Pathology of the liver Flashcards Preview

Yr 3 - December lectures 2018 > Pathology of the liver > Flashcards

Flashcards in Pathology of the liver Deck (47)
Loading flashcards...
1

What is the relevance of doing a liver biopsy?

establish primary diagnosis
- provide additional info in cases where a primary diagnosis has already been established by other investigations

2

What does it mean by sampling variability of liver biopsies?

average needle biopsy samples a tiny fraction of the whole liver
however lesions affecting liver diffusely can still be reliably assessed
this could be an issue if the disease had uneven distribution (e.g. fibrosis in chronic cholestatic disease)
problems can occur with inversely proportional to the length and diameter of the biopsy specimen

3

Why are liver biopsies so useful?

most common patterns of liver damage have more than one potential cause
therefore final interpretation depends on clinics-pathological correlation

4

What are the different zones of the liver?

Zone 1: periportal
Zone 2: mid-zonal
Zone 3: perivenular or centrilobular = furthest away from portal blood supply, high conc of p450 enzymes

5

What are the different causative agents of viral hepatitis?

A-G

6

What is the causative agent, incubation period and route of transmission for hepatitis A?

RNA virus (picornavirus) 27nm diameter
15-40 days
faecal-oral route

7

What is the causative agent, incubation period and route of transmission for hepatitis B?

DNA virus (hepadnavirus) 42nm diameter
4-26 weeks
- mainly blood/bloody products
- other body secretions
- vertical tranmission (mother to baby)

8

What is the causative agent, incubation period and route of transmission for hepatitis C?

RNA virus (flavivirus) 30-40nm diameter
2-26 weeks
- mainly blood / blood products
- other body fluids
- sporadic infection

9

What are the outcomes for the following things in terms of hepatitis A infection?
- asymptomatic carrier
- acute hepatitis
- fulminant hepatitis
- chronic hepatitis
- cirrhosis
- hepatocellular carcinoma

- asymptomatic carrier = no
- acute hepatitis = Yes
- fulminant hepatitis = very rare
- chronic hepatitis = no
- cirrhosis = no
- hepatocellular carcinoma = no

10

What are the outcomes for the following things in terms of hepatitis B infection?
- asymptomatic carrier
- acute hepatitis
- fulminant hepatitis
- chronic hepatitis
- cirrhosis
- hepatocellular carcinoma

- asymptomatic carrier = yes
- acute hepatitis = yes
- fulminant hepatitis = rare
- chronic hepatitis yes (5-10%)
- cirrhosis = yes
- hepatocellular carcinoma = yes

11

What are the outcomes for the following things in terms of hepatitis C infection?
- asymptomatic carrier
- acute hepatitis
- fulminant hepatitis
- chronic hepatitis
- cirrhosis
- hepatocellular carcinoma

- asymptomatic carrier = yes
- acute hepatitis = yes
- fulminant hepatitis = very rare
- chronic hepatitis = yes >70%
- cirrhosis = yes
- hepatocellular carcinoma = yes

12

What histopathological features are common in acute hepatitis?

spotty inflammation and lobular disarray
acidophil body
in severe cases = panacinar necrosis

13

What are the features of hepatitis D?

defective RNA virus
can only be replicated when encapsulated by hep B surface antigens
increases severity of HBV

14

What are the features of hepatitis E?

RNA virus - 32-34 diameter
transmitted by water-borne route
acute self-limiting illness
high mortality in pregnant women
can cause chronic liver disease in immunocompromised pts

15

What are the features of hepatitis F?

no definite viral agent found yet

16

What are the features of hepatitis G?

RNA virus (flavivirus)
transmitted via blood
associated with acute and chronic hepatitis
BUT pathogenetic role in liver disease uncertain

17

What is the definition of chronic hepatitis?

inflammation of the liver continuing without improvement for at least 6 months
HOWEVER
- most chronic liver disease has an inflammatory component that persists for >6 months
therefore term is restricted to number of diseases

18

What are the causes of chronic hepatitis?

viral - hep B, C, D
autoimmune (types 1-3)
Biliary - primary biliary cholangitis or primary sclerosing cholangitis
metabolic - alpha-1 -antitrypsin deficiency, wilson's disease
fatty liver disease - alcoholic or non-alcoholic
drugs - methyldopa, isoniazid, nitrofurantoin
unknown

19

How is chronic hepatitis classified?

Etiology
necroinflammatory activity (grade)
fibrosis (stage)

20

What is portal/periportal inflammation: interface hepatitis?

inflammation at the interface between connective tissue (portal tract, fibrous septa) and the liver parenchyma

21

What are the causes of fatty liver disease?

alcohol
- commonest cause of cirrhosis in UK - increasing

non-alcoholic
- now commonest cause of newly diagnosed chronic liver disease
- only 6% deaths in patients with NAFLD are from liver disease

22

What are the histological features of steatohepatitis?

hepatocellular injury
- fatty change
- ballooning
- mallory-dene bodies
- apoptosis/necrosis
inflammation
- neutrophil polymorphs
- other cells
fibrosis
- perisinusoidal
- pericellular

23

What are examples of chronic (autoimmune) biliary disease?

primary biliary cholangitis
primary sclerosing cholangitis
overlap syndromes (pbc/psc/autoimmune hepatitis)

24

What are the clinical features of primary biliary cholangitis?

peak incidence 40-60
F:M = 9/10:1
Signs/symptoms:
- pruritus, lethargy, jaundice, diarrhea, bone symptoms, portal hypertension, liver failure (late)
biochem
- elevated ALP and bile acids
- bilirubin increases later
immunology
- AMA (anti-mitochondrial ab)
- raised IgM
associated conditions
- sjorgen's syndrome, RA, autoimmune thyroiditis, coeliac disease
prognosis = progressive liver disease, with survival of 5-10 years

25

What are the histological features of PBC?

stage 1: inflammatory (granulomatous) bile duct destruction
stage 2: periportal (interface) hepatitis / bile ductular reaction
stage 3: periportal fibrosis
stage 4: cirrhosis
lots of overlap between stages
fibrosis unevenly distributed within the liver

26

What are the clinical features of primary sclerosing cholangitis?

any age, peak incidence 20-50
F:M = 2/3:1
Signs/symptoms
- progressive/intermittent jaundice, recurrent acute cholangitis
biochem
- raised ALP and bilirubin
immunology
- HLA-B8 and DR3 phenotype
- hypergammaglobinaemia
- anti-neutrophil abs
radiology
- cholangiography - strictures and beading
associated conditions
- IBD (mainly UC (60-70%))
- retroperitoneal fibrosis, mediastinal fibrosis
prognosis
- most develop progressive disease
- survival 5-15 years
- cholangiocarcinoma in up to 20%

27

What are the histological features of PSC?

1) small ducts - usually disappear without trace
2) medium sized ducts - periductal inflammation/fibrosis, nodular scars
3) large intrahepatic ducts = inflammation, ulceration, dilatation (cholangiectasia)
4) extraheptaic ducts = inflammation, ulceration, fibrosis

28

What is the definition of cirrhosis?

irreversible condition affecting the whole liver, characterized by:
- loss of normal lobular architecture
- nodular regeneration
- fibrosis
(fibrosis and early cirrhosis may be reversible)

29

How is cirrhosis classified?

micro nodular
macro nodular
mixed

30

What are the common causes of cirrhosis ?

fatty liver disease - alcoholic or non-alcoholic
viral - hepatitis B, C (rarely E)