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Liver Pathology Flashcards

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1
Q

What is liver blood supply?

A

Dual- portal vein and hepatic artery

Makes vascular disease of the liver a non event.

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2
Q

What are the cells in liver?

A 
Hepatocytes
Bile ducts
Blood vessels
Endothelial cells
Kupffer cells
Stellate cells
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3
Q

Where are the enodothelial cells found?

A

They line the sinusoids, unique.

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4
Q

What are kupffer cells?

A

The resident macrophages of the liver

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5
Q

What do stellate cells do in healthy people?

A

They store vitamin A

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6
Q

What do stellate cells do when activated?

A

They become myofibroblasts, producing collagen.produce scarring.

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7
Q

What is in the portal tract?

A

Portal vein, hepatic artery and bile duct.

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8
Q

Where does the blood from the portal tract flow?

A

The portal vein and hepatic artery blood mix together and flow down the sinusoids. They emerge through the hepatic vein which leads to the IVC.

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9
Q

What are the 3 zones in the liver?

A

The peri-portal zone, a mid zone and a peivenular zone.

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10
Q

Why does relative hypoxia in zone 3 matter in unhealthy people?

A

Alcoholic liver disease

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11
Q

What is border between the portal tract and the hepatocytes called?

A

The limiting plates

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12
Q

What are sinusoids lined with?

A

Endothelium

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13
Q

What are in sinusoids?

A

Kupffer cells

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14
Q

What is between the endothelium of the sinusoids and the hepatocytes?

A

Stellate cells

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15
Q

What are the two unique properties of endothelium cells?

A

They don’t sit on a basement membrane.

They are discontinuous.

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16
Q

Where does the blood go from the sinusoids?

A

They go between the hepatocytes, and do homestatic function

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17
Q

What happens to the liver when it is injured?

A

The kupffer cells are activated, they deal with the by products of inflammation.
The endothelial cells stick together and secrete a basement membrane.
The stellate cells become myofibroblasts and secrete collagen.
The microvilli from the hepatocytes are gone.

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18
Q

What is the space between the endothelial cells and hepatocytes where collagen is secreted by myofibroblasts?

A

Space of Disse

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19
Q

Why does the liver work badly when injured?

A

It doesn’t come in contact with the blood

Its own nutrition is impaired.

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20
Q

What is the official definition of cirrhosis?

A

End stage liver disease regardless of its cause.

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21
Q

What does cirrhosis entail?

A

The whole liver is involved
Fibrosis
There are nodules of regenerating hepatocytes.
Functionally most important- distortion of liver vasculature. Intra and extra hepatic shunting of the blood.

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22
Q

Extra hepatic shunts?

A

Blood bypasses liver in oesophageal varices, rectal varices, umbilical varices. Liver function and nutrition impaired.

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23
Q

What are nodules in the liver?

A

A group of regenerating hepatocytes surrounded by a fibrous cuff.

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24
Q

How many ways can you classify cirrhosis?

A

2

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25
What is one way to classify cirrhosis?
According to nodule size | Micro or macro nodular. Or mixed.
26
What is the size difference between a micro and macro nodule?
3 mm, that is the size of a normal physiological liver lobule.
27
What other way can you classify cirrhosis?
By aetiology Alcohol/insulin resistance (UK) Viral hepatitis (global)
28
What is the most useful way to classify cirrhosis?
By aetiology, informs treatment. Size is outdated.
29
What size nodules does alcohol produce?
Micronodular (s Africa they are macro- people here drink everyday, liver doesn't get a chance to recover).
30
What size nodules does viral hepatitis produce?
Macronodular
31
What are the complications of cirrhosis?
Portal hypertension due to shunting Hepatic encephalopathy, toxins go to Brain Liver cell cancer- biggest risk factor is cirrhosis
32
What can happen to the spleen in portal hypertension?
Chronic passive congestion, much like the lung in right sided heart failure.
33
What can happen if you aggressively treat the cause of cirrhosis in a number of patients?
You can reverse it. Paradigm shift.
34
What are the causes of acute hepatitis?
Viruses (any of the hepatic viruses) key cells are lymphocytes Drugs
35
What is the histology of acute hepatitis?
Spotty necrosis
36
What are causes of chronic hepatitis (6 months or more)?
Viral hepatitis (B, C, D) d only occurs if b is there already Drugs Auto immune
37
What two histological features are you looking for in chronic hepatitis?
Grade- severity of inflammation | Stage- severity of fibrosis
38
What happens in interface hepatitis?
The limiting plates disappear, inflammation at the interface between the portal tract and the lobule. Piecemeal necrosis. But it's actually apoptosis.
39
What is a bridge?
Link between a portal tract and the central vein- fibrosis.
40
What is the sequalae in hepatitis?
Acute infection, chronic infection, cirrhosis, cancer.
41
What are the histological patterns caused by alcoholic liver disease?
``` Fatty liver (reversible) Alcoholic hepatitis (fatty change plus inflammatory cells which are neutrophils, damage to hepatocytes) Cirrhosis micro nodular ```
42
What are mallory desk bodies?
Occurs in alcoholic hepatitis. Alcohol dehydrogenase breaks down alcohol to toxic acetaldehyde. It binds to lysine residues causing cross linking of proteins in the cell especially cytoskeleton of damaged hepatocytes.
43
What are mallory desk bodies also associated with?
Ballooning of hepatocytes, cells lose their cytoskeleton.
44
What is another feature in fatty liver alcoholic hepatitis?
Peri cellular fibrosis in contrast to bridging in viral hepatitis
45
What is one of the main causes of non alcoholic fatty liver disease?
Insulin resistance associated with raised bmi and diabetes. | Looks like alcoholic liver disease. Neutrophils, ballooning, mallory denk bodies, pericellular fibrosis.
46
What is primary biliary cirrhosis?
Bile duct loss associated with chronic inflammation with granulomas,not actually cirrhosis. Anti mitochondrial bodies. Middle aged ladies
47
What is a granulomas?
An organised collection of activated macrophages
48
What is primary sclerosing cholangitis?
There is periductal bile duct fibrosis leading to loss It's associated with UC Increased risk of cholangiocarcinoma
49
How do you diagnose PSC.
Visualise bile ducts with ERCP
50
What is haemochromatosis?
Genetically determined disease, where there is increased gut iron absorption Chromosome 6 Presents later in life
51
What is a complication of haemochromatosis?
There is parenchyma not damage to organs secondary to iron deposition, leading to bronzed diabetes
52
What effect does haemochromatosis have on the liver?
Damages the hepatocytes, causing cirrhosis
53
What is haemosiderosis?
The iron accumulates in macrophages. | Due to excessive blood transfusion. Or parental iron injection
54
What is Wilson's disease?
Accumulation of copper due to failure of excretion by hepatocytes- there is a lack of the transporter protein into the bile. Chromosome 13 Happens in liver and CNS leading to hepato-lenticular degeneration
55
What stain is used for copper?
Rhodanine stain
56
What are kayser-fleischer rings?
Copper desemates membranes in cornea- wilsons.
57
What are the features of autoimmune hepatitis?
Interface hepatitis with plasma cells Anti-smooth muscle actin antibodies Responds to steroids Women
58
What is alpha one anti trypsin deficiency?
``` Rare. Affects liver and lungs Failure to secrete alpha one antitrypsin- lots in liver cells, none in the blood Intramcytoplasmic inclusions Hepatitis and cirrhosis Lung- pan acinar emphysema ```
59
Why does alcohol mostly affect zone 3?
Hepatocytes are born near portal tract. Then they mature near central vein in zone 3. They have the most enzymes including alcohol dehydrogenase. The same system metabolises paracetamol.
60
Which diseases cause granulomas specifically in the liver?
PBC | Drugs
61
What are the general causes of granulomas in the liver?
TB | Sarcoidosis
62
What is the commonest liver tumour?
Haemangioma
63
What are the benign liver tumours?
Liver cell adenoma Bile duct adenoma Haemangioma
64
What is different about the epidemiology of liver cell adenoma?
It's very rare, but with the intro of the OCP, it became common. Now fallen again. Common in women. Well demarcated.
65
What are the malignant tumours?
Secondary (most common carcinoma of the liver) and primary (developing countries).
66
Why is the liver a common site for secondary tumours?
Any tumour arising from the portal vasculature bed, it will firstly go to the liver. They are adenocarcinomas- commonest liver biopsy in the UK. pancreas, stomach,small and large bowel.
67
What are the primary malignant tumours?
Hepatocellular carcinoma Hepatoblastoma (children) Cholangiocarcinoma Haemangiosarcoma
68
What is liver cell cancer associated with?
Elderly men in the west, usually with cirrhosis, most important risk factor.
69
What is cholangiocarcinoma associated with?
Increased risk of PSC Worm infections Cirrhosis
70
Where can cholangiocarcinoma arise from?
Anywhere in the biliary tree. The intrahepatic ducts Extra hepatic ducts including gall bladder They can present as primary or secondary in the liver
71
Which hepatitis is not associated with fatty change in the liver?
Hep B
72
How much does the liver weigh?
1500g

Histopathology (4 decks)

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