Pathology of liver

Question 1

True or False.
The liver is very resistant to injury?
Explain

Answer 1

= true

Because it has a large functional reserve

Question 2

What are 3 possible consequences from liver injury?

Answer 2

1) severe parenchymal necrosis but heal entirely by restitution
2) Whereas some types of injury leave permanent damage
3) some types of injury produce predictable pathological patterns

Question 3

describe the pathogenesis of liver disease?

Answer 3

1) insult to hepatocytes via viral, drugs, toxins or antibody
2) grading = degrees of inflammation
3) staging = degree of fibrosis
4) cirrhosis

Question 4

what happens when there is acute liver failure?

Answer 4

= acute onset of jaundice

Question 5

what are 4 causes of acute liver failure?

Answer 5

• viruses
• alcohol
• drugs
• bile duct obstruction

Question 6

what is a leading cause of acute liver failure and what does this cause?

Answer 6

acetaminophen toxicity

• confluent necrosis producing massive acute necrosis and liver failure

Question 7

what are 3 possible outcomes of acute liver failure?

Answer 7

• complete recovery
• chronic liver disease
• death from liver disease

Question 8

how do you classify jaundice?

Answer 8

• pre-hepatic
• hepatic
• post-hepatic
• conjugated
• un-conjugated

Question 9

what is the cause of pre-hepatic jaundice?

Answer 9

= too much haem to break down

• haemolysis of all causes
• haemolytic anaemias
• un-conjugated bilirubin

Question 10

what is the cause of hepatic jaundice?

Answer 10

= liver cells are injured or dead

• acute liver failure
• alcoholic hepatitis
• cirrhosis (decompensated)
• bile duct loss (atresia, PBC, PSC)
• pregnancy

Question 11

what is the cause of post-hepatic jaundice?

Answer 11

= bile cannot escape into the bowel

• congenital biliary atresia
• gallstones block CBDuct
• strictures of CBDuct
• tumours (Ca head of pancreas)

Question 12

what is cirrhosis?

Answer 12

= final common end point for liver disease

Question 13

Is cirrhosis reversible or irreversible?

Answer 13

= irreversible

Question 14

what is cirrhosis defined by?

Answer 14

= bands of fibrosis separating regenerative nodules of hepatocytes
- macro nodular or micro-nodular (alcoholic)

= alteration of hepatic micro-vasculature
= loss of hepatic function

Question 15

what are 3 complications of cirrhosis?

Answer 15

1) portal hypertension (porto-caval anastimoses)
- oesophageal varices
- caput medusa
- haemorrhoids

2) ascites
3) liver failure
4) hepatocellular carcinoma
5) malnutrition

Question 16

what does the pathology of alcoholic liver disease depend on?

Answer 16

= extent of alcohol abuse

= depends upon individual factors

Question 17

describe the duration of drinking and whether alcoholic liver disease is reversible or irreversible.

Answer 17

2-3days = fatty liver
= reversible

4-6weeks = hepatitis
= reversible if drinking stops

Months/years = fibrosis
= irreversible

Years = cirrhosis
= irreversible

Question 18

in alcoholic fatty liver, i.e. after a weekend bindge, what is the histological appearance of cells?

Answer 18

= fat vacuoles appear clear in hepatocytes

Question 19

in alcoholic hepatitis, i.e. heavy drinking for weeks or months, what is the histological appearance?

Answer 19

= hepatocyte necrosis
= neutrophills
= mallory bodies
= pericellular fibrosis

Question 20

in alcoholic fibrosis, i.e. drinking heavy for months or years, what is the histological appearance?

Answer 20

= collagen is layer down around cells

= collagen is stained blue

Question 21

what is the histological appearance in alcoholic cirrhosis?

Answer 21

• micro-nodular cirrhosis with abundant white scarring

Question 22

describe non-alcoholic steatohepatitis (NASH)?

Answer 22

= non-drinkers but pathology is identical to alcoholic liver disease

Question 23

who most commonly gets NASH?

Answer 23

• diabetics
• obese patiens
• hyperlipidaemia

Question 24

what can NASH lead to?

Answer 24

• fibrosis

- cirrhosis

Question 25

what common virus leads to acute or chronic liver injury?

Answer 25

= viral hepatitis

Question 26

describe hepatitis A-E.

Answer 26

Hep A = Epstein Barr virus Hep B = yellow fever virus Hep C = herpes simplex virus Hep e = cytomegalovirus

Question 27

what is seen histologically with chronic viral hepatitis?

Answer 27

= dense portal chronic inflammation = piecemeal necrosis = lobular inflammation - councilman body - small amounts of steatosis present - fibrosis

Question 28

what are 5 outcomes of hep B?

Answer 28

- fulminant acute infection (death) - chronic hepatitis - cirrhosis - hepato-cellular carcinoma - asymptomatic (carrier)

Question 29

what are 2 outcomes of hep C?

Answer 29

- chronic hepatitis | - cirrhosis

Question 30

what is primary biliary cirrhosis?

Answer 30

= rare auto-immune disease,e unknown cause

Question 31

what is primary biliary cirrhosis associated with?

Answer 31

= auto-antibodies to mitochondria

Question 32

who is most likely to get primary biliary cirrhosis?

Answer 32

= females

Question 33

what is histologically seen in primary biliary cirrhosis?

Answer 33

- chronic portal inflammation - bile ducts inflamed - granuloma around duct

Question 34

describe auto-immune hepatitis?

Answer 34

- more common in females - associated with other AI disease - chronic hepatitis pattern - numerous plasma cells - auto-antibodies to smooth muscle, nuclear or LKM, raised IgG - may have triggers, including some drugs

Question 35

describe chronic drug-induce hepatitis?

Answer 35

- similar to all other chronic hepatitis - may trigger an auto-immune hepatitis - chronic active process

Question 36

what is primary sclerosing cholangitis?

Answer 36

= chronic inflammatory process affecting intra and extra hepatic bile ducts

Question 37

what does primary sclerosing cholangitis lead to?

Answer 37

- leads to peri-ductal fibrosis, duct destruction, jaundice and fibrosis

Question 38

what is primary sclerosing cholangitis associated with?

Answer 38

ulcerative collisi and males

Question 39

what does primary sclerosing cholangittis increase the risk of?

Answer 39

= malignancy in bile ducts and colon

Question 40

what are 3 storage diseases

Answer 40

- haemochromatosis - Wilsons disease - alpha 1 antitrypsin deficiency

Question 41

what is haemochormatosis?

Answer 41

= excess iron within the liver | - iron accumulates in hepatocytes

Question 42

describe primary and secondary haemochormatosis?

Answer 42

primary = genetic condition = increased absorption of iron from small intestine, abnormal iron metabolism secondary = iron overload from diet = transfusions = iron therapy

Question 43

describe the genetics behind primary haemochormatosis?

Answer 43

= inherited autosomal recessive condition - genetic defect v. complex = worse in homozygotes, men

Question 44

describe what happens in primary haemochormatosis?

Answer 44

= iron is deposited into the liver, asymptomatic for years = eventually deposited in portal connective tissue, stimulating fibrosis = cirrhosis if not teated = predisposes to carcinoma = also causes diabetes, cardiac failure and impotence

Question 45

how is the presence of iron confirmed in haemochormatosis?

Answer 45

= Perls stain

Question 46

what is the outcome of haemochormatosis?

Answer 46

= depends on genetics, therapy (venesection) and co-factors like alcohol = cirrhosis = hepatocellular carcinoma

Question 47

what is Wilsons disease?

Answer 47

= inherited autosomal recessive disorder of copper metabolism = copper accumulates in liver and brain (basal ganglia) - low serum caeruuloplasmin

Question 48

what rings appear at Corneal limbus as a result of Wilsons disease?

Answer 48

= Kayser-fleischer

Question 49

what does Wilsons disease cause?

Answer 49

= chronic hepatitis | = neurological deterioration

Question 50

what is alpha-1 antitrypsin deficiency?

Answer 50

= inherited autosomal recessive disorder of production of an enzyme inhibitor = cytoplasmic globules of un-secreted globules of protein in liver cells

Question 51

what does alpha-1 antitrypsin deficiency cause?

Answer 51

= emphysema | = cirrhosis

Question 52

what are 2 types of tumour of the liver?

Answer 52

1) primary (rare) - hepato-cellular adenoma hepato-cellular carcinoma (hepatoma) 2) secondary (common) - multiple = metastases from colon, pancreas, stomach, breast, lung and others

Question 53

is hepatocellular adenoma benign or malignant?

Answer 53

= benign - more common in females

Question 54

what can happen in hepatocellular adenoma?

Answer 54

= may become large and rupture and bleed - most remain asymptomatic

Question 55

what is hepato-cellular carcinoma associated with?

Answer 55

= HBV, HCV and cirrhosis

Question 56

what does hepato-ceellular carcinoma usually present with?

Answer 56

= mass = pain = obstruction