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Pathology- Liver Flashcards

(114 cards)

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1
Q

where is the liver

A

in the upper right hypochondrian

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2
Q

what is the periportal zone

A

area nearest blood supply- receives most oxygenated blood

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3
Q

what is the mid acinar zone

A

zone between periportal and pericentral

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4
Q

whyacinar zone furthest from blood supply most at risk to injury

A

as is cut off from the blood supply

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5
Q

what happens when the liver is acutely injured

A

liver is very resistant- Some liver insults can produce severe parenchymal necrosis but heal entirely by restitution

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6
Q

when does liver injury leave permanent damage

A

when injury chronic

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7
Q

what is the pathogenesis of liver disease

A

insult- inflammation- fibrosis- cirrhosis

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8
Q

what can cause insult to hepatocytes

A

viral, drug, toxin, antibody

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9
Q

what is acute liver failure

A

acute onset of jaundice (raised bilirubin)

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10
Q

what can cause acute liver failure

A

viruses, alcohol, drugs, bile duct obstruction

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11
Q

what is acetoaminophen toxitiy

A

poisoning of the liver, seen in suicides- confluent necrosis produces massive acute necrosis and liver failure

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12
Q

what are the possible outcomes of acute liver failure

A

complete recovery, chronic liver disease, death from liver failure

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13
Q

how is jaundice classified

A

site; pre, hepatic and post hepatic

type: conjugated, unconjugated

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14
Q

what is pre-hepatic jaundice

A

when there is too much haemolysis resulting in too much bilirubin being delivered to the liver

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15
Q

what can cause pre hepatic jaundice

A

haemolysis of all causes, haemolytic anaemias, unconjugated bilirubin, sickle cell disease

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16
Q

what is unconjugated bilirubin

A

not water soluble as not bound to other substances

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17
Q

what is hepatic jaundice

A

when the liver cells are injured or dead

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18
Q

what causes hepatic jaundice

A

acute liver failure, alcoholic hepatitis, cirrhosis (decompensated), bile duct loss, pregnancy

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19
Q

what is post hepatic jaundice

A

when the bile cannot escape into the bowl

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20
Q

what can cause post hepatic jaundice

A

congenital biliary atresia, gall stones blocking the common bile duct, strictures of the common bile duct, tumours at head of pancreas

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21
Q

is cirrhosis reversible

A

no

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22
Q

what are the characteristic features of cirrhosis

A

bands of fibrosis seperating regenerative nodules of hepatocytes, alteration of microvasculature, loss of hepatic function

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23
Q

what are the causes of cirrhosis

A

alcohol, hep b and c, iron overload, gallstones, cirrhosis, autoimmune liver disease

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24
Q

why is liver function impaired in cirrhosis

A

as healthy areas cut off from circulation and cannot receive or transmit substances in blood

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25
what are the complications of cirrhosis
portal hypertension, ascites, liver failure
26
how can portal hypertension present
oesophageal varices, caput medusa, haemorrhoids
27
what makes up the portal vein
superior mesenteric and splenic vein
28
what are the other clinical features of chronic liver disease and cirrhosis
oedema (reduced albumin) ascites (reduced albumin and increased aldosterone and portal hypertension) haematemesis (ruptured varices) spider naevi and gynaecomastia coma (toxins still in blood) purpura and bleeding (reduced clotting factor synthesis infection (reduced kupffer cells)
29
what does alcohol cause in the liver
fatty liver- releases fatty acids and triglycerides
30
what injurs hepatocytes in alcoholic liver disease
acetaldehyde- metabolite of ethanol
31
what causes the laying down of collagen in alcoholic liver disease
fibroblasts
32
when does alcohol injury become irreversible
after months-years
33
what is steatosis
fatty liver
34
is a fatty liver reversible
yes
35
what else can cause a fatty liver
``` NASH Pregnancy Drugs Nutritional Diabetes (type 2) HepCV (type 3) ```
36
what are the features of alcoholic hepatitis
Hepatocyte necrosis Neutrophils Mallory Bodies Pericellular fibrosis
37
what is massons trichrome
in alcoholic cirrhosis when defined bands of cirrhosis separates regenerative nodules
38
what are the possible outcomes of alcoholic liver disease
``` cirrhosis portal hypertension- varices and ascites malnutrition hepatocellular carcinoma social disintegration ```
39
what is NASH
non alcoholic steatohepatitis
40
what are the features of NASH and what causes it
pathologically identical to alcoholic liver disease | diabetes, obesity, hyperlipidaemia
41
what is now the commonest cause of liver cancer
NASH because of obesity
42
what viruses other than hep can cause viral heptatitis
ebstein barr, yellow fever, herpes simplex, cytomegalovirus
43
what is delta agent
hepatitis D
44
how is Hep a spread
faecal oral
45
what is the incubation period of hep a
2-6 weeks
46
what does it mean the hep a is directly cytopathic
infection causes structural changes in a host cell
47
is there a carrier state in hep B
No- recovery or death (death v rare)
48
what is the usual outcome for hep a infection
mild illness followed by full recovery
49
what type of degeneration is seen in the liver during hep a
ballooning degeneration- sign of hepatocyte injury
50
how is hep B spread
blood, blood products, sexually, vertically (utero)
51
what damages the liver in Hep b
the antiviral immune response
52
is there a carrier state in hep b
yes
53
what are the outcomes of hep b infections
acute hepatitis followed by resolution acute hep with liver failure, death chronic inflammation either: - non progressive - progressive, cirrhosis, liver failure hepatocellular carcinoma
54
is there a vaccine for hep b
ye
55
how is hep c spread
blood, blood products, possibly sexually
56
does hep c have a long/ short incubation period
short
57
why is there not a vaccine for hep c
as lots of virus subgroups, need a good antigen to develop vaccine
58
what is the usually course of hep c
usually assymptomatic, tends to become chronic
59
what does hep c increase your risk of
heptocelullar carcinoma
60
what does chronic viral hepatitis look like on microscopy
dense portal chronic inflammation - portal triad surrounded by inflammatory cells: mainly lymphocytes
61
what are inflammatory cells in acute inflammation
neutrophils
62
what is piecemeal necrosis and what causes it
interface hepatitis- when inflammatory cells infiltrate into the liver and obscure the border of the portal area seen in chronic viral hepatitis
63
what is a councilman body
a dead hepatocyte
64
what is bridging fibrosis
when fibrosis caused by chronic viral hepatitis bridges between two portal areas
65
what does bridging fibrosis do to the liver
causes it to shrink- scar tissue is hard and contracts
66
what are the micro and macro nodules found in cirrhosis
macrondule> 3mm in diameter micronodule <3mm in diameter
67
what are the outcomes of hep B
fulminant (severe or sudden onset) acute infection -> death chronic hepatitis cirrhosis-> from progressive to chronic hepatocellular carcinoma increased risk asymptomatic (carrier)
68
what is the outcome of hep c
chronic hepatitis death
69
what autoimmune diseases can cause chronic hepatitis
primary biliary cirrhosis autoimmune hepatitis primary sclerosing cholangitis
70
who is more likely to get primary biliary cirrhosis
females 90%
71
what might be seen on biopsy of primary biliary cirrhosis
granulomas and bile duct loss
72
how is PBC staged
biopsy
73
what does primary biliary cirrhosis involve pathologically
chronic portal inflammation causes destruction of the bile duct- bile ducts inflamed, granulomas around ducts
74
what is a granuloma
collection of histoctyes
75
what is a histocyte
macrophage
76
why does PBC give you a green liver
as bile gets trapped in the liver because of the bile duct injury
77
what can untreated PBC lead to
cholestasis, liver injury, inflammation, fibrosis, cirrhosis
78
what is cholestasis
a reduction or blockage of bile flow
79
who is autoimmune hep more common in
females
80
what pathological pattern in seen in autoimmune hep
chronic hepatitis pattern- portal inflammation
81
what else in seen histologically in autoimmune hepatitis
the presence of numerous plasma cells, antibodies to sooth muscle or LKM, IgG
82
when can LKM be raised
in acute of chronic liver fialure
83
what is the process of chronic drug induced hepatitis
chronic active process
84
what might drug induced hepatitis trigger
autoimmune hepatitis
85
what is primary sclerosing cholangitis
chronic inflammatory process affecting intra and extra hepatic bile ducts
86
what does primary sclerosing cholangitis lead to
periductal fibrosis, duct destruction, jaundice and fibrosis
87
what is primary sclerosing cholangitis associated with
ulcerative collitis
88
who is more likely to get primary scleroing cholangitis
males
89
what does primary sclerosing cholangitis increase your risk of
malignancy in bile ducts and colon
90
what is seen microscopically of PSC
cholangitis= inflammation of the ducts periductal onion-skinning fibrosis
91
name three liver storage diseases
haemochromatosis, wilsons disease, alpha-1-antitrypsin deficiency
92
what is haemochromatosis
excess iron in the liver
93
what causes primary haemochromatosis
genetic condition, increased absorption of iron
94
what causes secondary haemochromatosis
iron overload from diet, transfusions, iron therapy
95
what inheritance pattern does primary haemochromatosis folllow
autosomal recessive
96
what processes cause primary haemochomatosis
excess absorption of iron from intestine, abnormal iron metabolism
97
in who is primary haemochromatosis worse in- why
men as they are homozygotes
98
when and why does primary haemochromatosis produce symptoms
iron deposited in liver, asymptomatic for years until deposited in portal connective tissue and stimulated fibrosis
99
what can primary haemochromatosis cause
predisposes to carcinoma causes diabetes, cardiac failure and impotence
100
what is seen on the microscopy of haemochromatosis
iron accumulation- brown pigments in the hepatocyte
101
how is iron accumulation in haemochromatosis confirmed via microscopy
perls stain- goes blue
102
what happens if haemochromatosis goes left untreated
cirrhosis, hepatocelluar carcinoma
103
what is wilson's disease
inherited autosomal recessive disorder of copper metabolism where copper accumulates in the liver and brain
104
what are the clinical signs of wilsons disease
kasyer-fleischer rings at corneal limbus, low serum caeruloplasmin
105
what does wilsons disease lead to
chronic hepatitis and neurological deterioration
106
what is an alpha-1-antitrypsin deficinecy
inherited automsomal recessive disorder of production of an enzyme inhibitor
107
what does an alpha-1-antitrypsin deficiency cause
empysema and cirrhosis
108
what is seen microscopically in aplha-1-antitrypsin deficiency
cytoplasmic globules of unsecreted globules of protein in liver cells- accumulates in liver and causes hepatocyte damage
109
what are the two main primary tumours of the liver
hepatocellular adenoma (benign) hepatocellular carcinoma (hepatoma)
110
who is more likely to get hepatocellular carcinoma
females- associated with oestrogen
111
what is hepatocellular carcinoma associated with
HBV, HCV and cirrhosis
112
how does HCC usually present
as a mass, pain or obstruction
113
what is the prognosis for HCC
usually poor
114
what are the two histopathological types of HCC
hepatocytic- looks like hepatocytes cholangio- looks like bile ducts

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