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Anatomic Pathology 2 > Unit 4 - Liver 2 > Flashcards

Unit 4 - Liver 2 Flashcards

1
Q

What does Fusobacterium necrophorum do to the liver?

A

it causes liver necrosis

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2
Q

What is the pathogenesis of liver necrosis caused by Fusobacterium necrophorum?

A
  1. Fusobacterium necrophorum is present in the rumen 2. Ruminal acidosis 3. Loss of ruminal mucosal integrity 4. Fusobacterium necrophorum enters portal circulation 5. Liver becomes infected 6. liver necrosis
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3
Q

What microscopic pattern is observed in a liver with an ascending bacterial infection via the biliary tree?

A

there is inflammation involving the bile ducts and adjacent liver with neutrophils as an infiltrate (+/- lymphocytes and plasma cells)

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4
Q

What two liver flukes are the cause of hepatic trematodosis in the United States?

A

Fasciola hepatica and Fascioloides magna

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5
Q

How can liver flukes cause liver damage?

A
  1. the larvae wonder through the liver for more than a month causing necrosis with eosinophils and fibrous tracts or 2. adults in the bile ducts or in cysts in the liver causing cholangiohepatitis
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6
Q

What liver lesion is associated with ascarid larval migration in the pig?

A

milk spot liver - randomly scattered irregular, slightly depressed, firm, white lesions

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7
Q

What typically causes hepatic necrosis?

A

hypoxia and hepatotoxins

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8
Q

What gross lesions are associated with hepatic necrosis?

A

diffuse injury to a specific region of the hepatic lobule leads to an accentuated lobular pattern

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9
Q

Microscopically, what does centrilobular necrosis indicate as the potential differential?

A

hypoxia or metabolized hepatotoxins

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10
Q

Microscopically, what does mid-zonal necrosis indicate as the potential differential?

A

hexachlorophene or alphatoxins

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11
Q

Microscopically, what does periportal necrosis indicate as the potential differential?

A

direct-acting hepatotoxins

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12
Q

Microscopically, what does massive neccrosis indicate as a potential differential?

A

specific toxins or specific infectious agents

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13
Q

What are some special attributes of the centrilobular region?

A

part of the lobule with the lowest oxygen tension and part of the lobule with the greatest concentration of cytochrome P-450 mixed function oxidases

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14
Q

What is the most common cause of centrilobular necrosis?

A

hypoxia

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15
Q

What can cause hypoxia?

A

anemia, pneumonia/pulmonary edema, passive congestion due to heart failure, or shock

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16
Q

Where is the highest concentration of mixed function oxidases found?

A

in centrilobular hepatocytes

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17
Q

What gross changes are seen with centrilobular necrosis?

A

you will see an accentuated lobular pattern +/- hepatomegaly

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18
Q

What microscopic changes do you see with centrilobular necrosis?

A

dgeneration and loss of centrilobular hepatocytes

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19
Q

What are the two major types of hepatotoxins?

A

toxins that cause direct hepatocellular injury or toxins that are transformed by liver to toxic metabolies

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20
Q

Where is the expected pattern of injury to occur with toxins that cause direct hepatocellular injury?

A

periportal

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21
Q

Where is the expected pattern of injury to occur with toxins transformed by the liver into toxic metabolites?

A

centrilobular

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22
Q

What does carbon tetrachloride metabolize into and what does it do to the liver?

A

trihalomethane leads to oxygen free radical formation and centrilobular hepatocyte necrosis

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23
Q

Where does periportal necrosis occur?

A

around vessels in portal triads

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24
Q

What is periportal necrosis seen most commonly with?

A

direct-acting hepatotoxins

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25
Q

Midzonal necrosis is uncommon. What species is it seen in and why?

A

it is seen in pigs and horses with aflatoxicosis and cats with hexachlorophene

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26
Q

What can cause massive hepatic necrosis?

A

toxins, infectious agents, and nutrition

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27
Q

What are some examples of causes of massive hepatic necrosis?

A

hepatosis dietetica (swine), blue-green algae, poisonous mushrooms

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28
Q

Can the liver regenerate itself?

A

yes, when needed it has remarkable regenerative abilities by replicating mature hepatocytes and progenitor cells

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29
Q

What are some consequences of severe and/or chronic injury to the liver?

A

fibrosis, biliary proliferation, or nodular regeneration

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30
Q

What does fibrosis result from?

A

repetitive injury or massive necrosis with damage to ECM scaffold

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31
Q

What is the process of fibrosis in the liver?

A

the activated hepatic stellate cells proliferate and produce increased extracellular matrix

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32
Q

What does hepatic fibrosis represent?

A

a wound healing response to liver injury from a wide variety of etiologies

33
Q

What gross changes are associated with hepatic fibrosis?

A

irregular surface, shrunken/smaller in size, firm (fibrotic), and pale

34
Q

How does injury lead to bile duct proliferation?

A

the release of cytokines at injured limiting plates causes the bile duct to proliferate

35
Q

What can cause biliary hyperplasia?

A

biliary obstruction, periportal inflammation and fibrosis, sustained attempts at regeneration, and toxins (phomopsin, pyrrolizidine alkaloids, and aflatoxin)

36
Q

What is nodular regeneration due to?

A

the loss of the extracellular matrix and the presence of fibrosis, regeneration is typically nodular

37
Q

Why does nodular regeneration lead to diminished functional capacity?

A

regenerative nodules + fibrosis leads to an abnormal blood flow in and abnormal bile flow out

38
Q

What is cirrhosis?

A

the combination of fibrosis, biliary proliferation, and nodular regeneration

39
Q

What do the changes in a cirrhotic liver lead to?

A

distortion of the liver parenchyma, altered blood flow, and the potential development of liver failure

40
Q

What clinical issues are associated with cirrhosis?

A

ascites and hypoproteinemia

41
Q

What gross changes are seen with cirrhosis?

A

livers are smaller than normal with an irregular surface, pale in color, firm and fibrotic, and numerous nodules throughout the parenchyma

42
Q

What microscopic changes are associated with cirrhosis?

A

bridging fibrosis, nodular regeneration, biliary proliferation, +/- chronic inflammation

43
Q

What can cause cirrhosis?

A

chronic toxicity, chronic cholangitis and/or obstruction, chronic congestion, chronic inherited disorders of copper or iron metabolism, chronic hepatitis

44
Q

What agents are potentially associated with cirrhosis?

A

toxins, drugs, copper, infectious agents

45
Q

What canine breeds are predisposed to chronic hepatitis?

A

American and English cocker spaniel, West Highland white terrier, Laborador retriever, doberman pinscher, and scottish terriers

46
Q

What age dog is cirrhosis commonly found in?

A

8 year old dogs

47
Q

What are some lesions that can happen to the gall bladder?

A

cystic hyperplasia, mucocele, cholelithiasis, cholecystitis, and gall bladder distention

48
Q

What is cystic hyperplasia of the gall bladder?

A

hyperplasia of the mucosal epithelium in the gall bladder with multilobular gelatinous mucosal cysts due to the dilation of deep invaginations of surface epithelium

49
Q

What is a mucocele?

A

an abnormal, intraluminal accumulation of inspissated bile and/or mucous within the gallbladder

50
Q

What is cholelithiasis?

A

formation of stones from inspissated bile

51
Q

What is cholecystitis?

A

inflammation of gall bladder (mucosa/wall)

52
Q

What species does gallbladder cystic mucosal hyperplasia occur in?

A

dogs and sheep

53
Q

True or False: Gallbladder cystic mucosal hyperplasia is a commoon incidental aging change in dogs

A

TRUE

54
Q

Is gallbladder cystic mucosal hyperplasia a significant finding in dogs?

A

no

55
Q

What dogs seem to be predisposed to gallbladder mucoceles?

A

older, small to medium breed dogs

56
Q

What clinical signs are associated with gallbladder mucoceles?

A

vomiting, lethargy, anorexia, abdominal pain, icterus, and polyuria-polydipsia

57
Q

In the case of a gallbladder mucocele, what does serum biochemistry usually reveal?

A

increased liver enzymes

58
Q

What are some predisposing factors to mucoceles?

A

hyperlipidemias, hypothyroidism, hyperadrenocorticism, and poor gallbladder motility

59
Q

What can rupture of a gallbladder mucocele lead to?

A

peritonitis

60
Q

What is the pathogenesis of cholelithiasis?

A

bile causing supersaturation leading to precipitate leading to stones

61
Q

What is the clinical significance of cholelithiasis?

A

stones may migrate down the biliary tree and obstruct the bile duct causuing post-hepatic jaundice

62
Q

What may bile stones be made up of?

A

cholesterol, bilirubin, CaPO4, or CaCO3

63
Q

What can cause cholecystitis?

A

ascending infection from duodenum or bacteremia

64
Q

What is cholecystitis a sequela to?

A

cholelithiasis

65
Q

How does cholecystitis benefit bacteria residing in the gall bladder?

A

they allow the bacterium to escape the host immune system and allow them to be released into the intestine in bile

66
Q

What is biliary obstruction due to?

A

cholangitis, gall stones, stenosis due to scarring of the dugs, and space occupying masses compressing the common bile duct

67
Q

What is a frequent gall bladder lesion associated with anorexia?

A

distended gallbladders with viscous bile

68
Q

What are tumors and tumor like lesions are associated with the liver and biliary system?

A

nodular hyperplasia, primary neoplasms, and secondary neoplasia

69
Q

What are the more frequent/common tumors of the liver?

A

metastatic neoplasias - 2.5 times more frequent

70
Q

What primary neoplasms affect the liver and biliary systems?

A

hepatocellular neoplasms, biliary tract neoplasms, and hemangiosarcomas

71
Q

What are some primary hepatocellular neoplasms?

A

adenomas and carcinomas

72
Q

What are some primary biliary tract neoplasms?

A

adenoma (cystadenoma), and carcinoma

73
Q

What are some metastatic neoplasias of the liver and biliary system?

A

intestinal carcinoma, exocrine pancreatic carcinoma, islet cell carcinoma, splenic hemangiosarcoma, lymphosarcoma, and leukemia

74
Q

What species is nodular hyperplasia common in?

A

the dog

75
Q

What is the consistency of nodules in nodular hyperplasia?

A

they feel the same as the adjacent liver

76
Q

What do nodules from nodular hyperplasia that are lighter in color indicate?

A

they are made up of fat and glycogen

77
Q

What do nodules from nodular hyperplasia that are darker in color indicate?

A

congestion

78
Q

True or False: Nodular hyperplasia causes livers to be reduced in size

A

FALSE

Anatomic Pathology 2 (48 decks)

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