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Pathology > Lecture 13 > Flashcards

Lecture 13 Flashcards

1
Q

What are the 4 main anatomical units of the liver

A

Hepatocytes Bile duct system Vascular system Kupffer cells

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2
Q

What is the functional organisation of the liver

A

Blood flows from portal triads around periphery towards the central vein in the centre of the lobule Bile drains from hepatocytes to portal triads at centre

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3
Q

What are periportal hepatocytes affected by

A

Direct acting toxins

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4
Q

What are periacinar hepatocytes affected by

A

Activated toxins, hypoxia

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5
Q

What is hepatobiliary injury

A

Injurious agents may enter liver and biliary system by - Haematogenous - Retrograde biliary entry from GIT - Direct penetration from trauma

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6
Q

What may hepatobiliary injury cause

A

Inflammation, degeneration (reversible) or apoptosis or necrosis (irreversible)

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7
Q

What are the defence towards hepatobiliary injury

A

Kupffer cells in sinusoids Biliary tree - Mucosal immunity: IgA - Flow of bile - Sphincter at end of common bile duct

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8
Q

What is seen grossly with acute cellular degeneration: Acute swelling

A

Liver is pale and swollen

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9
Q

What is seen histologically with acute cellular degeneration: acute swelling

A

Cells are pale, swollen and finely vacuolated

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10
Q

What do you see grossly with fatty change

A

Liver is pale, yellowish, large, rounded edges

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11
Q

What do you see histologically with fatty change

A

Cells have large lipid vacuoles, nuclei pushed to the side

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12
Q

What is the nature and distribution of degeneration, necrosis and inflammatory lesions in the liver affected by

A

Route of entry Type of injurious agent Predilection for particular cell types Host response

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13
Q

What is the patterns of hepatocellular degeneration and necrosis

A

Random - no pattern to the damage - e.g. haematogenous infectious agent Zonal patterns - Periaciner/centrolobular - toxins that require activation, anaemia, heart failure - Midzonal - Massive - necrosis of entire lobule

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14
Q

What is cholecystitis

A

Inflammation of gall bladder

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15
Q

When classifying liver/biliary disease, what should you consider

A
  • Distribution and pattern of involvement - Types of inflammatory cells if present - Evidence of degeneration, necrosis or fibrosis - Evidence of regeneration - Presence of etiologic agent - Severity - Duration
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16
Q

What is seen in acute hepatitis

A

Often random distribution of inflammation - Often neutrophils esp if bacterial - May be lymphocytes if viral - Hepatocellular necrosis +/- apoptosis

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17
Q

What is seen in chronic hepatitis

A

Persistence of antigenic stimulus - Accumulation of mononuclear cells - Maybe also be neutrophils present - Fibrosis and biliary hyperplasia - May get regeneration of hepatocytes

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18
Q

What is cholangitis

A

Inflammation centred on biliary tract

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19
Q

What is cholangiohepatitis

A

Inflammation around portal triads that also extends into liver parenchyma

20
Q

What are the responses of the liver due to injury

A

Regeneration Fibrosis Biliary hyperplasia Cirrhosis Hepatic failure

21
Q

What is the cirrhosis liver

A

Diffuse process characterised by fibrosis and the conversion of the normal liver architecture into structurally abnormal lobules

22
Q

What are the responses of liver injury (fibrosis)

A
  • Increased ECM within the liver - Common in chronic/repetitive liver damage - Often severely impairs hepatic function - Pattern may assist identification of type of insult: periacinar, periportal, multifocal
23
Q

What are the responses of liver injury (bile duct hyperplasia)

A
  • Proliferation of new bile ducts in periportal area - Nonspecific response to liver injury
24
Q

What are the major determinants of the final outcome of liver injury

A
  • Whether hepatocellular injury is sustained or repetitive - Severity and extent of fibrosis - How much of the liver’s framework remains on which regeneration can take
25
Q

What does hepatocellular loss result in

A

Small liver

26
Q

What does hepatocellular hyperplasia result in

A

Randomly distributed regenerative nodules

27
Q

What is variable fatty change due to

A

Disturbances in liver lipid metabolism

28
Q
A

Acute cellular degeneration: acute swelling in liver

29
Q
A

Acute swelling in liver

30
Q
A

Fatty change

31
Q
A

Fatty change

32
Q
A

Random hepatocellular injury

33
Q
A

Zonal hepatocellular injury: accentuation of the normal lobular pattern

34
Q
A

Zonal hepatocellular injury: periacinar/centrolobular necrosis

35
Q
A

Massive necrosis

36
Q
A

Periportal necrosis

37
Q
A

Midzonal necrosis

38
Q
A

Massive necrosis

39
Q
A

Massive necrosis

40
Q
A

Regeneration: stem cell hyperplasia and biliary hyperplasia

41
Q
A

Chronic nodular hyperplasia

42
Q
A

Periportal fibrosis and bile duct hyperplasia

43
Q
A
44
Q
A

Cirrhosis

45
Q
A

Cirrosis

46
Q
A

Cirrhosis

Pathology (26 decks)

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