Liver Pathology

Question 1

Demographic of liver disease?

Answer 1

1.9% of all deaths due to liver disease
Eight leading cause of death

7.2/100.000/year chronic liver disease

57% Hepatitis C
24% Alcohol related
9% Non-alcoholic fatty liver
4% Hepatitis B

Question 2

Indications and purpose of a liver biopsy?

Answer 2

Indications:
Acute and chronic liver dysfunction
Hepatomegaly
Space occupying lesions

Purpose
Cause
Severity (stage of progression)

Question 3

Liver biopsy methods?

Answer 3

Open (per-operative)
Laparoscopic
Trans-jugular
Fine needle aspiration cytology
Per-cutaneous
blind
targeted

Question 4

Diagnosis of liver disease?

Answer 4

Functional abnormalities:
Metabolism
Protein
Carbohydrate
Lipid
Bile acid
Bilirubin
Hormone and drug
Removal of microbes/toxins
Exctretion
Immunological function

Pathological manifestations:
Limited number of pathological response patterns to injury

Question 5

Manifestation of liver disease?

Answer 5

Intracellular accumulation
Fatty change (steatosis)
Iron
Copper / Copper assoc. protein
Storage disease

Liver cell necrosis
Liver cell apoptosis
Inflammation
Cholestasis
Fibrosis

Question 6

Pathogenesis of liver regen and damage?

Answer 6

Question 7

Aetiology of acute liver diease?

Answer 7

ACUTE
Infective Hepatitis
Autoimmune
Toxic
Vascular Damage
Biliary Obstruction
gall stones
tumours

Metabolic

Question 8

Aetiology of chronic liver injury?

Answer 8

CHRONIC
Infective Hepatitis
Autoimmune
Toxic
Vascular Damage
Biliary Disease
primary biliary cirrhosis
sclerosing cholangitis
graft vs host disease
transplant rejection
Metabolic

Question 9

Causes of acute hepatitis?

Answer 9

Hepatitis viruses
EB Virus, CMV
Leptospirosis

Question 10

Tell me about the hep viruses?

Answer 10

Question 11

Tell me about he hep viruses and IG response in acute liver injury?

Answer 11

Question 12

Tell me about hep and IG response in chronic viral injury?

Answer 12

Question 13

Visual diff in acute and chronic hepititis?

Answer 13

Question 14

Hep B stats?

Answer 14

Question 15

Hep C stats?

Answer 15

Question 16

Autoimmune hep?

Answer 16

Acute, fulminant onset
chronic active hepatitis (anti SM, ANA, LKM1 antibodies)

Question 17

Describe changes in alcoholic liver disease?

Answer 17

Fatty change (steatosis)
Steatohepatitis:
Spotty (focal) liver cell necrosis
Neutrophils
Mallory’s hyaline:
eosinophilic globules of intermediate filaments in hepatocytes
Perivenular fibrosis
Micronodular cirrhosis

Question 18

What causes Non-Alcoholic Steato-Hepatitis (NASH)Non-Alcoholic Fatty Liver (NAFL)?

Answer 18

Diabetes mellitus
Drugs
Parenteral nutrition
Intestinal by-pass surgery

Question 19

Describe Drug-induced hepatotoxicity?

Answer 19

Intrinsic hepatotoxins
e.g. paracetamol
Idiosyncratic hepatotoxins
hypersensitivity
metabolic

May lead to
hepatitis
cholestasis
fatty change (steatosis)
fibrosis

Question 20

Causes of hepatocellular damage?

Answer 20

Question 21

Vascular pathology that causes liver disease?

Answer 21

acute:

hypotension
right sided cardiac failure
hepatic venous outflow obstruction (Budd-Chiari)

Chronic:

right sided cardiac failure
venoocclusive disease

Question 22

Hepatic venous outflow obstruction and veno-occlusive diease?

Answer 22

Membranous obstruction
Tumours
Hepatic venoocclusive disease
alkaloids
Senecio (ragwort)
Crotalaria (bush tea)
alcoholic liver disease
blood disorders
radiotherapy
cytotoxic drugs

Question 23

Biliary obstruction, acute and chronic?

Answer 23

Acute:

Gallstones

tumours

Chronic:

primary biliary cirrhosis
Antimitochondrial antibodies

sclerosing cholangitis
 With IBD (UC)

graft vs host disease
transplant rejection

Metabolic
iron overload - Genetic haemochromatosis (chromosome 6p) C282Y mutation HFE gene (see pic)

Chronic anaemia
increased absorption
multiple transfusions
High dietary intake
Alcoholic liver disease
Chronic liver failure
Porphyria cutanea tarda

-1-antitrypsin deficiency
PiZ mutation; PiZZ phenotype
Cathepsin, elastase, proteinase inhibition
Wilson’s disease (copper overload)
Chr 13 Copper transporting ATPase

Question 24

List metabolic diseases for carb, protein, glycoprotein and lipid?

Answer 24

Carbohydrate: glycogen storage disease
galactosaemia
Protein: tyrosinaemia
urea cycle disorders
Glycoprotein: mucopolysaccharidoses
Lipid: lipidoses

Question 25

What is Cirrhosis?

Answer 25

diffuse process in which the normal lobular architecture is destroyed and the parenchyma is converted into structurally abnormal nodules of liver cells separated by bands of fibrosis ## Footnote It is an irreversible condition that represents the end stage of chronic liver cell damage and regeneration occurring simultaneously

Question 26

Causes of cirrhosis?

Answer 26

Alcoholic liver disease 60%-70% Non-Alcoholic Fatty Liver Disease ? high Viral Hepatitis 10% Autoimmune hepatitis Chronic cholestatic liver disease 5-10% Iron and copper overload 5% Drugs & toxins Rare -1-antitrypsin deficiency Rare Idiopathic 10-15%

Question 27

types of nodules in cirrhosis?

Answer 27

Micronodular: nodules up to 3mm Macronodular nodules more than 3mm (up to 30mm)

Question 28

Consequences of cirrhosis

Answer 28

Impaired liver function: hypoalbuminaemia oedema reduced synthesis of coagulation factors bleeding decreased metabolism of endogenous oestrogens testicular atrophy gynaecomastia spider naevi failure of detoxification encephalopathy (decompensated cirrhosis) alcohol binge intercurrent infection gastrointestinal bleed shock hepatocellular carcinoma hepatorenal syndrome Portal hypertension: varices at sites of porto-systemic anastomosis oesophageal rectal peri-umbilical (caput medusae) splenomegaly portal vein thrombosis