Pathology of the Liver Flashcards by Sasha Murdoch

What ribs cover the liver

7-11

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What is the normal appearance of the liver?

Red brown colour with a smooth outline and contour

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What 3 terms are used to describe the patterns of liver injury

1) Periportal Zone
2) Mid Acinar
3) Pericentral

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What is the zone that is closest to the vascular supply

Zone 1

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Cells in which zone are most vulnerable to injury?

Why is this the case?

Zone 3

They are furthest from the vascular supply - it takes longer for oxygen to reach them

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What 4 aspects can cause insult to hepatocytes

Viral
Drug
Toxin
Antibody

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How can we measure the degree of injury to the liver?

Insult
Grading the degree of inflammation
Staging the degree of fibrosis
Cirrhosis

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What is cirrhosis

A chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis.

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What are 4 causes of the acute onset of jaundice

Viruses
Alcohol
Drugs (paracetamol
Bile duct obstruction

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What is the underlying cause of acute onset of jaundice

Hepatic necrosis

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What is necrosis?

The death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.

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What is the chemical name for Paracetamol

Acetoaminophen

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Describe the structure of the liver which has been damaged by aracetamol

not a normal structure
Necrotic hepatocytes are more rounded and not polyhedral
Majority of cells have lost their nuclei

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What 3 things can occur as a consequence of acute liver failure?

Complete recovery
Chronic liver disease
Death from liver failure

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What is jaundice

Yellowing of the skin due to excess bilirubin

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What are the 3 classifications of jaundice

Pre- hepatic
Hepatic and
Post-hepatic

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What are the 2 types of jaundice

Conjugated or Unconjugated

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What is the cause of pre-hepatic jaundice

Too much haem to break down

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Describe pre-hepatic jaundice

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin (uncombined)

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What is hepatic jaundice

When the liver cells are injured or dead and so we have reduced hepatic function

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Describe hepatic jaundice

Acute liver failure (virus, drugs, alcohol)
Alcoholic hepatitis
Cirrhosis (decompensated)
Bile duct loss (atresia, PBC,PSC)
Pregnancy

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What is post hepatic jaundice

Bile cannot escape into the bowel

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Describe post-hepatic jaunice

Congenital biliary atresia
Gallstones block CB Duct
Structures of CB duct
Tumours (head of the pancreas)

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What does cirrhosis of the liver signify

The endpoint of liver disease

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Define cirrhosis of the liver

Bands of fibrosis separating regenerative nodules of hepatocytes

What does cirrhosis result in

Loss of hepatic function

What is the main cause of cirrhosis of the liver

Alcohol

Describe the histological appearance of cirrhosis in the liver

Islands of hepatocytes have been cut off from eachother by bands of fibrous tissue has been deposited

What is the main complication of Cirrhosis

Portal hypertension

What are 2 other complications of cirrhosis

Ascites | Liver failure

What is the result of pre hepatic jaundice

Obstructive thrombosis and narrowing of the portal vein (

What is the result of hepatic jaundice

Cirrhosis

What is the result of post hepatic jaundice

Right sided Heart failure | Hepatic outflow obstruction

What are 6 clinical manifestations of liver disease

``` Oedema Ascites Haematemesis Spider naevi Infection Coma ```

What is the purpose of a biopsy in suspected alcoholic liver disease

Usually to rule out another condition

What can influence the severity of alcoholic liver disease

Duration of alcohol abuse Genetic factors Ethnicity

What is the metabolite of alcohol metabolism that is responsible for a lot of the cell injury

Acetaldehyde (ADH)

After what duration of drinking would fibrosis occur?

Months to Years

After what duration of drinking would cirrhosis occur?

Years

Describe the appearance of a liver after a weekend binge

Normal liver with a smooth outline and countour but a chance in colour to yellow/ orange due to the accumulation of fat within the liver

What are some other differentials for for the appearance of fatty liver disease

``` NASH Pregnancy Drugs Nutritional Dibaetes HPV ```

Describe the histological appearance with alcoholic hepatitis

Hepatocte necrosis Neutrophils Mallory bodies Pericellular fibrosis

Describe the appearance of a liver with alcoholic cirrhosis

White areas | Lots of nodules due to not being able to the move bile

What is the name of the 3 staining protocol

Massons Trichrome

What are 5 outcomes of alcoholic liver disease

``` Cirrhosis Portal hypertension: varices and ascites Malnutrition Hepatocellular carcinoma Social disintegration ```

What appearance would non-alcoholic steatotohepatitis NASH produce?

The same morphilogical appearance as alcoholic liver disease

Why is Non-alcoholic steatohepatitis on the increase

Due to obesity and diabetes

What might Non-alcoholic steatohepatitis lead to

Fibrosis and cirrhosis

What would viral hepatitis cause

Acute liver injury or chronic liver injury

What are the 4 most common causes of viral hepatitis

Hep A,B, C, E

What are 5 rare causes of viral hepatitis

``` Delta agent Ebstein-Barr virus Yellow fever virus Herpes Simplex virus Cytomegalovirus ```

What can be seen histologically in chronic viral hepatitis B or C

Dense portal chronic inflammation - lots of black dots

Name 3 autoimmune diseases related to chronic hepatitis

Primary Biliary Cirrhosis Autoimmune hepatitis Primary sclerosing cholangitis

What is primary biliary cirrhosis

Rare, autoimmune disease with unknown aetiology

Who is most likely to get primary biliary cirrhosis

Females, post pregnancy, smokers

What might be seen histologically in a patient with primary biliary cirrhosis

Granulomas and bile duct loss

What might happen if primary biliary cirrhosis is left untreated

Bile duct loss leads to cholestasis, liver injury, inflammation, fibrosis and cirrhosis

Is autoimmune hepatitis more common in men or women

Women

What is a trigger of autoimmune hepatitis

Some drugs

What is primary sclerosing cholangitis

Chronic inflammatory process affecting intra and extra hepatic bile ducts

What does primary sclerosing cholangitis lead to

Periductal fibrosis, duct destruction, jaundice and fibrosis

What is associated with primary sclerosing cholangitis

Ulcerative colitis

What are 3 storage diseases of the liver

Haemochromatosis Wilsons disease Alpha 1- antitrypsin deficiency

What is haemochromatosis

Excess iron within the liver

Describe primary haemochromatosis

Genetic condition (autosomal recessive) , increase absorption of iron

Describe secondary haemochromatosis

Iron overload from the diet, transfusions, iron therapy

What does iron deposited in the liver eventually deposit into and what does this stimulate?

Into the portal connective tissue and stimulates fibrosis

What can primary haemochromatosis cause

Diabetes, cardiac failure and impotence

How is iron confirmed

Perls stain - blue

What is dependent of the outcome of haemochromatosis

Genetics Therapy Cofactors (alcohol etc.)

What are the 2 most common outcomes of haemochromatosis

Cirrhosis | Heaptocellular carcinoma

What is Wilson's disease

Inherited autosomal recessive disorder of copper metabolism

Where does cooper accumulate in the body

Liver and brain

What might Wilson's disease cause?

Chronic hepatitis and neurological deterioration

What is alpha 1 antitrypsin deficiency

Inherited autosomal recessive disorder of production of an enzyme inhibitor

What does alpha 1 antitrypsin deficiency cause

EMpyema and cirrhosis

What would be seen histologically in alpha 1 antitrypsin deficiency

Cytoplasmic globules of unsecreted globules of protein in liver cells

What are the two types of liver tumours. What ones are rare and what ones are common

Primary (rare) and secondary (common)

Name 2 types of primary tumours

``` Hepatocellular adenoma Hepatocellular carcinoma (hepatoma) ```

Name the types of secondary liver tumours

Metastases from the colon, pnacreas or stomach mainly

Describe hepatocellular adenoma

Benign mostly in females which can increase in size and rupture or bleed Most are assymptomatic

Describe hepatocellular carcinoma

Rare in europe | Associated with HBV,HCV and Cirrhosis

What are the common presentations of hepatocellular carcinoma

Mass Pain Obstruction

What is the prognosis of hepatocellular carcinoma

Poor prognosis

Pathology of the Liver Flashcards

(84 cards)