Lec 23 LIver Path

Question 1

What are the 2 blood supplies to the liver?

Answer 1

portal vein = 70%

hepatic artery = 40%

Question 2

Of periportal hepatocytes, midzonal hepatocytes, centrilobular hepatocytes:

• where is most oxygen/nutrients?
• where is most metabolism?
• where is most susceptible to ischemia

Answer 2

periportal = rich in ox and nutrients

midzonal = middle

centrilobular = poorest ox/nutrients; highly susceptible to ischemia; major zone of drug metabolism

Question 3

What do you see histologically with acute hepatitis?

Answer 3

• panlobular liver cell balooning and acdiophil body formation
• lymphocytes
• DON’T SEE NEUTROPHILS

Question 4

What is cause of fulminant hepatitis?

Answer 4

2/3 due to viral hepatitis

1/3 due to drugs or chemicals

Question 5

What defines chronic hepatitis pathologically?

Answer 5

dense lymphoplasmacytic infiltrate in portal tracts

- may or may not be associated with hepatocyte necrosis and scarring

Question 6

What do you see grossly in fulminant hepatitis?

Answer 6

liver is shrunken and soft

capsule is wrinkled

Question 7

What do you see grossly in acute hepatitis?

Answer 7

liver swollen and red
capsule edematous
focal depression due to subcapsular necrosis
color bright yellow or green

Question 8

What is the reserve progenitor cell compartment of the liver?

Answer 8

canal of hering

Question 9

What histo findings mark regeneration?

Answer 9

• mitoses
• thickening of hepatocyte cords
• disorganization of structure

Question 10

What do you see on histology with hep A infection?

Answer 10

prominent plasma cells [w/ hoff body]

- cholestatic hepatitis

Question 11

What do you see in acute hep B infection histologically?

Answer 11

• apoptotic bodies
• macrophages
• inflammation

Question 12

What do you see in chronic hep B infection histologically?

Answer 12

• ground glass hepatocytes = finely granular eosinophilic cytoplasm containing HBsAg
• nucleus pushed to the side

Question 13

What is the cause of liver cell injury in chronic hep C?

Answer 13

attributed to cytotoxic T cells

Question 14

What do you see on pathology with chronic Hep C?

Answer 14

• lymphoid aggregates or lymphoid follicles

- steatosis

Question 15

What do you see on histology with autoimmune hepatitis?

Answer 15

• hepatocyte necrosis
• prominent plasma cells
• interface hepatitis
• necrosis

= similar to chronic viral hepatitis

Question 16

What defines type 1 autoimmune hepatitis?

Answer 16

• positive ANA and smooth muscle antibody
• women < 40 yo
• 1/3 have other autoimmune disease
• 80% of AIH cases

Question 17

What defines type 2 autoimmune hepatitis?

Answer 17

• children 2-14 yo
• positive liver kidney muscle antibody [LKM1]
• associated wtih type 1 DM, thyroiditis

Question 18

What do you see on pathology in alcoholic hepatitis?

Answer 18

• hepatocyte sweeling and necrosis [baloooning]
• mallory denk bodies = tangled cytokeratin filaments
• lobular inflammation w/ neutrophils
• chiken wire fibrosis

Question 19

What do you see in NASH histologically?

Answer 19

mimics alcoholic hepatitis
- macrovesicular steatosis
- ballooning hepatocytes
- mallory bodies
fibrosis