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Hugh's MD1 Abdominal > Liver pathology > Flashcards

Liver pathology Flashcards

1
Q

What are some risk factors for NASH?

A

Obesity

Diabetes

Metabolic syndrome

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1
Q

What do you screen for when cirrhosis is found?

A

Oesophageal varices

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2
Q

T/F Macrovescicular steatosis predisposes one to a high risk of cirrhosis

A

False, steatohepatitis is required for a high risk

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2
Q

What makes the nodules present in cirrhosis green?

A

Cholestasis

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3
Q

What histopathology is typical of acute viral hepatitis?

A

Lobular disarray - cell swelling, disordered plates, irregular sinusoids

Apoptosis

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3
Q

What attracts neutrophils in alcoholic hepatitis?

A

Mallory bodies

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3
Q

What diseases lead to cirrhosis?

A

All of the chronic liver diseases

  • Chronic hepatitis
  • Alcoholic liver disease
  • NASH
  • Chronic billary obstruction
  • Drugs
  • Metabolic disease
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3
Q

What do all diseases that lead to cirrhosis have in common?

A

Apoptosis and inflammation of hepatocytes

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3
Q

When is hepatic carcinoma in cirrhosis seen the most?

A

When there is underlying Hep B, C, alcoholic liver disease or haemachromatosis

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4
Q

What is the pathogenesis of portal hypertension due to cirrhosis?

A

Constriction of portal arteries and veins in response to increased blood flow

Hepatic vein direct compressed by fibrous bands

Loss of small vessels due to scar tissue

Shunts of hepatic arteries into portal veins

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5
Q

What is hepatic encephalopathy caused by?

A

Accumulation of ammonia in the brain

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6
Q

What other organs get cirrhosis?

A

None, cirrhosis is a term used purely for the liver

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8
Q

How do you differentiation ASH and NASH?

A

Clinical history

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9
Q

What is a councilman body?

A

A hepatocyte undergoing apoptosis

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10
Q

What is septa fibrosis the precursor for?

A

Cirrhosis

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10
Q

What is the greatest cause of portal hypertension?

A

Cirrhosis

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12
Q

Is hepatocellular ballooning due to water or lipid accumulation?

A

Water

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13
Q

What are the 4 feature of alcoholic hepatitis?

A

Mallory bodies

Fat vacuoles

Neutrophil infiltration

Swollen hepatocytes

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14
Q

What is the meaning of interface hepatitis?

A

Periportal inflammation

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15
Q

Describe the pathogenesis of cirrhosis

A

Chronic inflammation > Stellate cells act. into myofibroblast phenotype > Activated by cytokines from Kupffer cells > Produce collagen

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16
Q

What is a postsinusoidal cause of portal hypertension?

A

Thrombosis of hepatic veins

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17
Q

What are mallory bodies?

A

Collapsed cytoskeleton due to alcohol damage

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19
Q

What is macrovescicular steatosis caused by?

A

Increase synthesis of triglycerides or

Decrease in secretion of triglycerides

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19
Q

What are the three site of anastomosis where varices can occur in portal hypertension

A

Umbilicus

Oesophageal

Rectum

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20
Q

Which zone of hepatic lobules is most sensitive to toxic and ischaemic damage?

A

3

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20
Q

What are the clinical signs of chronic liver disease?

A

Jaundice

Hepatomegaly

Splenomegaly

Ascites

Varices

Spider naevi

Abdominal wall collaterals

Palmar erythema

Gynaecomastia

Testicular atropy

Clubbing

Asterixis

Dupuytrens contracture

22
Q

Where does apoptosis and inflammation occur in the liver during chronic hepatitis?

A

Portal and periportal (ie in and around the portal triad)

23
Q

What is more severe NASH or alcoholic steatohepatitis?

A

Alcohol steatohepatitis

24
Q

T/F Acute hepatitis usually involves the whole liver

A

True

24
Q

How is interface hepatitis graded?

A

By the degree with which lymphocytes are escaping the portal tract

25
Q

What is the hallmark feature of steatohepatitis?

A

Hepatocellular ballooning degeneration

26
Q

What the most common causes of chronic hepatitis?

A

Hep B and C

27
Q

What is the main immune cells present in viral hepatitis?

A

T lymphocytes

27
Q

What is histologically in chronic hepatitis?

A

Periportal inflammation

28
Q

T/F Neutrophils are present in viral hepatitis?

A

False, mainly T cells

29
Q

What are the causes of chronic hepatitis?

A

Hep B, C and autoimmune hepatitis

30
Q

What does vascular remodelling do the progression of cirrhosis?

A

Causes areas of local ischaemia > accelerates cirrhosis, particularly important in late stage development

31
Q

What are the cells that contribute to cirrhosis pathogenesis?

A

Stellate cells

32
Q

What are the three complications of cirrhosis?

A

Parenchymal liver failure

Endocrine

Portal hypertension

34
Q

What is the liver damaged by with paracetamol use?

A

The toxic metabolite of paracetamol NAPQI directly injures hepatocytes and causes the depletion glutathione

35
Q

What is the most important enzyme for acute hepatitis in liver functions tests?

A

ALT (alanine transaminase)

36
Q

T/F NAFLD is only in adults

A

False, children too

37
Q

How do you measure portal vein pressure?

A

Doppler ultrasound

39
Q

What is the primary form of cell death in acute viral hepatitis?

A

Apoptosis

41
Q

T/F There is an inflammatory response in paracetamol induced liver damage

A

False

42
Q

What is the pressure values in portal hypertension?

A

Portal pressure >8mmHg or

Pressure gradient from portal to hepatic veins of >5mmHg

44
Q

What is the hallmark feature of chronic and acute hepatitis?

A

Apoptosis

45
Q

What is cryptogenic cirrhosis?

A

A previously used terms for cirrhosis with an idiopathic cause - now replaced by NAFLD

46
Q

What syndromes come under the umbrella of chronic liver disease?

A

Chronic hepatitis

Alcohol liver disease

NASH

Metabolic disease eg Haemochromatosis

Chronic obstruction of bile duct

Drugs

47
Q

What is NASH?

A

Non-alcoholic steatohepatitis

49
Q

What is the definition of chronic hepatitis?

A

Raised serum aminotransferase for >6 months

50
Q

What can happen to the central vein in alcoholic hepatitis?

A

Fibrosed

51
Q

What are some things that can be done to help diagnose the cause of cirrhosis?

A

Hep B and C screening

Alcohol history

Autoimmune markers

BIle duct obstruction

52
Q

What are fibrous septa?

A

Bands of collagenous fibrosis radiating out from portal triads

54
Q

What type of damage does paracetamol do to the liver?

A

Coagulative necrosis

55
Q

What is steatohepatitis?

A

Macrovescicular steatosis with accompanying inflammation and hepatocyte injury

56
Q

How does the pattern of fibrosis in NASH and ASH differ from that in chronic hepatitis?

A

It is pericellular cf to intertriad

57
Q

What type of steatosis is most common?

A

Macrovescicular (large droplet) cf to microvescicular (small)

58
Q

What infiltrate is present in viral hepatitis?

A

T cells

59
Q

Describe the anatomy of cirrhosed liver

A

Nodules of regenerating tissue surrounded by bands of scar tissue

60
Q

How does alcoholic acute hepatitis present?

A

Jaundice

Fever

Right upper quadrant tenderness

62
Q

What is the mortality rate of acute alcohol hepatitis?

A

20-30% > increases to 50% if surgery is performed

63
Q

What is a pre-sinusoidal cause of portal hypertension?

A

Portal vein thrombosis

64
Q

What is a varix?

A

Dilated segment of a vein

Hugh's MD1 Abdominal (21 decks)

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