaliculi
red + white cells lining sinusoids

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7
Q

Describe the organisation of cells in a sinusoid

A

Hepatic sinusoid: blood flows through
Kupfer cells: resident macrophages in sinusoids
Discontinuous endothelial cells: allows blood plasma to enter space of disse
Stellate cells: in space of disse, store Vit A
Hepatocytes with microvillous border projecting into space of disse

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8
Q

Describe the cellular changes in a sinusoid due to liver injury (5)

A

Kupfer cells are activated
Stellate cells become myofibroblasts- contract + secrete collagen
Gaps between endothelial cells closed, firmly attached
Fibrillar collagen deposited in space of disse
Difficult for blood to reach hepatocytes + hepatocytes lose microvillous border

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9
Q

Which 4 features define cirrhosis?

A
  1. Whole liver involved
  2. Fibrosis
  3. Nodules of regenerating hepatocytes
  4. Distortion of liver vascular architecture: intra- + extra-hepatic shunting of blood (e.g. gastro-oesophageal)
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10
Q

What are the functional consequences of the vascular problems in cirrhosis?

A

No metabolic homeostasis
Hepatocytes themselves don’t receive nutrition they require

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11
Q

What is the consequence of the liver being unable to filter blood due to intra and extra hepatic shunts?

A

Unfiltered, toxic blood goes to heart + is delivered to the rest of the body

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12
Q

What is shown here?

A

Whole liver involved
Nodules

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13
Q

What is shown here?

A

Nodule surrounded by fibrous tissue

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14
Q

How is cirrhosis classified?

A

According to aetiology
1. Alcohol/ insulin resistance (usually micro nodular)
2. Viral hepatitis etc. (usually macro nodular)

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15
Q

Give 3 clinical complications of cirrhosis

A

Portal HTN
Hepatic encephalopathy
Liver cell cancer

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16
Q

What is shown here?

A

Large oesophageal varicie

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17
Q

What is shown here? What causes this?

A

Enlarged spleen
Back pressure of blood in portal circulation leads to passive enlargement of spleen
If palpable, likely portal HTN + probably cirrhotic

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18
Q

What can be seen here?

A

Cirrhotic liver with cancer visible

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19
Q

Until recently what was believed about cirrhosis?

A

That it was irreversible
It may be reversible if equilibrium is shifted as fibrosis is dynamic
Collagen is deposited + can be broken down

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20
Q

What are the most common causes of acute hepatitis?

A

Viruses: Hep A-E. A+E most common
Drugs: all drugs metabolised by liver. If PO, will reach gut 1st then transported to liver

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21
Q

What can be seen here? What is this pathogonomic of?

A

Spotty necrosis in Acute hepatitis
Damage to hepatocytes a/w lymphocytes
Damage focused in liver lobule

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22
Q

What are the most common causes of chronic hepatitis?

A

Viral hepatitis: B, C, D - D dependent on B
Drugs
AI: F>M, more prone to other AI

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23
Q

How are the histological findings in chronic hepatitis assessed?

A

Grade: severity of inflammation- how awful it looks down microscope
Stage: severity of fibrosis- how far along from normal to cirrhotic

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24
Q

What can be seen here?

A

Blue: inflammatory cells in portal tract
Red: limiting plate- interface between portal tract + hepatocytes

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25
Q

What can be seen here?

A

Interface hepatitis aka piecemeal necrosis
Limiting plate more difficult to see
Inflammation crossing limiting plate
Hepatocyte apoptosis drives fibrosis

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26
Q

What can be seen here?

A

Lobular inflammation

27
Q

How does the histology differ in acute and chronic hepatitis?

A

Acute: most inflammation in lobules
Chronic: most inflammation in or around portal tract

28
Q

What can be seen here?

A

Fibrous tissue stretching from portal tract to central vein
“Bridging fibrosis” allows intrahepatic shunting
Blood enters portal tract, goes direct to central vein, bypasses hepatocytes

29
Q

Once a patient has developed bridging fibrosis, what are they at increased risk of?

A

Cirrhosis
Hepatocellular carcinoma
Liver transplantation
Death

30
Q

What are the 3 patterns of alcoholic liver disease?

A
  1. Fatty liver: metabolic change, reversible
  2. Alcoholic hepatitis: inflammation
  3. Cirrhosis
31
Q

What is this and how does it differ from normal?

A

Fatty liver, yellow, greasy
Normal: red, beefy colour

32
Q

What is seen here?

A

Fatty change
Each hepatocyte contains a large droplet of fat

33
Q

Give 4 histological features of alcoholic hepatitis

A

Ballooning (+/- Mallory Denk bodies)
Apoptosis
Pericellular fibrosis
Mainly seen in Zone 3

34
Q

How does ballooning of hepatocytes occur?

A

In Z3, Alcohol converted by alcohol dehydrogenase to acetaldehyde
Acetaldehyde is toxic: causes cross linking of intermediate filaments of liver
Once cross linked + clumped, cells can’t retain shape, can’t transport fluids or proteins out well, so balloon
Clumped cytoskeleton = Mallory Denk body

35
Q

What is the diagnosis? What can be seen here?

A

Alcoholic hepatitis
Big white droplets of fat
Ballooned hepatocytes with dark pink clumps (Mallory Denk bodies)
Neutrophils

36
Q

What can be seen here?

A

Pericellular fibrosis (Orange arrow)

37
Q

Describe this

A

Alcohol induced cirrhosis
Pale yellow
Micronodular

38
Q

What can be seen here?

A

Fat in nodule
Surrounded by fibrosis

39
Q

Give 3 facts about non alcoholic fatty liver disease (inc. non alcoholic steatohepatitis)

A

Histologically looks like alcoholic liver disease
Due to insulin resistance a/w high BMI + DM
Tx: Mx of DM + weight loss

40
Q

Give 5 facts about primary biliary cholangitis

A

F > M
Middle aged
Bile ducts are lost due to chronic inflammation (often granulomatous)
Diagnostic test: detection of Anti-mitochondrial antibodies
50% have cirrhosis

41
Q

Give 5 facts about primary sclerosis cholangitis

A

M > F
Periductal bile duct fibrosis leads to obstruction + loss of intra + extra hepatic bile ducts
a/w UC
Increased risk of cholangiocarcinoma
Diagnostic test: MRCP/ ERCP imaging

42
Q

What is the diagnosis? What can be seen?

A

PSC
Dense consecutive fibrosis
“onion skin”

43
Q

Give 4 facts about haemochromatosis

A

Genetically determined increased gut iron absorption (Chr 6)
Parenchymal damage to organs secondary to iron deposition
In liver: fibrosis - cirrhosis
In skin: bronze pigmentation
In pancreas: severe pancreatitis, islet damage + DM

44
Q

What can be seen here? What is the diagnosis?

A

Iron in hepatocytes
Haemocromatosis

45
Q

What is haemosiderosis? What causes this?

A

Accumulation of iron in macrophages
Results from multiple blood transfusion e.g. in sickle cell/ thalassemia

46
Q

What is seen here? What is the diagnosis?

A

Iron in scattered cells (macrophages)
No iron in hepatocytes
Haemosiderosis

47
Q

Give 3 facts about Wilsons disease

A

Accumulation of copper due to failure of excretion by hepatocytes into bile
Deposits in CNS: lenticular degeneration- psych disturbances
Deposits in cornea: kayser fleishcer rings on slit lamp

48
Q

What can be seen here? What causes this?

A

Copper on rhodanine stain
Wilsons disease

49
Q

Give 4 facts about AI hepatitis

A

F > M
Very active chronic hepatitis, auto antibodies from plasma cells in liver
Anti-smooth muscle actin antibodies in serum
Responds to steroids

50
Q

Give 4 facts about alpha-1 antitrypsin deficiency

A

Failure to secrete alpha-1 antitrypsin
Intra-cytoplasmic inclusions due to misfolded protein from excess alpha 1 antitrysin in hepatocytes
Causes hepatitis + cirrhosis
a/w emphysema

51
Q

Why is alpha 1 antitrypsin deficiency associated with emphysema?

A

Alpha 1 antitrypsin usualy dampens inflammation
Without this, inflammation in lung is prolonged, allowing more lung destruction

52
Q

What can be seen here?

A

Globules of alpha 1 antitrypsin misfolded protein accumulating in hepatocytes

53
Q

What can be seen here? Why?

A

Hepatocytes around portal tract are ok
Hepatocytes in zone 2 + 3 are gone because this is where paracetamol is activated to NAPQI which is toxic

54
Q

Give 2 general and 2 specific causes of hepatic granulomas

A

General: TB + Sarcoid
Specific: PBC + drugs

55
Q

What can be seen here? What pathology is this seen in?

A

Giant cell surrounded by activated macrophages
Hepatic granuloma

56
Q

Give 3 types of benign liver tumour

A
  1. Liver cell adenoma
  2. Bile duct adenoma
  3. Haemangioma: endothelial
57
Q

What is this?

A

Liver cell adenoma
Sharply defined tumour, not invading local tissue

58
Q

What malignant tumours can arise in the liver?

A
  1. Secondary MORE COMMON: all blood from portal circulation goes via liver- mets from stomach, pancreas, small intestine, large intestine
  2. Primary
59
Q

What is seen here?

A

Secondary liver tumours
Often multiple when secondary

60
Q

What are the 4 primary malignant liver tumours?

A
  1. Hepatocellular carcinoma- liver cell
  2. Hepatoblastoma: more common in kids
  3. Cholangiocarcinoma: bile ducts
  4. Haemangiosarcoma: endothelial cells
61
Q

What is liver cell cancer usually associated with, especially in the West? Where may this not be seen?

A

a/w Cirrhosis, often in elderly men
In countries where Hep B more common may not be a/w cirrhosis as Hep B can be directly oncogenic

62
Q

What can be seen here?

A

Hepatocellular carcinoma

63
Q

Cholangiocarcinoma can be associated with which 3 conditions? From which bile ducts can it arise?

A

PSC
Worm infections
Cirrhosis
Can arise from intra-hepatic + extra-hepatic ducts (inc. gall bladder)

64
Q

What can be seen here?

A

Cholangiocarcinoma

YR5 Histopathology (27 decks)

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