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Flashcards in Liver Deck (110):
1

What congenital conditions may be found in the liver?

  1. Aplasia/ supernumerary lobes
  2. Intrahepatic cysts
  3. Portosystemic shunts

2

Describe this lesion

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The entire liver parenchyma has been disrupted by disseminated fluid-filled, soft cystic structures. Areas of tissue which are not cystic show multifocal areas of haemorrhage or yellow discolouration.

Chronic disseminated severe polycystic hepatopathy

Genetic in persians

3

What is the difference between an intra and extrahepatic shunt?

Which structures do they arise from?

Intra - within the liver - Persistence of ductus venosus

Extra - within and outside of the liver - a direct connection between HPV and vena cava/ azygous veins

4

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Intrahepatic shunt

Persistent ductus venosus

5

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Extrahepatic shunt

6

Describe the appearance of the liver of an animal which has a porto-systemic shunt.

  • Microhepatia
  • Small hepatocytes
  • Small or absent portal veins in triads
  • More arterioles in triads

 

7

Describe this lesion

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The normal anatomy of the thorax and abdomen of this cat has been severely disturbed, with the small intestine and other abdominal viscera being displaced cranially, presumably through the diaphragm.

Acute severe diffuse traumatic diaphragmatic herniation of the gastro-intestinal tract.

8

Outline the expected sequelae of hepatic torsion

Venous occlusion

Ischemia

Necrosis

9

In what situations may a liver be prone to rupture?

Trauma

Amyloidosis

Lipidosis

ie increased friability of parenchyma

10

Which of the zones of hepatic lobules is most vunerable to passive hyperaemia?

Zone 3 - closest to central vein

11

Which type of passive congestionmay be seen as an agonal change?

Acute

12

Describe this lesion.

Name a possible sequelae

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The parenchyma of the liver shows disseminated round black lesions with non-affected tissue showing either redenning or multifocally shown to be pale tan. The surface of the liver is diffusely roughened. 

Chronic disseminated severe fibrosing passive hyperaemia of the liver

Sequelae: acquired porto-systemic shunt

13

Chronic fibrosis of the liver leading to reduced and inadequate liver function.

Cirrhosis

14

What is shown here?

Possible cause?

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Dilation of non-functioning tortuous vessels between the portal vein and caudal vena cava.

Due to hepatic fibrosis/ cirrhosis

15

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Acute passive congestion due to heart failure

16

Teleangiectasis

Dilation of functional vessels - sinusoids in the liver

17

Describe this lesion

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Multifocal to coelescing black irregularly shaped (3cm across) lesions can be seen on the surface of this liver and also present on the cut surface.

Acute multifocal to coelescing severe teleangiectasis of hepatic sinusoids

18

Irregular blood-filled cystic spaces in the liver parenchyma.

Cause? 

Peliosis hepatis

Cause: focal hepatocyte necrosis

19

The most metabolically active hepatocytes are found where in hepatic ascini?

Zone 3 - centrolobular

20

Histologically how do degenerating hepatocytes appear?

Why?

  • Cloudy
  • Swollen
  • Rounded cells 

ie Hydropic degeneration

21

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Right of the image - hydropic degeneration of hepatocytes due to influx of Na+ and H2O

22

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Atrophy of the liver due to external pressure - neoplasia, dilated viscera etc

23

In which four situations can hepatic lipidosis occur?

  1. Nutritional - obesity/ fat rich diet
  2. XS FFA released from adipose due -ve energy balance
  3. Hypoxic lipidosis - decreased beta oxidation of fatty
  4. Toxic lipidosis due to decreased apoproteins

 

24

Describe this lesion

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The surface and deep tissue is focally extensively pale tan, with about 80% of the hepatic tissue being affected. The tissue itself is extremely friable when touched.

Diffuse moderate subacute hepatic lipidosis

25

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Pale yellow, greasy tissue seen with hepatic lipidosis

26

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Vacuolation and peripherisation of hepatocyte nuclei seen with hepatic lipidosis

27

Which type of stain is used for visualisation of lipids in hepatocytes?

Oil red orange

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28

What three conditions can animals be prediposed to hepatic lipidosis?

Hyperlipidaemia ​- DM, pancreatitis, hypothyroidism, hyperadrenocorticism, nutritional

  • equine hyperlipidaemia, feline idiopathic hepatic lipidosis

Ketosis - starvation, DM, pregnancy, lactation

  • Sheep; pregnancy toxaemia “twin lamb disease”

Hypoglycaemia and fatty liver syndrome in small dog breeds

29

How can ketosis lead to hepatic lipidosis

Increased demand for gluconeogenesis or glucose, impaired utilisation of glucose

Excessive breakdown of adipose tissue

Increased free fatty acids

30

Why does hyperadrenocorticism lead to hepatic lipidosis?

Action of glucocorticoids leads to: 

  • Decreased lipogenesis
  • Increased lipolysis of adipose tissue
  • Increased catabolism of skeletal muscle protein
  • Increased gluconeogenesis in the liver (↑ glycogen stores)

31

What does this PAS stained histological slide show?

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Increased glycogen storage within hepatocytes

32

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Feathery degeneration of glycogen filled cytoplasm of hepatocytes

33

What can cause increased glycogen storage in hepatocytes?

Diabetes mellitus

Glycogen storage disease

Steroid induced (exogenous/endogenous)

34

What is amyloid?

Pathological proteinaceous substance deposited between cells (in space of Dissé and sinusoids)

AA vs SAA

35

Describe this lesion

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Diffusely affected. The surface appears rough and yellow in colour and shows multifocal areas of haemorrhage and the liver has rounded edges suggesting enlargement.

Chronic diffuse severe necrotising hepatic amyloidosis

36

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Amyloid depositations within sinusoids

37

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Multifocal to coelescing moderate congenital melanosis

38

Increased iron uptake in birds and humans can lead to an accumulation of this substance.

What stain would be used for visualisation?

Haemosiderin - Haemochromatosis

Prussian blue

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39

What situations can lead to accumulation of haemosiderin in hepatocytes?

  1. Increased iron intake
  2. Erythrolysis

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40

Intoxication with which three plant types can lead to photosensitisation?

How does this work?

  • St. John`s wort (Hypericum perforatum)
  • buckwheat (Fagopyrum spp.)
  • spring parsley (Cymopterus watsoni)

Metabolism of iron porphyrins in the liver leads to build up of photosensitive uroporphyrins = photodermatitis

41

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Photodermatitis secondary to intoxication with iron porphyrins

42

Focal hepatic necrosis can be caused what aetiological agents

Herpes virus

Toxo

Disseminated pathogen

43

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Multifocal to coelescing coagulative necrosis (preservation of tissue of architecture)

Tyzzers - Clostridium piliforme

44

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Focally irregular area of hypereosinophilic hepatocytes with nuclear and cytoplasmic fragmentation.

Rabbit haemorrhagic disease

45

Describe this lesion

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Disseminated round 1x1mm pale red/tan surrounded by darker red rings.

Chronic severe disseminated necrotising hepatitis

46

Name the three types of zonal necrosis.

  1. Centrolobular/ periacinar necrosis - most frequent since they are the most metabolically active cells
  2. Mid-zonal - rare
  3. Periportal - rare (occurs with biliary inflammation/ gut pathogens)

 

47

What pathogens may lead to massive (diffuse) necrosis of the liver?

  • Infarct
  • Pigs: vitamin E/ selenium deficiency - gall bladder oedema & mulberry heart disease

48

Hepatosis dietetica can be caused by what nutritional deficiency?

What does the condition lead to?

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Vitamin E/ selenium deficiency

Associated with gall bladder oedema and mulberry heart disease

49

What is the physiological outcome of hepatic necrosis

Removal of dead hepatocytes

Regeneration of hepatic tissue - if reticular framework remains

Fibrosis with extensive injury

50

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Central-central fibrosis - connecting central veins

Chronic congestion

51

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Porto-central fibrosis

After centrolobular necrosis

52

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Porto-portal fibrosis

Portal inflammation

53

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Extensive interstitial hepatic fibrosis

54

Cirrhosis is characterised by what features?

  1. Bridging fibrosis
  2. Regenerative hepatocyte nodules
  3. Disruption of liver architecture

 

55

What gross and histological signs are present in cirrhosis of the liver?

  1. Extensive and diffuse fibrosis of parenchyma
  2. Regenerative nodules - pictured
    1. Lack lobular organisation
    2. Mitosis
    3. Hydropic degeneration
  3. Bile duct proliferation - wider bile ducts

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56

Describe this lesion.

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The liver of this dog is diffusely affected with the surface appearing rough and nighly nodular. The nodules arise due to constricting fibrosis throughout the tissue with functioning tissue remaining risen. Histologically extensive fibrosis is seen.

Chronic severe diffuse fibrosing cirrhosis.

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57

What are the most common causes of cirrhosis?

Idiopathic

CAV-1/ Lepto infection?

58

Name three potential causes of cirrhosis.

  • Parasitic - fluke and ascarids
  • Cardiac - chronic heart failure
  • Post-necrotic - toxin/ infectious agent
  • Pigment
  • Biliary
  • Toxic

 

59

What sequelae may be expected with a case of hepatic cirrhosis?

Explain.

  • Jaundice - high levels of bilirubin in the blood due to lack of processing in the liver
    • lack of excretion in bile
  • Ascites - portal hypertension (fibrosis)
  • Hepatoencephalic syndrome - liver fails to remove ammonia from the blood

 

60

What are the major components of bile?

Water

Cholesterol

Bile salts (Na+/K+)

Bile pigments - broken down haem

61

What can cause PRE-HEPATIC jaundice?

Haemolysis: IMHA

Haemorrhage: bilirubin from disintegrating erythrocytes

Infectious: Leptospirosis, EIA, Bacillus anthracis

62

Unconjugated bilirubin would be found in which type of jaundice?

Pre-hepatic

(or hepatic with hepatocyte dysfunction)

63

Unconjugated bilirubin would be found in HEPATIC jaundice in which situations.

Damaged hepatocytes are not taking up bilirubin and performing conjugation

64

Conjugated bilirubin would be found in HEPATIC jaundice in which situation?

Severe hepatocyte swelling (hydropic degeneration?) leads to blockage of outflow from the canaliculi

65

Conjugated bilirubin would be found in which type of jaundice?

Explain

Post-hepatic (and hepatic with canaliculi blockage)

Due to:

  • Duct obstruction - PARA, gall stones, external pressure
  • Closure of excretory duct
  • Fibrosis of tissue - cirrhosis
  • Cholangitis

 

66

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Accumulation of bile within hepatocytes (cannot see bilirubin)

Indicates cholestasis and maybe jaundice

67

What are seven main functions of the liver?

  1. Synthesis - glucose, LDLP, urea, plasma proteins
  2. Catabolism - lipids, ketones bodies
  3. Detoxification - intestinal tract, other organ 
  4. Secretion/excretion - bile
  5. Carb metabolism - glycogen storage and degradation, gluconeogenesis
  6. Lipid metabolism - lipid degradation, cholesterol storage and degradation
  7. Protein metabolism - synthesis, ammonia detoxification

68

What clinical signs may be expected with a presentation of hepatic failure?

  • Jaundice
  • Hypoalbuminaemia - ascities
  • Coagulopathies
  • Hypoammonaemia - encephalopathy
  • Portal hypertension- ascites

69

What histological lesions would be expected with a case of hepatic failure induced hepatic encephalopathy?

  • Cerebral oedema - status spongiosus
  • Neuronal necrosis and swelling
  • Degeneration of astrocytes - t2 alzheimer cells
  • Lacking portal veins in liver triads

 

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70

Acute hepatitis is characterised by what histological signs?

Degeneration/ necrosis of hepatocytes

Leukocyte infiltration - cell type varies with infectious agent

Leukocytes within sinusoids/ kupffer cell activation with septicaemia

71

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Cholestasis

Infiltration of sinusoids with leukocytes - septicaemia

Haemosiderin pigment depositation within cells - kupffer cells (erythrophagocytosis)

72

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Periportal inflammation seen within acute hepatitis

73

Chronic hepatitis is characterised by what histological signs?

Which breed of dog may be predisposed to this condition?

Periportal lymphoplasmacytic inflammation

Progressive fibrosis

Hepatocyte apoptosis and necrosis

Predisposed: Doberman

74

Cholangitis

Inflammation originating from the biliary tree

75

What is shown in this bile duct?

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Cholangitis

Pericholangitis

76

Triaditis

  • Feline cholangitis/ cholangiohepatitis
  • Inflammatory bowel disease
  • Pancreatitis

Clinical disease: ascitis, jaundice, polyphagia, weight loss

77

What three characteristics are seen on histology of a cat with cholangitis/ cholaniohepatitis?

  • Suppurative inflammation - degenerate neurophils
  • Lymphoplasmacytic periportal infiltration, bile duct hyperplasia and periportal fibrosis
  • Biliary cirrhosis - portoportal fibrosis, bd hyperplasia, nodular hepatic hyperplasia

 

78

What viral agents can cause hepatitis?

  1. CAV1 - infectious hepatitis
  2. EHV1
  3. CaHV1
  4. Calicivirus - rabbit haemorrhagic disease
  5. FCV - calici
  6. FIP - coronavirus

 

79

Outline the transmission and pathogenesis of CAV1

Transmission - oronasal

Pathogenesis - tonsils, LNs and lymphatics >> blood >> liver, cornea, glomerulus, vasculitis

 

80

Describe this lesion.

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Multifocal to coelescing areas of black haemorrhage affecting all of the liver tissue and penetrating the parenchyma. White friable deposites are seen over the surface (fibrin). The tissue is shiney and friable to touch.

Acute (subacute) multifocal severe haemorrhagic hepatitis

Canine adenovirus 1 - infectious hepatitis

81

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Necrotising hepatitis and intranuclear inclusion bodies associated with canine adenovirus 1 (infectious hepatitis)

82

Which equine herpes viruses have been implicated in viral hepatitis?

Which age group of horses is it seen in?

1 and 4()

Due to transplacental transmission it is seen in the aborted foetus (also necrosis of lungs, thymus, spleen, brain, adrenal glands)

83

Describe this histological lesion found in a foal

A central area of hypereosinophilic material (necrotic debris)

Areas of hyperaemia of sinusoids

Leukocytic infiltration - purple stippled nuclei

Intranuclear inclusion bodies 

Acute focal severe necrotising, hyperaemic hepatitis - associated with equine herpes virus 1 

84

Outline the mechanisms of transmission of CaHV-1.

What are the outcomes of infection?

Adult: venereal and respiratory - leads to localised replication and latent infection

Neonate: ingestion and inhalation (in utero/ fomites) - either latent infection or generalised depending on the immunocompetence

Foetus: in utero - viraemia and generalised visceral infection (death or resolution)

85

Which organs may be infected in a neonatal generalised infection of canine herpes virus?

Why?

The virus causes necrotising vasculitis which can affect multiple organs, eg brain, liver, kidney

86

Outline the mechanism of transmission of Rabbit Haemorrhagic Disease.

What is the pathogenesis?

Faecal-oral transmission

Pathogenesis - massive necrosis of the liver/ DIC

87

This virus specifically affects hepatocytes in the cat

FCV - systemic disease

88

A feline coronavirus causing granulomatous hepatitis

Feline Infectious Peritonitis - multifocal to coelescing hepatitis

89

Which bacterial agent is associated with rumenitis-liver abscess syndrome?

Fusobacterium necrophorum

Its a commensal in the rumen, with ruminal acidosis the mucosal lining is compromised and F. necrophorum get into blood vessels -> portal vein leading to liver infiltration

Necrobaciliosis

90

Describe this lesion

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Multifocal to coelescing abscesses of the liver.

Raised on the hepatic surface and extending into the parenchyma (1x1 cm)

White to yellow friable material, encapsulated

Subacute multifocal-coelescing severe necrotising, suppurative hepatitis - secondary to ruminal compromise

91

What bacterial agent is associated with disseminated hepatitis and splenitis and spread by ticks?

Tularaemia - Francisella tularensis

92

Which bacterial agent is associated with abscessation of the liver in guinea pigs?

Yersinia paratuberculosis

93

Which leptospira species are associated with bacterial hepatitis?

Canicola

Icterohaemorrhagica

Grippotyphosa

Causes chronic hepatitis and tubular necrosis of the kidney

94

Outline the pathogenesis of Leptospira associated hepatitis.

Causes loss of cell-cell junctions - mitosis of hepatocytes (due to loss of cohesiveness between cells)

95

What agent causes Tyzzers disease?

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Clostridium piliforme

Causes multifocal coagulative necrosis

96

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Proliferation of Eimeria stiedai in the bile duct epithelium

Causes multifocal hyperplastic cholangitis and hepatitis

97

Parasite causing granulomatous hepatitis.

Leishmaniasis

98

Parasitic infection causing haemorrhagic necrotic tracts in the liver - granulomatous and eosinophilic inflammation.

Acute fascioliasis - leads to black leg, chronic fascioliasis (or resolution)

99

Parasitic disease causing biliary duct hyperplasia and fibrosis in chronic cases (maybe calcification).

Chronic fascioliasis

100

Name three cestodes than can be described as hepatophilic.

Echinococcus granulosus

Echinococcus multicularis

Taenia bovis

101

Milk spot liver is caused by what parasite?

Ascaris suum

102

Describe this lesion

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Liver, multifocal to coelescing irregularly shaped white lesions. Poorly demarcated and soft to touch. 1x1cm. 

Chronic multifocal to coelescing severe parasitic intersitial hepatitis

103

What effect do toxic substances have on the liver?

Direct oxidation, denaturation and inhibition of cellular structures

Indirect - blockage of receptors, modification of proteins

104

Differentials for hepatitis

Infectious - bacterial, viral - suppurative/ disseminated/ hepatic necrosis

Parasitic - multifocal tracts/ lesions 

Toxic - massive to centrolobular necrosis

105

Toxin leading to cirrhosis, single cell necrosis and encephalomyopathy..

Pyrrolizidine alkaloidosis - ragwort

106

Toxin causing renal tubular casts and centrolobular necrosis in Bedlington terriers.

Copper toxicity

107

Aflatoxin

Apergillus flavus

108

A benign tumour of the liver caused by aflatoxins/ virus

Hepatic adenoma

109

Describe this lesion

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Poorly demarcated, infiltrative, affecting only one lobe. White to grey, firm, lobulated, slightly raised.

Hepatic carcinoma

110

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Hepatic haemangiosarcoma