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Hugh's MD1 Abdominal > Liver pathology > Flashcards

Liver pathology Flashcards

(64 cards)

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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
Which zone of hepatic lobules is most sensitive to toxic and ischaemic damage?
3
20
What are the clinical signs of chronic liver disease?
Jaundice Hepatomegaly Splenomegaly Ascites Varices Spider naevi Abdominal wall collaterals Palmar erythema Gynaecomastia Testicular atropy Clubbing Asterixis Dupuytrens contracture
22
Where does apoptosis and inflammation occur in the liver during chronic hepatitis?
Portal and periportal (ie in and around the portal triad)
23
What is more severe NASH or alcoholic steatohepatitis?
Alcohol steatohepatitis
24
T/F Acute hepatitis usually involves the whole liver
True
24
How is interface hepatitis graded?
By the degree with which lymphocytes are escaping the portal tract
25
What is the hallmark feature of steatohepatitis?
Hepatocellular ballooning degeneration
26
What the most common causes of chronic hepatitis?
Hep B and C
27
What is the main immune cells present in viral hepatitis?
T lymphocytes
27
What is histologically in chronic hepatitis?
Periportal inflammation
28
T/F Neutrophils are present in viral hepatitis?
False, mainly T cells
29
What are the causes of chronic hepatitis?
Hep B, C and autoimmune hepatitis
30
What does vascular remodelling do the progression of cirrhosis?
Causes areas of local ischaemia \> accelerates cirrhosis, particularly important in late stage development
31
What are the cells that contribute to cirrhosis pathogenesis?
Stellate cells
32
What are the three complications of cirrhosis?
Parenchymal liver failure Endocrine Portal hypertension
34
What is the liver damaged by with paracetamol use?
The toxic metabolite of paracetamol NAPQI directly injures hepatocytes and causes the depletion glutathione
35
What is the most important enzyme for acute hepatitis in liver functions tests?
ALT (alanine transaminase)
36
T/F NAFLD is only in adults
False, children too
37
How do you measure portal vein pressure?
Doppler ultrasound
39
What is the primary form of cell death in acute viral hepatitis?
Apoptosis
41
T/F There is an inflammatory response in paracetamol induced liver damage
False
42
What is the pressure values in portal hypertension?
Portal pressure \>8mmHg or Pressure gradient from portal to hepatic veins of \>5mmHg
44
What is the hallmark feature of chronic and acute hepatitis?
Apoptosis
45
What is cryptogenic cirrhosis?
A previously used terms for cirrhosis with an idiopathic cause - now replaced by NAFLD
46
What syndromes come under the umbrella of chronic liver disease?
Chronic hepatitis Alcohol liver disease NASH Metabolic disease eg Haemochromatosis Chronic obstruction of bile duct Drugs
47
What is NASH?
Non-alcoholic steatohepatitis
49
What is the definition of chronic hepatitis?
Raised serum aminotransferase for \>6 months
50
What can happen to the central vein in alcoholic hepatitis?
Fibrosed
51
What are some things that can be done to help diagnose the cause of cirrhosis?
Hep B and C screening Alcohol history Autoimmune markers BIle duct obstruction
52
What are fibrous septa?
Bands of collagenous fibrosis radiating out from portal triads
54
What type of damage does paracetamol do to the liver?
Coagulative necrosis
55
What is steatohepatitis?
Macrovescicular steatosis with accompanying inflammation and hepatocyte injury
56
How does the pattern of fibrosis in NASH and ASH differ from that in chronic hepatitis?
It is pericellular cf to intertriad
57
What type of steatosis is most common?
Macrovescicular (large droplet) cf to microvescicular (small)
58
What infiltrate is present in viral hepatitis?
T cells
59
Describe the anatomy of cirrhosed liver
Nodules of regenerating tissue surrounded by bands of scar tissue
60
How does alcoholic acute hepatitis present?
Jaundice Fever Right upper quadrant tenderness
62
What is the mortality rate of acute alcohol hepatitis?
20-30% \> increases to 50% if surgery is performed
63
What is a pre-sinusoidal cause of portal hypertension?
Portal vein thrombosis
64
What is a varix?
Dilated segment of a vein

Hugh's MD1 Abdominal (21 decks)

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