Pathology of liver Flashcards Preview

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Flashcards in Pathology of liver Deck (32):

What is the normal structure of the liver

  • Zone 1  - Periportal zone 
  • Zone 2 - Mid acinar 
  • Zone 3 - Pericentral 

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What is the normal hisotlogy of the liver 

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What are the steps that lead up to fibrosis 

  1. Insults 
  2. Inflammation 
  3. Fribrosis 
  4. Cirrhosis 

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What are the feactures and causes of acute liver failure 

  • Acute onset of jaundice 
  • Causes: Viruses, Alcohol, drugs and bile obstruction 


What is Acetoaminophine Toxicity 

paracetamol poisoning 


What are the histological features of Acetoaminophine toxicity 

Extensive zone 3 or panacinar necrosis with minimal inflammatory infiltrate

Repeated necrosis produces massive acute necrosis and liver failure 

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What are the consequences of acute liver failure 

  • Compelete recovery
  • Chronic liver disease
  • Death from liver failure 


What are the different types of jaundice by site 

  • Pre-hepatic
  • Hepatic 
  • Post-hepatic


Different types of jaundice by type 

  • Conjugated - water soluble 
  • Unconjugated - lipid soluble - does not dissolve in water 


What is pre-hepatic jaundice 

Due to haemolytic anaemia or ineffective haematopoises 

  • Too much haem to break down 
  • Unconjugated bilirubin - overwhelmed hepatocytes cannot conjugate too much 


What is haptic jaundice 

Damaged liver cells or dead liver cells

  • Acute liver failure - Drugs,alcohol or virus
  • Alcoholic hepatitis  
  • Cirrhosis - decompensated 
  • Bile duct loss 
  • Pregnancy


What is post hepatic jaundice 

Obstruction: bile cannot escape into doudenum 

  • Congenital biliary atresia 
  • Gallstones block CB duct 
  • Strictures of CB duct
  • Tumours - Carcinoma of head of pancrease 


What is cirrhosis 

  • irreversible damage of liver disease - end point
  • Defined by bands of fibrosis separating regenerative nodules of hepatocytes 
  • Macronodular or micronodular 
  • Alteration in hepatic microvasculature 
  • loss of hepatic function


what are a few causes of cirrhosis 

  • Alcohol 
  • Hep B and c viruses
  • Fe overload
  • Autoimmune
  • Gallstones 


What does cirrhosis look like histologically 

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What are complications of Cirrhosis 

  • Portal hypertension 
  • Oesophageal varices 
  • Caput medusa 
  • Haemorrhoids 
  • Acites
  • Live failure 

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What are other causes of portal hypertesion 

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clinical fatures and explanation explanation of chronic liver disease 

  • Oedema
  • Acites
  • Haematemesis
  • Spider naevi and gyanocomastia 
  • Purpura and bleeding
  • Coma 
  • Infection

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What is alcoholic liver disease 

  • Liver damage caused by excess alcohol 
  • Common 
  • Well need a biopsy to rule out other causes
  • Depends on the extent of alchol abuse


What is the pathogenesis of Alcoholic liver disease 

  • Initially liver is 4 - 6 kg, yellow, greasy, easily fractured
  • Later liver becomes red with bile stained areas
  • May contain visible nodules and fibrosis

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relate duration of drinking to disease progression 

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What is Steatosis 

  • Most common and earliest form of alcoholic liver disease
  • Predominantly macrovesicular steatosis: large droplet and small / medium droplets
  • First appears in perivenular region (zone 3) and spreads to other regions if drinking persists; may disappear within 1 month after alcohol cessation


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What is the histological appearance of Steatosis 

  • Fat vacuoles appear clear in hepatocytes 

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What is the differential diagnosis of steatosis 

  • NASH 
  • Hepititis C virus
  • Pregnancy
  • Drugs
  • Diabetes
  • Nutritional 


Describe the features of Alcoholic hepatitis 

  • Steatosis with inflammation and ballooning degeneration.
  • Ballooning degeneration is characterized by cellular swelling, rarefaction of the hepatocytic cytoplasm and clumped strands of intermediate filaments
  • surrounded by neutrophils
  • Hepatocyte necrosis
  • Neutrophils
  • Mallory Bodies
  • Pericellular fibrosis 

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Describe the features of alcoholic fibrosis 

  • Collagen layed down around cells - stained blue 
  • Months- years of heavy drining 

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Describe the features of alcoholic cirrhosis 

  • Micronodular cirrhosis
  • Bands of fibrosis separating regenerative nodules
  • Massons Trichrome 
  • Irreversible 

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Histological features of alcoholic cirrhosis

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Complication of alcoholic liver disease

  • Cirrhosis
  • Portal hypertension - varices and acites
  • Malnutrition 
  • Hepatocellular carcinoma
  • Social disintegration 


What is NASH

Non-alcholic steatohepatitis 

  • Non drinkers
  • Identical to ALD 
  • Patients with diabetes, obesity, hyperlipidaemia 
  • May lead to fibrosis and cirrhosis 


Summary of the pathogenesis of ALD

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