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Liver Flashcards

(106 cards)

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1
Q

Blood supply to liver

A

Portal circulation (70-80%)
Hepatic artery (30-20%)

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2
Q

Classic lobule

A

Centrilobular region: at center of hexagon (central vein - blood out of liver, bile in)
Midzonal region: middle region
Periportial region: (portal triad, blood into liver, bile out)

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3
Q

Hepatic acinus

A

Zonal model
Zone 1 ~ periportal
Zone 2 ~ midzonal
Zone 3 ~ centrilobular

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4
Q

Portal triad

A

Portal venule
Hepatic arteriole
Bile ductule

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5
Q

Indicators of liver injury

A

Leakage enzymes (cytosolic) - ALT (dogs/cats), AST (liver and muscle), SDH (large animals)

Inducible enzymes (membrane bound) - ALP (dogs/cats), GGT- liver and biliary (all species)

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6
Q

Kupffer cells

A

Macrophages living in space of Disse
Phagocytize RBCs, accumulate iron
Also phagocytize bacteria, endotoxin, apoptosis cells, etc.
Can accumulate ceroid/lipofusin (wear and tear pigment)/lipid

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7
Q

Lipogranuloma

A

Fatty cyst
Accumulate in macrophage??

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8
Q

Stellate cells

A

Vitamin A metabolism
May —> myfibroblasts —> fibrosis
Between sinusoids and hepatocytes in space of Disse

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9
Q

Liver function

A

Protein synthesis (albumin, fibrinogen, clotting factors, globulins)
Bile metabolism/transport
Bilirubin metabolism
Drug metabolism
Conversion of toxic compounds of GI origin (i.e. NH3)
Lipid/CHO

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10
Q

Sequelae of hypoalbuminemia

A

Ascites

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11
Q

Sequelae due to coagulopathy

A

Hemorrhage

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12
Q

Primary photosensitization

A

Photodynamic compound that can’t be excreted goes to skin (e.g. St John’s wort)

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13
Q

Secondary (hepatogenous) photosensitization

A

Follows colestasis in herbivores
Phylloerythrin (catabolism of chlorophyll) or other photodynamic compound accumulates

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14
Q

Congenital porphyria

A

Hereditary defect in heme metabolism —> photosensitization

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15
Q

Hyperbilirubinemia

A

Leads to icterus/jaundice

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16
Q

Types of icterus

A

Prehepatic
Hepatic
Post hepatic

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17
Q

Prehepatic icterus

A

Caused by hemolysis
Causes vary (immune-mediated, infectious, trauma, metabolic, toxin, etc)
Increased unconjugated bilirubin

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18
Q

Hepatic icterus

A

Liver disease comprises ability to uptake/excrete bilirubin
Increased conjugated and unconjugated bilirubin

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19
Q

Posthepatic icterus

A

Bile duct obstruction —> increased conjugated bilirubin

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20
Q

Hepatoencephalopathy

A

Inability to detox NH3 —> travels to brain and produces neurological signs

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21
Q

Reaction to liver injury

A

Hydropic or vacuolar degeneration
Glycogen accumulation
Fatty change/lipidosis
Storage disorders
Necrosis
Inflammation
Bile stasis

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22
Q

Vacuolar hepatopathy

A

Reversible injury
- hepatocellular swelling
- glycogen accumulation
- hepatic lipidosis

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23
Q

Hepatocellular swelling

A

Cells accumulate water due to inability to maintain fluid/ionic homeostasis
First sign of must injury

Swelling with pale staining cytoplasm

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24
Q

Glycogen accumulation

A

Hepatocytes swelling with clear cytoplasm, WITHOUT displacement of nucleus from cell center

Usually midzonal

Orangey hue to liver

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25
Steroid hepatopathy
ONLY in dogs Associated with glucocorticoids —> accumulation of glycogen in hepatocytes
26
Hepatic lipidosis
Vacuoles of lipid in cytoplasm of hepatocytes Yellowy liver
27
Mechanisms of fatty Change in liver
Over-ingestion of fats or carbs (leading to FA synthesis) Mobilization of fatty stores Decreased oxidation of FAs Decreased apoprotein in synthesis Decreased export of lipoproteins
28
Tension lipidosis
Lipid accumulations at edges of liver due to anoxic environment created by tension
29
Feline fatty liver syndrome
Hepatic lipidosis in cats - usually a larger cat going off feed
30
Storage disorders
Accumulations in hepatocytes/Kupffer cells due to inherited metabolic disorders Need to identify storage product and enzyme deficiency/defective gene for definitive diagnosis
31
Requirements for definitive diagnosis of storage disorder
Identification of storage product and enzyme deficiency / defective gene
32
Canine copper-associated hepatopathy
Accumulation of copper in hepatocytes, overlap with chronic hepatitis Cu accumulates in centrolobular hepatocytes —> necrosis and inflammation —> chronic hepatitis/cirrhosis
33
Breeds with predilection for copper-associated hepatopathy
Bedlington terrier West highland white terrier, Dalmatian (familial association) Doberman pinschers, labs, cocker spaniels (breed predisposition)
34
Stain for detecting Cu
Rubeanic acid stain
35
Types of necrosis
Liquefactive Coagulative
36
Patterns of necrosis
Focal Multifocal Confluent Bridging Massive Piecemeal
37
Pattern of necrosis indicating infectious agents
Multifocal random
38
Pattern of necrosis indicating toxic or nutritional cause
Massive
39
Pattern of necrosis indicated toxic or hypoxic cause
Zonal
40
Hepatitis
Inflammation of liver parenchyma
41
Cholangitis
Inflammation of bile ducts
42
Cholangiohepaitits
Inflammation of bile ducts with extension into liver parenchyma
43
Cholecystitis
Inflammation of the gall bladder
44
Choledochitis
Inflammation of the larger/common bile ducts
45
Bile stasis / colestasis
Bile in canaliculi or bile ducts Intracellular or extra/post-hepatic Due to toxins, inflammation, duct obstruction Often with Hyperbilirubinemia Inc in inducible enzymes in circulation
46
Pyrollizidine alkaloid toxicosis
Specific toxic insult in horses —> bile stasis
47
Sequelae of necrosis and inflammation
Regeneration > fibrosis > bile duct hyperplasia Cirrhosis
48
Cirrhosis
severe diffuse (bridging) hepatic fibrosis with nodular regeneration and bile duct hyperplasia
49
Fibrosis and nodular regeneration
Bands of fibrosis between nodules of normal (restored) hepatic tissue Often seen with chronic hepatitis Visualization of fibrosis with Masson’s trichrome or Van Gieson’s stain
50
Sequelae of cirrhosis
Portal hypertension —> multiple acquired portosystemic shunts —> Ascites Loss of hepatic function —> insufficiency —> failure—> coagulopathy, Hyperbilirubinemia, hepatoencephalopathy, edema, Ascites, photosensitization
51
Congenital liver disease
Hereditary Hyperbilirubinemia Storage diseases Peritoneal-pericardial diaphragmatic hernia Vascular shunts (common) Biliary abnormalities
52
Biliary cysts
Nodules will be greenish or yellowish in color Can be multifocal or focal
53
Traumatic insult to liver
Displacement through hernia Rupture Hematoma from blunt trauma Lobar torsion (may occur with trauma)
54
Factors predisposing liver to rupture
Hepatitis Neoplasia Fatty liver Amyloidosis
55
Amyloidosis
Eosinophilic material in space of Disse Atrophy of adjacent hepatocytes, dilation of sinusoids; Lugol’s iodine to see amyloid (black) Increases friability of liver Can be associated with inflammatory conditions (secondary/reactive amyloid), breed predisposition Can hemorrhage with biopsy
56
Vascular causes of liver injury
Congestion Infarction Portal thrombi Portosystemic shunts/vascular anomalies
57
Passive congestion in liver
Secondary to CHF Can form fibrosis “Nutmeg” liver - blood pooling and loose
58
Congenital portosystemic shunt
Often leads to hepatic hypoplasia/microhepatica Typically a single, less tortuous shunt Small stature, anesthetic intolerance, behavior abnormalities, head pressing, seizures, GI signs, …
59
Acquired portosystemic shunt
Tend to be multiple, extra-hepatic, tortuous Ascites may develop Associated with cirrhosis, portal hypertension
60
Intrahepatic portosystemic shunt more frequently found in
Large breed dogs (patent ductus venosus)
61
Extrahepatic portosystemic shunt more frequently found in
Small breed dogs, cats, ferrets
62
Primary portal vein hypoplasia
Microvascular dysplasia Non-cirrhosis portal hypertension Congenital
63
Peliosis hepatis (telangiectasia)
Dilation of small groups of sinusoids Generally incident finding Primarily in cattle/cats
64
Causes of inflammatory liver disease
Viral Bacterial Fungal Parasitic Idiopathic (serum hepatitis in horse, chronic hepatitis in dogs, lobular dissecting hepatitis) Cholangitis
65
Infectious canine hepatitis
Canine adenovirus 1 Rare due to vaccination Edema blue eyes Necrosis/inflammation of liver (Also caused turkey spotted kidney)
66
Viral causes of hepatitis
CAV-1 (dogs) Herpesviruses (mammals, birds) Coronaviruses (FIP virus, murine coronavirus) Rift Valley fever (ruminants)
67
Bacterial causes of hepatitis
Clostridium spp Salmonella spp Leptospirosis Mycobacteria spp
68
Parasitic causes of hepatitis
Protozoa (T. Gondii, N. Caninum, Eimeria stiedae) Nematodes (larval migrans, Ascaris suum) Cestodes (cysts in liver) Trematodes (Fasciola spp, Fascioloides spp)
69
Tyzzer’s disease
C. Piliforme (Gram NEGATIVE clostridium) Obligate intracellular K9, Equine
70
Fibrinous cholecystitis
Caused by Salmonella Inflammation of gall bladder
71
Clostridium hemolyticum
Bacterial cause of hepatitis Focally extensive, bacillary haemoglobinuria
72
Clostridium novyi
Infectious necrotic hepatitis / black disease In cattle / sheep Proliferate in area of ischemia often associated with a liver fluke
73
Liver abscesses
Common in cattle Associated with omphalitis Often Fusobacterium necrophorum in large animals Also Salmonella, Lepto, Mycobacteria Multifocal necrosis
74
Granulomatous hepatitis can be caused by
Mycobacterium spp Histoplasma capsulatum (fungi)
75
Eimeria stediae
Causes severe proliferative hepatitis in rabbits Proliferative colangitis
76
Milk spot liver caused by
Ascarid migration in pigs (A. suum)
77
Hepatic tremadoiasis
Fasciola hepatica - bovine Opisthorchis felineus - felin
78
Serum hepatitis / Theiler’s disease
(Small friable) Dish rag liver in horses with severe diffuse centrilobular necrosis Historically associated with administration of xenobiotics, vaccines, idiopathic Most recently suggests Equine parvovirus hepatitis Acute massive necrotizing hepatitis
79
Chronic Canine Hepatitis
Chronic inflammation of liver (often periportal) Lymphocytes, plasma cells, few neutrophils Most canine hepatitis is idiopathic Approximately 1/3 associated with excess Cu
80
Chronic (lymphocytic) Cholangitis in cats
Chronic inflammation of bile duct/ductules Often associated with IBD/pancreatitis (triaditis) Idiopathic Histologically may overlap with small cell lymphoma —> immunohistochemistry may be needed
81
Lobular dissecting hepatitis
Rare idiopathic inflammatory disease Young to middle aged large breed dogs Mixed inflammation with fibroplasia throughout sinusoids (separates hepatocytes) Poor prognosis
82
Acute neutrophilic (Suppurative) Cholangitis
Believed to involve ascending bacterial infection, in rare occasions, obstruction of extrahepatic bile ducts Cats > dogs Histo: onion skin like lesions, looser/more clear space than lymphocytic Cholangitis
83
Predictable (e.g. toxin)
Dose-dependent
84
Idiosyncratic
Individual response (i.e. dose independent toxin)
85
Direct toxin
Toxic as ingested
86
Indirect toxin
Toxic as metabolized
87
Mechanisms of hepatoxicity
DNA damage (alkylation, intercalating) RNA damage (binding RNA polymerase, impair RNA transcription) Inhibition of lysosomal enzymes Production of free radicals - membrane damage Canalicular damage —> bile stasis/icterus Stimulation of apoptosis Idiopathic
88
Manifestation of liver toxicity
No morphological abnormalities (biochem only) Fatty change / lipidosis Cell swelling Bile stasis Necrosis
89
Examples of toxins
Pharmaceuticals (NSAIDs, phenobarbital) Plants Mushrooms Algae
90
Acute copper toxicity results in liver disease in … grazing on pasture high in … and low in … Often associated with a stressful event
Sheep Cu Mo
91
Hepatosis dietetica
Liver disease in swine attributed to Vit E / Se deficiency
92
Pathogenesis of Hepatosis dietetica
Lack of antioxidants —> massive centrilobular necrosis by ROS damage
93
Hepatosis dietetica is seen in combination with what cardiovascular disease?
Mulberry heart disease
94
Hepatocutaneous syndrome is associated with what other disease condition
Superficial necrolytic dermatitis (severe keratosis of paws/nose)
95
Cystic mucosal hyperplasia of the gall bladder
Incidental finding
96
Nodular hyperplasia
Incidental finding Most dogs >10 will develop 0.5 to 10 cm nodules
97
Hepatocellular adenoma
Single large mass Uncommon, but present in dogs; rare in other species
98
Cholangiocellular (biliary) cystadenoma
Green or yellow tumor in liver Singular or multifocal
99
Gall bladder adenoma
Occurs uncommonly in dogs
100
Hepatocellular carcinoma
Uncommon in dogs (rarely metastatic) Rare in other species
101
Cholangiocellular (bile duct) carcinoma
Biliary duct tumor Umbilicated lesions Highly infiltrative and metastatic Uncommon, but both dogs and cats
102
Metastatic tumors affecting the liver
Lymphosarcoma Metastatic (pancreatic) carcinoma Diffuse mast cell tumor Histiocytic sarcoma Hemangiosarcoma
103
Gall bladder lesions
Cystic mucosal hyperplasia Mucocele Infarction / cholecystitis Choleliths (stones)
104
Mucocele
Kiwi fruit ultrasound Accumulation of inspissated bile and/or mucin in gall bladder Idiopathic May lead to obstruction / rupture
105
Cholelithiasis
Infrequent May lead to obstruction
106
Cholecystitis
Secondary to pressure necrosis/inflammation with obstruction or ascending bacterial infection

Pathology (21 decks)

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