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MD2 Surgery and Anaesthesia > Liver Pathology > Flashcards

Liver Pathology Flashcards

(58 cards)

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1
Q

What is the classical liver lobule?

A

Unit drained by central vein

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2
Q

What is the portal lobule?

A

Unit supplied and drained by portal triad

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3
Q

What is the central acinus?

A

Unit supplied and drained by terminal branches of portal triad

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4
Q

What are the three acinar zones?

A 
1
- Most nutrients and oxygen
- Most toxic metabolites
2
3
- Least nutrients and oxygen
- Most susceptible to ischaemic change
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5
Q

What causes ascites?

A

HTN in portal tract

Low albumin levels

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6
Q

Which liver function tests tell you about liver synthesis function?

A 
Albumin
Prothrombin time (INR)
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7
Q

Which liver function tests tell you about hepatocellular damage?

A

ALT

AST

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8
Q

Which liver function tests tell you about bile duct damage?

A

ALP

GGT

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9
Q

Which liver function tests tell you about hepatic bile secretion?

A

Bilirubin

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10
Q

What are albumin levels like in acute and chronic liver disease?

A

Normal in acute liver damage, due to 20-day half-life

Slow decline in chronic disease

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11
Q

What governs the decline of prothrombin time?

A

Short half-life of coagulation factors

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12
Q

Where are GGT and ALP located?

A

Bile canaliculi

Sinusoids

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13
Q

Secondary to what conditions are GGT and ALP induced?

A

Cholestasis
EtOH > GGT
- Good test in alcoholics to determine if abstaining from alcohol

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14
Q

Where else in the body is ALP found, other than the liver?

A

Bone

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15
Q

Which of the transaminases is more liver specific?

A

ALT

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16
Q

Which of the transaminases is relatively higher in chronic liver disease?

A

AST, especially in alcoholic hepatitis

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17
Q

How long does it take for transaminases to rise after hepatic injury?

A

24 hours

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18
Q

Where are the transaminases located?

A

Predominantly in periportal hepatocytes

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19
Q

What form of bilirubin rises in prehaptic hyperbilirubinaemia?

A

Unconjugated

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20
Q

What form of bilirubin rises in intrahepatic hyperbilirubinaemia?

A

Conjugated

Unconjugated

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21
Q

What form of bilirubin rises in post-hepatic hyperbilirubinaemia?

A

Conjugated

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22
Q

What are common alcoholic liver diseases?

A

Steatosis
Alcoholic steatohepatitis (ASH)
Cirrhosis

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23
Q

What is the histology of steatosis?

A

Microvesicular and macrovesicular fat

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24
Q

What is the histology of ASH?

Study These Flashcards
A

Steatosis
Ballooning degeneration
Mallory’s hyaline
PMN satellitosis

25
What are the clinical features of alcoholic steatohepatitis?
``` Generally unwell Low fever Tender hepatomegaly Often icteric +/- diarrhoea +/- nausea and vomiting Transaminases may be greatly elevated ```
26
What is non-alcoholic steatohepatitis?
Histologically similar to ASH Usually less severe Hepatic manifestation of metabolic syndrome Thought to be most common cause of idiopathic cirrhosis
27
What are the prehepatic causes of portal hypertension?
Portal vein thrombosis Stenosis Compression
28
What are the intrahepatic causes of portal hypertension?
``` Perivenular fibrosis Cirrhosis Schistosomiasis Severe steatosis Sarcoidosis ```
29
What are the post-hepatic causes of portal hypertension?
Hepatic vein obstruction Severe right heart failure Constrictive pericarditis
30
Of which condition is perivenular fibrosis a feature?
Alcoholic steatohepatitis
31
What are common benign liver neoplasms?
Hepatic adenoma Focal nodular hyperplasia (FNH) Bile duct hamartoma = von Meyenburg complex Bile duct adenoma = prebiliary gland hamartoma Cavernous haemangioma
32
What are common malignant liver neoplasms?
Hepatocellular carcinoma Cholangiocarcinoma Angiosarcoma Metastases
33
What is the histopathology of hepatocellular carcinoma?
``` Abnormal architecture - Trabeculae >3 cells thick - Abnormal bile canalicular architecture 50% or less alpha-foetal protein +ve in immunostains Bile production in some ```
34
What are the causes of chronic hepatitis?
``` Chronic viral hepatitis Autoimmune hepatitis (AIH) Drug induced Metabolic - Wilson's disease - Alpha-1 antitrypsin deficiency Idiopathic ```
35
What are the causes of acute viral hepatitis?
HAV HBV HCV (rare) HEV
36
What is the pattern of damage in acute viral hepatitis?
Predominantly lobular inflammation | Hepatocellular injury
37
What are the causes of chronic viral hepatitis?
HBV HCV HDV
38
What is the pattern of damage in chronic viral hepatitis?
Predominantly portal inflammation
39
What defines chronic viral hepatitis?
More than 6 months with hepatitis, due to viral infection
40
What is the clinical presentation of chronic viral hepatitis?
Chronic fatigue Generally unwell Poor appetite Low level nausea
41
What are the pathological findings in chronic viral hepatitis?
Low level elevation of transaminases Periportal +/- lobular hepatocellular inflammation and necrosis Portal fibrosis > cirrhosis Nodular regeneration
42
What are some of the complications of chronic viral hepatitis?
Portal HTN Liver failure Hepatocellular carcinoma
43
How is AIH diagnosed?
AutoAbs
44
Which antibodies are positive in type 1 AIH?
``` Smooth muscle Abs (SMA) Antinuclear Abs (ANA) ```
45
Which antibodies are positive in type 2 AIH?
Liver-kidney microsomal Abs (LKM1)
46
Which antibodies are positive in type 3 AIH?
Antisoluble liver Ag/liver pancreas Abs (anti-SLA/anti-LP)
47
What is the treatment for autoimmune hepatitis?
Steroid therapy > good response
48
What is the histology of autoimmune hepatitis?
Dense periportal inflammation with plasma cells Lymphocytic piecemeal/bridging necrosis Milder forms often seen
49
What is primary biliary cirrhosis?
Non-suppurative autoimmune cholangitis characterised by - Increased ALP and GGT - Antimitochondrial Abs (AMA) - Increased IgM - Typically affects middle aged females
50
What is the treatment for primary biliary cirrhosis?
Ursodeoxycholic acid | Poor response to steroids
51
What is the pathophysiology of primary biliary cirrhosis?
``` Immune attack on small bile ducts Chronic cholestasis and loss of small bile ducts Variable periportal hepatitis Progression to cirrhosis Overlap syndrome with AIH exists ```
52
What is primary sclerosing cholangitis?
Fibrosing and lymphocytic cholangitis > irregular stenoses and strictures Usually involves intrahepatic and extrahepatic bile ducts Overlap syndrome with AIH exists
53
How is primary sclerosing cholangitis diagnosed?
``` Cholangiography - Irregular strictures and beading - +/- diverticula - Pruned tree Liver biopsy when cholangiography non-diagnostic ```
54
What are the histological features of primary sclerosing cholangitis?
Onion skin periductular fibrosis | Loss of bile ducts
55
What gene defect causes haemochromatosis?
HFE gene defect on ch 6
56
How is haemochromatosis diagnosed?
``` Raised serum ferritin Raised serum transferrin saturation Genetic testing: C282Y, H63D Hepatic iron index (HII) Hepatic dry weight iron Liver biopsy ```
57
What are the features of a liver biopsy from someone with haemochromatosis?
Fibrosis > cirrhosis Fe overload in hepatocytes Hepatocellular carcinoma/precursors may be detected Negligible inflammation/necrosis
58
What are common causes of hepatic granulomas and granulomatous hepatitis?
Sarcoidosis Primary biliary cirrhosis TB Drugs

MD2 Surgery and Anaesthesia (31 decks)

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