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HistoPath > Histopathology 8: Liver pathology > Flashcards

Histopathology 8: Liver pathology Flashcards

1
Q

Aspergillus produces …………. which causes hepatocellular carcinoma

A

Aflatoxin

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2
Q

Which tumour marker indicates hepatocellular carcinoma ?

A

alphaFP

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3
Q

List 5 causes of hepatocellular carcinoma (liver cell carcinoma)?

A
  • Hepatitis B or C
  • Alcoholic cirrhosis
  • Haemochromatosis
  • Aflatoxin (from asprgillus)
  • NAFLD

Associated with cirrhosis in the West and viral infections in developing countries

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4
Q

Which syndrome is associated with cholangiocarcinoma ?

A

Lynch syndrome type II

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5
Q

What are the macrophages in the liver called ?

A

Kupffer cells

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6
Q

Where do stellate cells reside in the liver ?

A

Space of disse (this is the space between the endothelial cells and hepatocytes)

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7
Q

Is alcoholic cirrhosis micronodular or macronodular ?

A

Micronodular

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8
Q

Is cirrhosis due to viral hepatitis micronodular or macronodular ?

A

Macronodular

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9
Q

List 3 histological features of alcoholic liver disease ?

Features of alcoholic hepatitis (NB this leads to scarring)

A
  • Fatty liver
  • Alcoholic hepatitis (fatty liver hepatitis)
  • Cirrhosis
  • Ballooning +/- Mallory Denk bodies (ballooning = cell swelling, Mallory Denk = pink deposits in cells)
  • Apoptosis
  • Pericellular fibrosis
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10
Q

What causes NAFLD ?

How do you distinguish from alcoholic liver disease?

A

Insulin resistance e.g due to diabetes or obesity

Not under microscope - based on alcohol Hx

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11
Q

What is the characteristic histological features of PBC ?

A

Granulomatous destruction of bile ducts secondary to chronic inflammation

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12
Q

Which auto antibody is associated with Primary Biliary Cholangitis?

A

anti-mitochondrial antibodies (HALLMARK)

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13
Q

Describe the characteristic histological features of PSC ?

A
  • Periductal bile duct cirrhosis leading to bile duct loss
  • “Onion skinning”
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14
Q

Which disease is associated with PSC ?

A

Ulcerative colitis

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15
Q

Is cirrhosis due to biliary tract disease micronodular or macronodular ?

A

Micronodular

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16
Q

List 5 genetic causes of liver cirrhosis ?

A
  • haemochromatosis
  • wilson’s disease
  • alpha 1 antitrypsin deficiency
  • galactosaemia
  • glycogen storage disease
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17
Q

What is the most common benign liver tumour ?

A

Haemangioma (endothelial cells)

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18
Q

Which zone in liver lobules is the first to be affected by alcoholic liver disease ?

A

Zone 3 (these are most metabolically active)

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19
Q

Which HLA is associated with autoimmune hepatitis ?

A

HLA-DR3

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20
Q

List 3 auto antibodies seen in autoimmune hepatitis ?

A

ANA
Anti-Smooth muscle antibodies
Anti-LKM (anti-liver-kidney microsomal antibody)

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21
Q

ERPC shows beading of bile ducts.

Most likely diagnosis ?

A

PSC (Primary Sclerosing Cholangitis)

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22
Q

What is Budd-Chiari syndrome ?

A

Compression/ Occlusion of the hepatic vein

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23
Q

Which stain is used to identify copper in Wilson’s disease “

A

Rhodanine stain (sees copper accumulating in the hepatocytes)

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24
Q

What happens to Caeruloplasmin levels in Wilson’s disease ?

A

They are reduced

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25
Q

Which genetic disease causes both Emphysema and liver cirrhosis ?

A

Alpha 1 antitrypsin deficiency

(so lung and liver problem, think this)

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26
Q

Which auto-immune disease is associated with PBC ?

A

Sjogrens

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27
Q

What is the triad for PBC ?

A

Jaundice
Xanthelasma
Pruritus

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28
Q

What is haemosiderosis

Main cause of haemosiderosis

A

Iron overload: accumulation of iron in macrophages

Blood transfusions

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29
Q

describe the dual blood supply of the liver

A

hepatic portal vein
hepatic artery

Hence why liver does not tend to get affected by ischaemic diseases

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30
Q

what are stellate cells

A
  • store vitamin A
  • when activated - become myofibroblasts and lay down collagen
  • responsible for most of the scarring in liver disease
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31
Q

which liver zone has the most metabolically active enzymes

A

3 (closest to central vein)

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32
Q

describe the process of stellate activation

A

Normal:

  • normal hepatocytes have microvilli
  • endothelial cells have no BM and have spaces between
  • stellate cells sit in the space between endothelial cells (space of disse)
  • blood gets through the endothelial cells

Liver injury:

  • kupffer cells (macrophages) activate
  • endothelial cells stick together
  • hepatocytes lose their microvilli
  • stellate cells secrete BM type collagen into space of disse
  • All this means blood finds it hard to diffuse into the hepatocytes (liver disease)
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33
Q

what is cirrhosis

A
  • fibrosis of liver
  • NB whole liver involvement
  • get intra- and extra-hepatic shunting of blood
  • intrahepatic shunting = blood comes through liver but not in contact with hepatocytes
  • extrahepatic = blood backlogs into porto-systemic anastamoses (so it is totally unfiltered and toxic)
34
Q

3 complications of cirrhosis

A

portal hypertension
hepatic encephalopathy
liver cell cancer

35
Q

causes of acute hepatitis (2)

Feature on histology

A
  • hep A and E mainly
  • drugs

Histology: spotty necrosis

36
Q

causes of chronic hepatitis (3)

A

viral hepatitis
drugs
AI

37
Q

features of NASH

A
  • hepatitis resulting from NAFLD
  • caused by insulin resistance associated with raised BMI and diabetes
  • one of commonest causes of liver disease ww
38
Q

Aetiology of Primary Biliary Cholangitis (NB not called cirrhosis anymore since not always cirrhotic)

Which gender is more common?

Mx

A

Autoimmune (Characterised by bile duct loss secondary to chronic inflammation)

Female

Urso

39
Q

Aetiology of Primary Sclerosing Cholangitis

A

Characterised by periductal bile duct fibrosis leading to loss

40
Q

Aetiology of haemochromatosis

A
  • genetically determined increased gut iron absorption
  • HFe gene on chr 6
  • iron deposition in parenchymal cells -> organ damage -> cirrhosis and HCC
41
Q

Presentation of haemochromatosis

A
  • Sx of liver damage
  • deposit in the heart, leading to cardiomyopathy
  • in the testes leading to infertility
  • bronzed diabetes: tanned complexion and in the pancreas leading to diabetes

So all in all: hepatomegaly, micronodular cirrhosis, pseudogout, hypogonadism, DM, cardiomyopathy

42
Q

what is haemosiderosis

A

iron overload
accumulation of iron in macrophages
result of blood transfusions

43
Q

what is wilsons disease

A

accumulation of copper due to failure of excretion of copper by hepatocytes into bile
chr 13
accumulates in liver and CNS and iris (KF rings)

44
Q

antibodies in AI hepatitis

A

anti-smooth muscle antibodies (ASMA)
responds to steroids

45
Q

what is alpha-1 antitrypsin deficiency

A

failure to secrete alpha- 1 antitrypsin
deficiency in the blood, excess in hepatocytes
chronic hepatitis
emphysema

46
Q

causes of hepatic granulomas

A

specific - PBC, drugs
general - TB, sarcoidosis

47
Q

list benign liver tumours

A

liver cell adenoma
bile duct adenoma
haemangioma

48
Q

list malignant liver tumorus

A

secondary (most common)
hepatocellular carcinoma
hepatoblastoma
cholangiocarcinoma (associated with PSC, worm infections, cirrhosis)
hemangiosarcoma

49
Q

What happens to liver of someone who drinks and is this reversible?

A
  • Get fatty changes (white parts = fat droplets)
  • REVERSIBLE
50
Q

Cancer at increased R in Primary Sclerosing Cholangitis

A

cholangiocarcinoma

51
Q

Marker that increases in Primary Sclerosing Cholangitis

A

pANCA

52
Q

Primary Sclerosing Cholangitis vs Primary Biliary Cholangitis - key difference in aetiology

A

in PBC, the bile duct loss is caused by inflammation, whereas in PSC, it is caused by fibrosis

53
Q

Mx of haemochromatosis

A

Venesection, iron chelation with desferrioxamine

54
Q

Stain for haemochromatosis

A

Prussian Blue

55
Q

Diagnostic lesion for PBC

A

bile duct is surrounded by epithelioid macrophages suggestive of granulomatous destruction of bile ducts

56
Q

Liver colour in cirrhosis

Type of cirrhosis in terms of size

A

Pale (+ fatty change)

micronodular cirrhosis

57
Q

Most characteristic immune cell seen in alcoholic hep

A

neutrophil polymorph

58
Q

Alcohol vs acetaldehyde in terms of toxicity

A

alcohol is NOT toxic, but acetaldehyde IS TOXIC

the cells that get damaged are the ones that contain the most alcohol dehydrogenase, thereby having the greatest capacity to produce acetaldehyde

59
Q

3 histological patterns in alcoholic liver disease

A
  • Fatty liver
  • Alcoholic hepatitis (fatty liver hepatitis)
  • Cirrhosis
60
Q

Grade vs stage meaning in chronic hepatitis

A
  • Severity of inflammation = GRADE (how bad does it look)
  • Severity of fibrosis (scarring) = STAGE (how far is the patient from cirrhosis)
61
Q

Can cirrhosis be reversible?

A

Yep - If the underlying cause is treated i.e. alcoholism (which is tricky) or viral hepatitis (which is easily done with new medications), then it can reverse the cirrhosis

62
Q

Micro vs macronodular in terms of cause

A
  • Micronodular (< 3mm): tends to be associated with alcoholism and insulin resistance (producing fatty change) as well as biliary tract disease
  • Macronodular (> 3mm): tends to be associated with viral infections (these tend to be causes of chronic viral hepatitis, B C, D) + Wilson’s disease and a1-antitrypsin
63
Q

What is the portal triad

A

hepatic artery, portal vein and bile duct

64
Q

Name of ring of collagen surrounding portal triad

A

limiting plate

65
Q

What colour does the collagen in the liver stain?

A

Blue (distinct from purple of rest of liver)

66
Q

What is bridging fibrosis?

A

CRITICAL feature for intra-hepatic shunting:

Blood comes into the portal tract and instead of trickling past the hepatocytes and into the central vein, it takes a short cut from the portal tract straight into the central vein (NOT coming into contact with hepatocytes)

67
Q

Aetiology of Wilson’s disease

A

accumulation of copper in liver due to the failure of excretion of copper by hepatocytes into the bile

68
Q

Where does the copper in Wilson’s deposit, there what is presentation?

A

Liver, CNS, iris

  • Liver: acute hepatitis, fulminant liver failure or cirrhosis
  • CNS: parkinsonism, dementia, psychosis
  • Iris: Kayser-Fleischer rings
69
Q

Mx of Wilson’s

A

penicillamine

70
Q

Degree of inflammation in autoimmune hep vs viral hep

A

degree of inflammation is much more marked in autoimmune hep

71
Q

Mx of autoimmune hep

A

Steroids

72
Q

Aetiology of alpha-1 antitrypsin def

A
  • failure to secrete a1-antitrypsin from hepatocytes
  • NB deficiency of a1 anti-trypsin in the BLOOD but there is a gross excess in the liver
  • Therefore you get a1-antitrypsin forming globules within the hepatocytes, damaging them and resulting in chronic hepatitis and cirrhosis
73
Q

Which zones are mainly affected in paracetamol toxicity?

A

Zone 2, but mainly 3 (so furthest away from portal triad on histology, you’ll get paler parts on the outside which are the parts that have been damaged)

74
Q

Cause of caseating granuloma in liver

Cause of non-caseating

A

TB/Sarcoidosis

PBC

75
Q

Hepatic adenomas are associated with what?

A

oral contraceptive pill use

76
Q

Most common tumours in liver

A

Secondary: from the GIT, breast or bronchus

77
Q

Tumours of primitive hepatocytes which mainly Occur in childhood

A

Hepatoblastoma

78
Q

adenocarcinoma arising from the bile ducts called?

What 3 things is it associated with?

A

Cholangiocarcinoma

PSC, Worm infections, Cirrhosis

79
Q

Why is the liver such a common site for secondary tumours?

A

liver is supplied by the hepatic artery which is a branch of the aorta, so tumours cells that have circulated in the systemic circulation have a good chance of getting to the liver

all the blood from the portal circulation comes to the liver (i.e. for all tumours from the stomach, small bowel, large bowel and pancreas, the liver will be the first capillary bed that they see)

80
Q

Which is the commonest carcinoma seen in the liver?

A

Metastatic adenocarcinoma

81
Q

Which hep is not associated with fatty change in liver?

A

Hep B

HistoPath (21 decks)

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