Digestion & Metabolism 2: Liver Response to Injury

Question 1

what 3 things make up the PORTAL TRIAD?

Answer 1

1. PORTAL VENULE
2. HEPATIC ARTERIOLE
3. BILE DUCTULE

Question 2

SPACE OF DIESSE…

contains WHAT 2 kinds of cells?

can help with ___ ___ function

Answer 2

2 cells?
1. KUPPFER
2. STELLATE

HEPATIC METABOLIC

Question 3

give each NAME & ZONE

Answer 3

P = PERIPORTAL, ZONE 1

M = MIDZONAL, ZONE 2

C = CENTRILOBULAR, ZONE 3

Question 4

KUPPFER cells…

= what are they?

what is their function? (2)

Answer 4

= MACROPHAGES within SINUSOIDS & SPACE OF DIESSE

function?
1. PHAGOCYTOSE SENESCENT RBCs & ACCUMULATE IRON
2. PHAGOCYTOSE BACTERIA & ENDOTOXINS

Question 5

STELLATE CELLS…

aka?

located between ____ and ____ in….

in OLDER CATS… (2)

involved in metabolism of WHAT?

in INJURY… (2)

Answer 5

AKA ITO CELLS or LIPOCYTES

located between HEPATOCYTES and SINUSOIDS in SPACE OF DIESSE

in OLDER CATS…
1. MORE NUMEROUS
2. have MORE VACUOLES

involved in VITAMIN A METABOLISM

in INJURY…
1. can transform into MYOFIBROBLASTS
2. can CONTRIBUTE TO FIBROSIS

Question 6

PHOTOSENSITIZATION…

what type of reaction is this?

usually occurs after WHAT in HERBIVORES?

Answer 6

TYPE 3 REACTION

usually occurs after CHOLESTASIS or OBSTRUCTION OF BILE FLOW

Question 7

HEPATOCELLULAR SWELLING

in MOST forms of liver injury….

what usually happens?

2 findings on HISTO?

is this reversible?

can lead to…

Answer 7

this is the FIRST MANIFESTATION

what usually happens?
–> cells ACCUMULATE WATER due to INABILITY TO MAINTAIN IONIC & FLUID HOMEOSTASIS aka HYDROPIC CHANGE

2 findings on HISTO?
1. SEVERE MARKED SWELLING
2. PALE CYTOPLASM

THIS IS REVERSIBLE

can lead to NECROSIS

Question 8

describe what’s happening in the LIVER

what about the cytoplasm?

Answer 8

HEPATOCELLULAR SWELLING

cytoplasm is PALE

Question 9

the liver here is FULL OF…

what DZ could this be?

Answer 9

liver is FULL OF GLYCOGEN

could be STEROID HEPATOPATHY

Question 10

GLYCOGEN accumulation in the liver…

can cause ____ hepatocytes with ____ cytoplasm due to ____ accumulation

usually appears in WHAT zone of HEPATOCYTE?

in NEONATES….

what disease can occur in DOGS ONLY?

reversible?

usually NOT associated with…

Answer 10

SWOLLEN, CLEAR, GLYCOGEN

usually appears MIDZONAL

in NEONATES, can be PHYSIOLOGIC & helps them GROW

can have STEROID HEPATOPATHY in DOGS ONLY

REVERSIBLE

usually NOT associated with NECROSIS

Question 11

HEPATIC LIPIDOSIS…

aka? (2 different names)

usually the result of ____ imbalance

can be both a DISEASE state & what else?

reversible?

might lead to….

Answer 11

AKA….
1. FATTY CHANGE
2. STEATOSIS

usually the result of ENERGY imbalance

can be both DISEASE state & HISTOLOGIC PATTERN (fat inside hepatocytes)

IS REVERSIBLE

might lead to NECROSIS

Question 12

how can LIPID accumulate in the HEPATOCYTES/LIVER? (7)

hints: moving fat, diet, blood lipoproteins, oxidation, protein, apoprotein secretion

Answer 12

1. INCREASED MOBILIZATION OF FAT STORES with NEGATIVE ENERGY BALANCE
2. INCREASED FAT IN DIET
3. TOO MUCH MOBILIZATION OF BLOOD LIPOPROTEINS
4. DECREASED OXIDATION of FATTY ACIDS and TRIGLYCERIDES due to HEPATIC DYSFUNCTION
5. DISORDERS in CHOLESTEROL PRODUCTION
6. LACK of PROTEIN to make APOPROTEIN to allow SECRETION OF LDL
7. ISSUE WITH HEPATIC MEMBRANE AND APOPROTEIN SECRETION

Question 13

TENSION lipidosis = definition?

what SPECIES can we see this in?

Answer 13

= TRIANGULAR ligament holding LIVER IN PLACE is PLACED UNDER TENSION BY EXCESS LIPIDS

can see this in HORSES

Question 14

AMYLOIDOSIS…

usually associated with a ____ or ____ protein

causes ___ material in the…. (2)

causes ____ of HEPATOCYTES and ____ of the SINUSOIDS

associated with WHAT kinds of conditions?

3 breed dispositions?

how does the liver look GROSSLY?

can cause ___ hepatic DYSFUNCTION that is potentially ____ because of the risk of ____

Answer 14

REACTIVE, SECONDARY

EOSINOPHILIC, in the…
1. SPACE OF DIESSE
2. PORTAL AREAS

ATROPHY, DILATION

associated with INFLAMMATORY conditions

3 breeds?
1. SHAR PEIS
2. ABYSSINIANS
3. SIAMESE

grossly, liver is FRIABLE

can cause DOWNSTREAM dysfunction that is potentially LETHAL because of the risk of RUPTURE of the LIVER

Question 15

what do we expect on CBC if CELL INJURY/DEATH of HEPATOCYTES?

Answer 15

INCREASED LEAKAGE ENZYMES (ALT/AST)

Question 16

6 causes of NECROSIS & APOPTOSIS of HEPATOCYTES

Answer 16

1. HYPOXIA
2. TOXINS
3. MICROORGANISMS
4. IMMUNOLOGICAL EVENTS
5. SEVERE METABOLIC DISTURBANCES
6. TRAUMA

Question 17

in ACUTE/CHRONIC hepatitis we tend to see APOPTOTIC hepatocytes

Answer 17

CHRONIC

Question 18

if we see LIQUEFACTIVE necrosis occurs in liver, WHAT CAUSED IT?

Answer 18

likely CLOSTRIDIAL

Question 19

define type of necrosis

what 2 things would be present in the liver?

Answer 19

LIQUEFACTIVE

in the liver…
1. PUS
2. BACTERIA

Question 20

define type of NECROSIS

Answer 20

COAGULATIVE

Question 21

define LEFT and RIGHT types of NECROSIS

Answer 21

LEFT = ZONAL

RIGHT = DIFFUSE/MULTIFOCAL RANDOM

Question 22

define LEFT and RIGHT types of NECROSIS

Answer 22

LEFT = MASSIVE

RIGHT = BRIDGING

Question 23

what are the ETIOLOGIES of these TYPES of necrosis?

1. MULTIFOCAL RANDOM (1, 3 subs)
2. MASSIVE (2)
3. ZONAL (2)

Answer 23

1. MULTIFOCAL RANDOM = INFECTIOUS agents
   –> VIRAL
   –> PROTOZOAL
   –> BACTERIAL
2. MASSIVE
   –> TOXIC
   –> NUTRITIONAL
3. ZONAL
   –> TOXIC
   –> HYPOXIA

Question 24

CHOLANGITIS definition?

Answer 24

INFLAMMATION OF THE BILE DUCTS (in LIVER and GALLBLADDER)

Question 25

CHOLANGIOHEPATITIS definition

Answer 25

inflammation of BILE DUCTS with EXTENSION INTO LIVER PARENCHYMA

Question 26

CHOLECYSTITIS definition

Answer 26

inflammation of the GALLBLADDER

Question 27

CHOLEDOCHITIS definition

& describe anatomical location

Answer 27

inflammation of the COMMON BILE DUCTS

anatomy = COMMON BILE DUCT coming OUT of GALLBLADDER and INTO INTESTINE

Question 28

TIZZER’S DZ

caused by ____ infection of the ____, resulting in ____

Answer 28

caused by CLOSTRIDIAL INFECTION of HEPATOCYTES, resulting in HEPATITIS

Question 29

what kind of PARASITE likes to LIVE IN THE BILE DUCTS?

what kind of DISEASE PROCESS can they cause?

Answer 29

LIVER FLUKES can live in BILE DUCTS

can cause SUPPURATIVE CHOLANGITIS

Question 30

IBD tends to affect the ___ ____ in WHAT species?

Answer 30

tends to affect the BILE DUCTS in CATS

Question 31

TRADITIS definition?

similar to SEVERE ____ ____

can also resemble _____

Answer 31

INFLAMMATION of the…
1. BILE DUCTS
2. INTESTINE
3. PANCREAS

similar to SEVERE LYMPHOCYTIC IBD

can also resemble LYMPHOMA

Question 32

CHOLESTASIS/BILE STASIS definition

secondary to…

this is INTRA/EXTRA hepatic

what do we see on CBC? (1)

Answer 32

= bile stuck in CANALICULI or BILE DUCTS

secondary to LIVER DAMAGE

this is INTRA-HEPATIC

can see HYPERBILIRUBINEMIA on CBC

Question 33

DUCTULAR bile stasis is when ____ are filled with ____ due to ____ cause

Answer 33

when DUCTS are filled with BILE due to OBSTRUCTIVE cause

Question 34

how much of the liver can we resect without causing liver damage?

Answer 34

up to 75%!

Question 35

CIRRHOSIS…

= definition?

has WHAT 3 histologic components?

Answer 35

= END-STAGE LIVER dz

3 histologic components…
1. SEVER DIFFUSE BRIDGING FIBROSIS
2. NODULAR or COMPLETE REGENERATION
3. BILE DUCT HYPERPLASIA

Question 36

when performing liver biopsy, WHAT should we be sure to do?

Answer 36

take MANY REPRESENTATIVE SAMPLES

Question 37

NODULAR REGENERATION vs. NODULAR HYPERPLASIA?

Answer 37

NODULAR REGENERATION = hepatocytes trying to PROLIFERATE to come back to NORMAL HEPATIC CAPACITY/SIZE

NODULAR HYPERPLASIA = usually normal finding for OLD DOG, usually SMALL from SCAR TISSUE/FIBROSIS