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Gastrointestinal System > Pathology of the Liver > Flashcards

Pathology of the Liver Flashcards

1
Q

acinar zones

A

each zone is centered on the line connecting two portal triads and extends outwards to the two adjacent central veins

zone 1 = periportal
zone 2 = mid acinar
zone 3 = pericentral

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2
Q

acinar zones and injury

A

zone 3 most vulnerable

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3
Q

liver injury

A

very resistant
large functional reserve

severe parenchymal necrosis but heal entirely by restitution

permanent damage

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4
Q

pathogenesis of liver disease

A 
insult to hepatocytes
(grading) 
degree of inflammation 
(staging)
degree of fibrosis
cirrhosis
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5
Q

acute onset of jaundice

A 
causes - 
viruses
alcohol
drugs
bile duct obstruction
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6
Q

acetaminophen toxicity

A

confluent necrosis produces massive acute necrosis and liver failure

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7
Q

consequences of acute liver failure

A

complete recovery
chronic liver disease
death from liver failure

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8
Q

jaundice

A

yellowing of the skin due to bilirubin

liver disease is not the only cause

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9
Q

jaundice - classification by site and type

A

pre-hepatic
hepatic
post-hepatic

conjugated
unconjugated

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10
Q

pre-hepatic jaundice

A

too much harm to break down

haemolysis of all causes
haemolytic anaemias
unconjugated bilirubin

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11
Q

hepatic jaundice

A

liver cells injured or dead

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

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12
Q

post-hepatic jaundice

A

bile cannot escape into the bowel

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

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13
Q

cirrhosis of liver

A

final common endpoint for liver disease
irreversible

defined by bands of fibrosis separating regenerative nodules of hepatocytes

macro nodular or mircronodular (alcoholic)

alteration of hepatic microvasculature

loss of hepatic function

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14
Q

complications of cirrhosis

A

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

ascites

liver failure

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15
Q

alcoholic liver disease

A

common pathology

biopsy - rule out another condition

pathology depends largely on the extent of alcohol abuse
individual factors

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16
Q

stages of alcoholic liver disease

A 
REVERSIBLE
fatty liver - steatosis
hepatitis
IRREVERSIBLE
fibrosis
cirrhosis
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17
Q

alcoholic liver disease outcoems

A 
cirrhosis
portal hypertension - varies, ascites
malnutrition
hepatocellular carcinoma
social disintegration
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18
Q

non-alcoholic steatohepatitis NASH

A

non-drinkers

pathologically identical to alcoholic liver disease

occurs in patients with diabetes, obesity, hyperlipidaemia

on the increase

may lead to fibrosis and cirrhosis

19
Q

viral hepatitis

A

may cause acute or chronic liver disease

A-E

20
Q

hep A

A

faecal-oral spread

short incubation period

sporadic or endemic

directly cytopathic

no carrier state

mild illness, usually full recovery

21
Q

hep B

A

spread by blood, blood products, sexually, vertically (in utero)

long incubation period

liver damage is by antiviral immune response

carriers exist

outcome is variable

22
Q

hep C

A

spread by blood, blood products, possible sexually

short incubation period

often asymptomatic

disease waxes and wanes

tends to become chronic

23
Q

hep B - outcome

A

fulminant acute infection (death)

chronic hepatitis

cirrhosis

hepatocellular carcinoma

asymptomatic (carrier)

24
Q

hep C -outcome

A

chronic hepatitis

cirrhosis

25
Q

chronic hepatitis

A

autoimmune disease

26
Q

causes of chronic hepatitis

A 
hep B and C
primary biliary cirrhosis
autoimmune hepatitis
drug induced hepatitis
primary sclerosing cholangitis
27
Q

primary biliary cirrhosis

A

rare autoimmune disease, unknown aetiology

associated with autoantibodies to mitochondria

females 90%

biopsy = stage the disease

may see granulomas and blue duct loss

28
Q

untreated bile duct loss

A 
cholestasis
liver injury
inflammation
fibrosis
cirrhosis
29
Q

autoimmune hepatitis

A

commoner in females
associated with other AI diseases

chronic hepatits pattern
numerous plasma cells
autoantibodies to smooth muscle, nuclear or LKM, raised IgG

may have trigger

30
Q

chronic drug-induced hepatitis

A

similar features to all other types of chronic hepatitis

may trigger an autoimmune hepatitis

chronic active process

causes are too many to list

31
Q

drugs and the liver

A

innumberable drugs can damage the liver

may be dose related or idiosyncratic

can cause hepatitis, granulomas, fibrosis, necrosis, failure, cholestasis or cirrhosis

can mimic any liver disease

32
Q

primary sclerosis cholangitis

A

chronic inflammatory process affecting intra- and exrta- hepatic bile ducts

leads to periductal fibrosis, duct destruction, jaundice and fibrosis

associated with ulcerative colitis

males

increased risk of malignancy in bile ducts and colon

33
Q

storage disease

A

haemochromatosis
wilsons disease
alpha-1-antitrypsin deficiency

34
Q

iron and the liver

A

haemochromatosis is excess iron within the liver

PRIMARY
genetic condition, increased absorption of iron

SECONDARY
iron overload from diet, transfusions, iron therapy

35
Q

primary haemochromatosis

A

inherited autosomal recessive condition

excessive absorption of iron from intestine, abnormal iron metabolism

worse in homozygotes, men

36
Q

primary haemochromatosis

A

iron deposited in liver, asymptomatic for years

eventually deposited in portal connective tissue and stimualtes fibrosis

cirrhosis if not treated

predisposes to carcinoma

also causes diabetes, cardiac failure and impotence

37
Q

haemochromatosis - outcome

A

depends on genetics, therapy (venesection) and cofactors such as alcohol

cirrhosis

hepatocellular carcinoma

38
Q

Wilsons disease

A

inherited autosomal recessive disorder of copper metabolism

copper accumulates in liver and brain (basal ganglia)

kayser-fleischer rings at corneal limbus

low serum caeruloplasmin

causes chronic hepatitis and neurological deterioration

39
Q

alpha-1-antitrypsin deficiency

A

inherited autosomal recessive disorder of production of an enzyme inhibitor

causes emphysema and cirrhosis

cytoplasmic globules of unscripted globules of protein in liver cells

40
Q

primary tumours of the liver - rare

A

hepatocellular adenoma

hepatocellular carcinoma - hepatoma

41
Q

secondary tumours of the liver - common

A

multiple

metastases from colon, pancreas, stomach, breast, lung, others …

42
Q

hepatocellular adenoma

A

benign
females
may become large… can rupture or bleed

most remain asymptomatic

43
Q

hepatocellular carcinoma

A

rare in europe

associated with HBV, HCV and cirrhosis

usually presents as a mass, pain, obstruction

usually advanced unless discovered incidentally

poor prognosis

Gastrointestinal System (43 decks)

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