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SBCP Pathology > Liver: Medical > Flashcards

Liver: Medical Flashcards

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1
Q

How many lobes does the liver have?

A

3

Right left and caudate

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2
Q

How many blood supplies does liver have?

A

2

Hepatic arterial and portal venous (65% from portal vein)

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3
Q

What drains blood from the liver?

A

Hepatic vein

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4
Q

What drains bile from liver?

A

Biliary tract

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5
Q

What is in the portal triads/tracts?

A

Hepatic artery, portal vein, bile duct

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6
Q

What is the anatomical unit of the liver? Which direction does the blood flow?

A

Hepatic lobule

Hexagonal structure, at the apical points are the portal tracts and in the centre is the hepatic vein.

Blood flows form portal tracts to the centre of the lobule

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7
Q

Difference between liver lobules and acini?

A

Lobules= structural unit, hexagonal unit with central vein at the centre

Acini= functional, centred on the dual blood supply with the central veins at the periphery. Divided into zones 1-3 of oxygenation

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8
Q

Functions of hepatocytes

A

Synthesis:

  • Bilirubin
  • Albumin
  • Clotting factors

Metabolise:
-Drugs

Contain:
-Enzymes (ALT/AST/GGT)

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9
Q

Which is a better marker of acute severe liver injury, albumin or coagulation factors?

A

Coagulation factors as albumin has a much longer half life

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10
Q

Where is ALP normally found?

A

In bile

Can b raised due to muscle or bone damage

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11
Q

Which viruses can affect the liver?

A

Hepatitis A,B,C,E

Rarely EBV or CMV

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12
Q

Imiaging investigations for any suspected liver disease? (4)

A

USS/CT for bile duct dilation

ERCP/MRCP to further assess bile duct dilatation

Endoluminal USS to look for mass in pancreatic head

Fibroscan for cirrhosis

CT/MRI liver

Liver biopsy

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13
Q

Does the liver produce immunoglobulins?

A

No

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14
Q

Causes of acute liver injury?

A 
Viral hepatitis
Alcohol
Drugs
Autoimmune
Biliary disease
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15
Q

What is chronic hepatitis?

A

Hepatitis > 6 months

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16
Q

At what bilirubin level is there clinical jaundice?

A

> 30 micromol/L

Hyperbilirubinaemia is >22

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17
Q

Most common cause of pre-hepatic jaundice?

A

Haemolytic anaemia (sickle cell, thalassaemia, drugs, infections)

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18
Q

Causes of hepatic jaundice

A 
Viral hepatitis
Alcoholic hepatitis
Drug induced liver disease
Autoimmune liver disease
PSC, PBC

**End stage cirrhosis (decompensation)

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19
Q

What causes cholestasis in liver?

A

Damage to hepatocytes or intra- or extrahepatic obstruction

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20
Q

What pattern of necrosis is seen with paracetamol toxicity?

A

Confluent (Centrizonal) necrosis

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21
Q

What pattern of necrosis is seen with individual hepatocyte death?

A

Spotty necrosis

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22
Q

What patterns of liver injury can be caused by drugs?

A 
Fatty change
Centrilobular necrosis
Massive necrosis
Hepatitis
Fibrosis
Granulomatous reaction
Cholestasis
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23
Q

Causes of chronic liver disease

A 
Viral hepatitis
Autoimmune hepatitis
Drug induced
Alcohol
NAFLD
PSC/PBC
**Metabolic: Haemochromatosis, Wilson's, anti alpha trypsin 1
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24
Q

What is secondary biliary cirrhosis?

A

Chronic biliary obstruction leading to liver cirrhosis

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25
Causes of extrahepatic biliary obstruction
Stones Benign stricture from PSC Tumour
26
Symptoms of PBC
Middle aged females Itch Jaundice
27
What markers are raised in PBC?
****AMA (anti mitochondrial antibodies)*** ALP and cholesterol
28
Histology: Portal tract lymphocytic infiltrate which destroys bile ducts +/- granulomas
PBC
29
What is ductopaenia?
Bile duct destruction
30
What is PBC?
Autoimmune ductopaenia
31
What is PSC?
Chronic inflammation involving intra and extra hepatic bile ducts
32
What bowel disease is linked to PSC?
UC
33
Diagnosis of PSC?
MRCP will show beading
34
Histology: periductal 'onion skinning' concentric fibrosis, ductopaenia
PSC
35
How is bilirubin conjugated in the liver?
Made water soluble by binding to glucuronic acid by the enzyme GLUCURONYL TRANSFERASE
36
Which viruses increase risk of HCC?
Hep B and C
37
Which hepatitis has the most risk for chronic hepatitis?
C
38
What type of virus is hepatitis?
RNA
39
Transmission route of hep A?
Faecal oral Benign and self limiting, no chronic infection or risk of chronic hepatitis
40
Which hepatitis viruses have a carrier state?
B,C,D
41
Which hepatitis viruses are spread though IV use?
BCD
42
Two phases of Hep B viral growth?
Proliferative Intergrative
43
3 patterns of Hep B disease?
Acute disease and recovery Asymptomatic carrier Chronic infection and cirrhosis
44
Important marker in hep B infection?
HBsAg
45
What % of people with hep C are asymptomatic?
75% but much higher percentage develop chronic infection and cirrhosis
46
What histological pattern of liver damage is cause by chronic hepatitis?
Interface hepatitis where inflammatory cells spill into adjacent hepatocytes Also called piecemeal necrosis
47
Example of a drug which can cause chronic hepatitis?
Methotrexate
48
Which autoantibodies are present with autoimmune hepatitis
ASMA (anti smooth muscle) ANA (anti nuclear)
49
How is hepatitis graded and staged?
grade: necroinflammatory disease activity stage 0-6: degree of fibrosis and nodularity
50
True/false: Hep D infection is limited to persons already infected with Heb B
True
51
Characteristics of liver cirrhosis? (Don't learn off)
1. Diffuse irreversible disruption of liver architecture 2. Structurally abnormal REGENERATIVE nodules of hepatocytes 3. Separated by bridging bands of fibrous tissue
52
Features of decompensated liver failure
``` Jaundice Coagulopathy Encephalopathy Hypoproteinaemia Hyperaldosteronism ```
53
What causes portal hypertension?
Increased portal blood flow Hepatic vascular resistance A-V shunting Causes ascites, splenomegaly, oesophageal varices, haemorrhoids, caput medusae
54
What cancer are people with cirrhosis at risk of?
Hepatocellular carcinoma
55
Where do oesophageal varcies commonly form?
At lower oesophagus at a site of portal-systemic anastomosis
56
Most common cause of liver cirrhosis?
Alcoholic liver disease 60-70% ``` Also: NASH Viral hepatitis Biliary disease Hereditary Haemochromatosis Autoimmune hep. Wilsons Alpha 1 anti trypsin deficiency Idiopathic ```
57
Histology of alcoholic liver disease: 3 overlapping patterns. Simple ____ or fatty change (80% of cases). ______ (10-20%). Cirrohosis (10%)
Steatosis (reversible fatty change) Steatohepatitis
58
Why does alcohol damage the liver? (3 factors)
Cellular energy diverted to alcohol metabolism instead of eg fat metabolism Toxic acetaldehyde accumulation Direct stimulation of collagen synthesis by alcohol
59
Histology features of steatohepatitis
CHICKEN WIRE Hepatocyte ballooning Fat vacuoles Mallory bodies (eosinophilic globules) Neutrophil reaction Fibrosis
60
Examples of metabolic causes of chronic liver disease?
Haemochromatosis WIlson's a1 anti trypsin deficiency
61
Which gene is associated with haemochromatosis?
HFE gene mutation (C282Y)
62
Pathogenesis of haemochromatosis?
Autosomal recessive HFE gene mutation results in excessive iron absorption in small intestine
63
Complications of haemochromatosis?
Iron deposits in liver, heart, pancreas etc. ``` Bronze pigmentation DM (pancreas involvement) Cardiac arrhythmias Infertility High risk of cirrhosis and HCC ```
64
Diagnosis of hameachromatosis?
iron studies (transferrin and ferritin) Histology Genetic testing for C282Y mutation
65
Histology of haemochromatosis: ____ _____ blue stain demonstrates granular distribution of iron in hepatocytes.
Perl's Prussian blue stain
66
Treatment of haemochromatosis
Venesection and iron chelating agents
67
Inheritance pattern of WIlson's
Autosomal recessive
68
Pathology of WIlson's disease
Accumulation of copper in hepatocytes due to mutation in Cu-transporting ATPase Usually presents with brain/eye involvement
69
Histology of WIlson's
Non specific May detect Copper in liver with stains but it is very patchy
70
Diagnosis of WIlson's
Confirmed by biochemistry (serum/urine.liver tissue Cu studies)
71
Treatment for WIlson's
Penicillamine (chelating agent)
72
What characteristic Wilson's sign appears on the peripheral iris?
Kayser-Fleischer RIng
73
WHat is alpha 1 anti trypsin? How does deficiency cause disease?
It is a serum protease inhibitor, produced in the liver. (PiMM is normal phenotype, PiZZ is abnormal). Causes cirrhosis of the liver and emphysema in the lung (because elastase activity is increased)
74
What stain is used to diagnosis a1AT globules?
PAS

SBCP Pathology (24 decks)

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