Liver pathology Flashcards Preview

Hugh's MD1 Abdominal > Liver pathology > Flashcards

Flashcards in Liver pathology Deck (64):
1

What are some risk factors for NASH?

Obesity

Diabetes

Metabolic syndrome

1

What do you screen for when cirrhosis is found?

Oesophageal varices

2

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

False, steatohepatitis is required for a high risk

2

What makes the nodules present in cirrhosis green?

Cholestasis

3

What histopathology is typical of acute viral hepatitis?

Lobular disarray - cell swelling, disordered plates, irregular sinusoids

Apoptosis

3

What attracts neutrophils in alcoholic hepatitis?

Mallory bodies

3

What diseases lead to cirrhosis?

All of the chronic liver diseases

- Chronic hepatitis

- Alcoholic liver disease

- NASH

- Chronic billary obstruction

- Drugs

- Metabolic disease

3

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

Apoptosis and inflammation of hepatocytes

3

When is hepatic carcinoma in cirrhosis seen the most?

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

4

What is the pathogenesis of portal hypertension due to cirrhosis?

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

5

What is hepatic encephalopathy caused by?

Accumulation of ammonia in the brain

6

What other organs get cirrhosis?

None, cirrhosis is a term used purely for the liver

8

How do you differentiation ASH and NASH?

Clinical history

9

What is a councilman body?

A hepatocyte undergoing apoptosis

10

What is septa fibrosis the precursor for?

Cirrhosis

10

What is the greatest cause of portal hypertension?

Cirrhosis

12

Is hepatocellular ballooning due to water or lipid accumulation?

Water

13

What are the 4 feature of alcoholic hepatitis?

Mallory bodies

Fat vacuoles

Neutrophil infiltration

Swollen hepatocytes

 

 

14

What is the meaning of interface hepatitis?

Periportal inflammation

15

Describe the pathogenesis of cirrhosis

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

16

What is a postsinusoidal cause of portal hypertension?

Thrombosis of hepatic veins

17

What are mallory bodies?

Collapsed cytoskeleton due to alcohol damage

19

What is macrovescicular steatosis caused by?

Increase synthesis of triglycerides or 

Decrease in secretion of triglycerides

19

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

Umbilicus

Oesophageal

Rectum

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