3 - Basic Principles of Liver Pathology Flashcards Preview

GI / Hepatology > 3 - Basic Principles of Liver Pathology > Flashcards

Flashcards in 3 - Basic Principles of Liver Pathology Deck (64)
Loading flashcards...
1

The most common cause of abnormal LFTs in the US today!

Fatty liver

2

Liver Biopsy is used for

Grading & Staging of chronic hepatitis
Workup of possible fatty liver disease (alcoholic or non-alcoholic)
Evaluation of cholestasis & jaundice
Establish a tissue dx of tumor
Determine whether cirrhosis is present

3

Hepatocellular Diseases

Acute Hepatitis
Chronic Hepatitis
Fatty Liver Diseases
Metabolic Diseases (Genetic mutations: AAT def., Fe, Cu, inherited storage disorders)

4

Biliary Tract Diseases

Large bile duct obstruction (LBDO)
Intrahepatic bile ducts
Bile canaliculi/hepatocytes ("pure" or intrahepatic cholestasis)

5

Vascular Diseases

Central veins & sinusoids
Portal veins/hepatic arteries

6

Hepatitis - Most common etiologies

Infection by the Hepatitis Viruses
Drug Hepatitis

7

Hepatitis Viruses

HAV (28nm) - RNA (oral-fecal)
HBV (42nm) - dsDNA (genome incorporated into human genome, lead to cancer)
HCV (60nm) - RNA (also causes cancer in the liver)
HDV (30nm) - RNA (delta agent, parasite. Can't exist without HBV at the same time. You're a carrier for HBV, and then you shoot up with something contaminated with HDV)
HEV (32nm) - RNA (fecal-oral, meat)
Other viruses (CMV, HSV, etc)

8

Drug Hepatitis

Predictable (CCl4, acetaminophen)
Unpredictable (INH, aldomet)

9

Viral Hepatitis - Pathogenesis

Virus enters cell
Is encoded
Reproduces
Viral antigens are expressed on the hepatocyte membrane
CD8 cells kill that bitch

10

Drug Hepatitis - Pathogenesis

Predictable
Metabolite directly damages hepatocyte (Tylenol)
No immune system necessary

OR

Unpredictable
Metabolism in the liver of the drug, producing antigen "hapten" that binds the hepatocyte, causing T-Cells or Eosinophils to KILLLLLLLL

11

Acute Hepatitis

Does not mean neutrophils
Diffuse inflammation (lymphocytes)
Lymphocytes come through portal tract, infiltrate and spread towards central vein
Lobular disarray
Hepatocyte ballooning/apoptosis
"Spotty Necrosis"

12

Spotty Necrosis

Hepatitis, but can't tell if it's idiosyncratic or if it's viral

13

Massive hepatic necrosis

Seen in Fulminant Hepatitis
Viral causes are HAV & HBV
HEV can do it too in the nondeveloped world
Destroys all the hepatocytes in the damn liver.
Periportal progenitor/steam cell activation leads to formation of bile ductular structures. They tryna make up the difference gurl.
Wrinkled capsule!!!!!!
Occurs within 8 weeks of onset of infection/drug
Sometimes it creeps along for months

14

Fulminant Hepatitis

Occurs in 1 - 3 % of cases (between all acute viral and acute drug hepatites)

15

Submassive Necrosis

A thing he didn't explain

16

Chronic Hepatitis

Inflammation of the liver continuing without improvement for 6 months or longer

Disease process involving portal tracts/pp regions, lobules

17

Causes of Chronic Hepatitis

HBV
HCV
HDV (with co-presence of HBV)
Autoimmune hepatitis
Drugs (Hx of chronic intake)
2 metabolic diseases (α-1-antitrypsin deficiency, Wilson's)

18

Presenting Time of Wilson's

Not 60 years old. Younger? I missed it.

19

Grade 1

Sometimes modest inflammation only in the portal tracts, intermittently seeding out lymphocytes.

20

Grade 2

Ground glass Hepatitis B surface antigen inclusions. More inflammation getting out, "interface hepatitis."

21

Scarring

Scarring occurs, usually through stellate cells, making irregular portal tracts and thickened plates

22

Interface Hepatitis

Interface in all the portal tracts leads to increased fibrosis, losing all the hepatocytes.

23

Chronic Hepatitis - Grade 1

Minimal

24

Chronic Hepatitis - Grade 2

Mild

Includes interface hepatitis at the edge, some lobular as well

25

Chronic Hepatitis - Grade 3

Moderate

More circumferential

26

Chronic Hepatitis - Grade 4

Marked

Extensive interface and extensive lobular involvement

27

Chronic Hepatitis - Stage 1

Dots

28

Chronic Hepatitis - Stage 2

Dots with legs

29

Chronic Hepatitis - Stage 3

Stars

30

Chronic Hepatitis - Stage 4

Needlepoint