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Systemic Pathology II > Hepatobiliary System, Pt. 5 > Flashcards

Hepatobiliary System, Pt. 5 Flashcards

1
Q

Why is the liver a common site of toxic injury?

A
  • receives blood from portal vein and systemic circulation
  • biotransformation site
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2
Q

What are the 3 phases of hepatic metabolism?

A
  1. fat-soluble toxins are activated by oxidation, reduction, hydrolysis, hydration, or dehalogenation by cytochrome P450
  2. activated metabolites are conjugated by sulfation, glucuronidation, glutathione, acetylation, or methylation into excretable water-soluble waste
  3. this new product is moved across the cell membrane and reaches the sinusoids/canaliculi for excretion via urine, bile, or stool
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3
Q

What are the 2 categories of hepatotoxins?

A
  1. INTRINSIC - predictable, reproducible, dose-related with an understood mechanism where most are converted into reactive metabolites (acetaminophen)
  2. IDIOSYNCRATIC - unpredictable, non-reproducible (only occurs in a small %), with an unknown mechanism (diazepam)
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4
Q

What are the 2 most probable mechanisms of idiosyncratic hepatotoxins?

A
  1. hypersensitivity related (drug allergy)
  2. toxic metabolite-dependent
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5
Q

How do acute and chronic hepatotoxicity compare?

A

ACUTE - zonal to massive necrosis characterized by centrilobular necrosis with hemorrhage (mushroom poisoning in dogs)

CHRONIC - many possible patterns including necrosis, inflammation, lipidosis, cirrhosis, atrophy, etc. (aflatoxicosis in pigs)

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6
Q

What drugs are considered hepatotoxins?

A
  • antibiotics (trimethoprim-sulfonamide)
  • anticonvulsants (primidone phenytoin, phenobarbital)
  • NSAIDs
  • diazepam (cat)
  • acetaminophen (cat)
  • xylitol (dog)
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7
Q

What plants/environmental toxins are considered hepatotoxins?

A
  • amanitins in dogs from Amanita mushrooms (acute)
  • pyrrolizidine alkaloid in ruminants from Senecio plants (chronic)
  • aflatoxins in pigs from Aspergillus flavus (chronic)
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8
Q

What kind of effect does amanitin have on the liver?

A

acute massive hepatic necrosis

  • dogs
  • bright red
  • massive hemorrhage
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9
Q

What is acute hepatic injury typically characterized by histologically?

A

centrilobular necrosis (central pallor)

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10
Q

What kind of effect does aflatoxin have on the liver?

A

chronic hepatotoxicity

  • rounded edges
  • wrinkled texture caused by fibrosis with white tracks
  • common in pigs and caused by chronic grazing on non-fatal doses of moldy grain/grass
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11
Q

What kind of effect does primidone have on the liver?

A

chronic hepatotoxicity

  • dogs
  • multifocal regenerative nodules
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12
Q

What is commonly seen in blood work and histopathology in xylitol toxicity in dogs?

A

BW - hypoglycemia, hyperinsulinemia (increased release from pancreas)

HP - acute severe hepatic centrilobular to massive necrosis

  • necrosis with inflammatory cells
  • loss of chord/plate structure
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13
Q

How does pyrrolizidine alkaloid affect the liver?

A

chronic hepatotoxicity

  • multiple leather-like nodules
  • common in horses
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14
Q

What 4 neoplastic lesions are seen in the liver?

A
  1. hepatocellular adenomas
  2. hepatocellular carcinomas
  3. sarcomas - rare, typically metastatic from hemangiosarcoma
  4. metastatic lymphoma, hemangiosarcoma, and carcinomas from the pancreas, GI, etc.
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15
Q

Hepatic nodular hyperplasia, dog:

A
  • incidental in older dogs
  • pale tan well-demarcated nodule that does not compress surrounding tissue
  • contain portal triads in nodule
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16
Q

Hepatocellular adenoma, dog:

A
  • similar to hyperplasia
  • well-circumscribed proliferation of neoplastic hepatocytes lacking portal triads
17
Q

Hepatocellular carcinoma, dog:

A
  • arises from liver
  • infiltrative into peripheral tissue
  • ability to metastasize
18
Q

Hemangiosarcoma liver metastasis, dog:

A
  • multifocal hemorrhagic nodules
  • endothelial origin

(multifocal suggests metastasis; focal suggests primary)

19
Q

Hepatic lymphoma:

A

multifocal white-tan nodules

20
Q

What 7 species lack gallbladders?

A
  1. horses
  2. cervids
  3. elephants
  4. giraffes
  5. rats
  6. camelids
  7. pigeons
21
Q

How does bile flow in the liver?

A
  • biliary canaliculi
  • intrahepatic ductules
  • interlobular ducts
  • hepatic ducts
  • cystic duct of gallbladder
  • common bile duct
  • duodenum

same direction as lymph and opposite of blood

22
Q

What is the function of the gallbladder? What are 4 sequels to obstruction?

A

stores and concentrates bile

  1. hyperbilirubinemia (post-hepatic icterus)
  2. cholecystitis
  3. maldigestion of fats resulting in acholic, white/gray feces (stores enzymes for digestion)
  4. rupture resulting in acute peritonitis
23
Q

Normal gallbladder histology:

A

layers = epithelium + submucosa

24
Q

What is the structure of normal gallbladder epithelium?

A

(pseudo)columnar ciliated

25
Q

What is a common incidental finding in feline gallbladders?

A

bilobed gallbladder - no clinical significance

26
Q

What are the 4 most common gallbladder lesions?

A
  1. mucocele
  2. infarction
  3. cholecystitis (commonly secondary to mucocele or obstruction)
  4. choleliths
27
Q

What is gallbladder mucocele? What 3 conditions is it commonly associated with? In what animals is it most common?

A

dilation of the gallbladder with semisolid mucoid secretions

  1. decreased gallbladder motility
  2. bile stasis
  3. altered bile composition and viscosity

dogs

28
Q

What is the characteristic ultrasound appearance of gallbladder mucocele?

A

kiwi appearance due to mucoid secretions forming strands within gallbladder

29
Q

Gallbladder mucocele, dog:

A

L = distended lumen

R = thick mucoid contents, thickened wall

30
Q

What hyperplastic and neoplastic lesions are seen in the gallbladder?

A

cystic mucinous hyperplasia (no significance)

cholangiocellular (biliary) adenoma or carcinoma

31
Q

Gallbladder cystic mucinous hyperplasia, dog:

A

mucoid bubbles/pearls representing proliferation of gallbladder mucosa into finger-like projections

32
Q

What does gallbladder infarction look like grossly?

A

diffuse dark red discoloration localized in the gallbladder without liver involvement

33
Q

Choleliths, pig:

A

concretions can cause a blockage, leading to jaundice or cholecystitis

34
Q

Choleangiocellular (biliary) cystadenoma, cat:

A

cystic lesion that doesn’t grow quickly or metastasize

  • not a significant clinical finding
35
Q

What is the characteristic appearance of cholangiocellular (bile duct) carcinoma?

A

umbilicated (donut-like) lesions of neoplastic biliary epithelium

  • bad prognosis —> affects liver function

Systemic Pathology II (24 decks)

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