Pathology of the Liver Flashcards Preview

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Flashcards in Pathology of the Liver Deck (84):
1

What ribs cover the liver

7-11

2

What is the normal appearance of the liver?

Red brown colour with a smooth outline and contour

3

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

1) Periportal Zone
2) Mid Acinar
3) Pericentral

4

What is the zone that is closest to the vascular supply

Zone 1

5

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

6

What 4 aspects can cause insult to hepatocytes

Viral
Drug
Toxin
Antibody

7

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

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

8

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.

9

What are 4 causes of the acute onset of jaundice

Viruses
Alcohol
Drugs (paracetamol
Bile duct obstruction

10

What is the underlying cause of acute onset of jaundice

Hepatic necrosis

11

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.

12

What is the chemical name for Paracetamol

Acetoaminophen

13

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

14

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

Complete recovery
Chronic liver disease
Death from liver failure

15

What is jaundice

Yellowing of the skin due to excess bilirubin

16

What are the 3 classifications of jaundice

Pre- hepatic
Hepatic and
Post-hepatic

17

What are the 2 types of jaundice

Conjugated or Unconjugated

18

What is the cause of pre-hepatic jaundice

Too much haem to break down

19

Describe pre-hepatic jaundice

Haemolysis of all causes
Haemolytic anaemias
Unconjugated bilirubin (uncombined)

20

What is hepatic jaundice

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

21

Describe hepatic jaundice

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

22

What is post hepatic jaundice

Bile cannot escape into the bowel

23

Describe post-hepatic jaunice

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

24

What does cirrhosis of the liver signify

The endpoint of liver disease

25

Define cirrhosis of the liver

Bands of fibrosis separating regenerative nodules of hepatocytes

26

What does cirrhosis result in

Loss of hepatic function

27

What is the main cause of cirrhosis of the liver

Alcohol

28

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

29

What is the main complication of Cirrhosis

Portal hypertension

30

What are 2 other complications of cirrhosis

Ascites
Liver failure

31

What is the result of pre hepatic jaundice

Obstructive thrombosis and narrowing of the portal vein (

32

What is the result of hepatic jaundice

Cirrhosis

33

What is the result of post hepatic jaundice

Right sided Heart failure
Hepatic outflow obstruction

34

What are 6 clinical manifestations of liver disease

Oedema
Ascites
Haematemesis
Spider naevi
Infection
Coma

35

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

Usually to rule out another condition

36

What can influence the severity of alcoholic liver disease

Duration of alcohol abuse
Genetic factors
Ethnicity

37

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

Acetaldehyde (ADH)

38

After what duration of drinking would fibrosis occur?

Months to Years

39

After what duration of drinking would cirrhosis occur?

Years

40

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

41

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

NASH
Pregnancy
Drugs
Nutritional
Dibaetes
HPV

42

Describe the histological appearance with alcoholic hepatitis

Hepatocte necrosis
Neutrophils
Mallory bodies
Pericellular fibrosis

43

Describe the appearance of a liver with alcoholic cirrhosis

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

44

What is the name of the 3 staining protocol

Massons Trichrome

45

What are 5 outcomes of alcoholic liver disease

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

46

What appearance would non-alcoholic steatotohepatitis NASH produce?

The same morphilogical appearance as alcoholic liver disease

47

Why is Non-alcoholic steatohepatitis on the increase

Due to obesity and diabetes

48

What might Non-alcoholic steatohepatitis lead to

Fibrosis and cirrhosis

49

What would viral hepatitis cause

Acute liver injury or chronic liver injury

50

What are the 4 most common causes of viral hepatitis

Hep A,B, C, E

51

What are 5 rare causes of viral hepatitis

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

52

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

Dense portal chronic inflammation - lots of black dots

53

Name 3 autoimmune diseases related to chronic hepatitis

Primary Biliary Cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis

54

What is primary biliary cirrhosis

Rare, autoimmune disease with unknown aetiology

55

Who is most likely to get primary biliary cirrhosis

Females, post pregnancy, smokers

56

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

Granulomas and bile duct loss

57

What might happen if primary biliary cirrhosis is left untreated

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

58

Is autoimmune hepatitis more common in men or women

Women

59

What is a trigger of autoimmune hepatitis

Some drugs

60

What is primary sclerosing cholangitis

Chronic inflammatory process affecting intra and extra hepatic bile ducts

61

What does primary sclerosing cholangitis lead to

Periductal fibrosis, duct destruction, jaundice and fibrosis

62

What is associated with primary sclerosing cholangitis

Ulcerative colitis

63

What are 3 storage diseases of the liver

Haemochromatosis
Wilsons disease
Alpha 1- antitrypsin deficiency

64

What is haemochromatosis

Excess iron within the liver

65

Describe primary haemochromatosis

Genetic condition (autosomal recessive) , increase absorption of iron

66

Describe secondary haemochromatosis

Iron overload from the diet, transfusions, iron therapy

67

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

Into the portal connective tissue and stimulates fibrosis

68

What can primary haemochromatosis cause

Diabetes, cardiac failure and impotence

69

How is iron confirmed

Perls stain - blue

70

What is dependent of the outcome of haemochromatosis

Genetics
Therapy
Cofactors (alcohol etc.)

71

What are the 2 most common outcomes of haemochromatosis

Cirrhosis
Heaptocellular carcinoma

72

What is Wilson's disease

Inherited autosomal recessive disorder of copper metabolism

73

Where does cooper accumulate in the body

Liver and brain

74

What might Wilson's disease cause?

Chronic hepatitis and neurological deterioration

75

What is alpha 1 antitrypsin deficiency

Inherited autosomal recessive disorder of production of an enzyme inhibitor

76

What does alpha 1 antitrypsin deficiency cause

EMpyema and cirrhosis

77

What would be seen histologically in alpha 1 antitrypsin deficiency

Cytoplasmic globules of unsecreted globules of protein in liver cells

78

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

Primary (rare) and secondary (common)

79

Name 2 types of primary tumours

Hepatocellular adenoma
Hepatocellular carcinoma (hepatoma)

80

Name the types of secondary liver tumours

Metastases from the colon, pnacreas or stomach mainly

81

Describe hepatocellular adenoma

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

82

Describe hepatocellular carcinoma

Rare in europe
Associated with HBV,HCV and Cirrhosis

83

What are the common presentations of hepatocellular carcinoma

Mass
Pain
Obstruction

84

What is the prognosis of hepatocellular carcinoma

Poor prognosis

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