13-1: 2/13 - Liver Pathology I

Front 1

Zone 1 of hepatic lobule acinus is near _______.

Back 1

portal tract (fresh blood)

zone = periportal

Front 2

Zone 3 of hepatic lobule acinus is near _______.

Back 2

hepatic vein (less blood supply)

zone 3 = centrilobular

Front 3

Space of Disse contains ________.

Back 3

Fibrin and Stellate Cells

Front 4

Kupffer cells are located ___________.

Back 4

ON luminal side of hepatocyte

Front 5

What is an oval cell?

Back 5

Cell located in Canal of Hering; will eventually become hepatocyte and bile duct cells

Front 6

What is the limiting plate?

Back 6

Layer of hepatocytes that directly surround portal tract.

Front 7

What lab tests results indicate bile duct injury/cholestasis?

Back 7

ALP
GGT

Front 8

What are the histologic signs of liver degeneration?

Back 8

Swelling
Ballooning
Feathery degeneration

Front 9

Feathery degeneration:
Describe
Associated disease

Back 9

Swelling of individual hepatocytes with yellow foam contents

Seen in cholestatis liver dz (retained biliary material)

Front 10

Macrovesicular steatosis:
Describe
Associated disease

Back 10

Single large droplet that displaces nucleus

Assocd: alcoholic fatty liver dz, obesity, DM, HCV

Front 11

Microvesicular steatosis:
Describe
Associated disease

Back 11

Multiple tiny droplets that do not displace nucleus

Assoc: Alcoholic fatty liver dz, REYE syndrome, acute fatty liver of pregnancy

Front 12

Utility of Prussian Blue stain

Back 12

Shows Fe

Front 13

Utility of Rhodanine stain.

Back 13

Shows Cu

Front 14

Utility of Period Acid-Schiff Stain (PAS).

Back 14

Stains glycogen, but after diastase digestion (breaks down glycogen), stains carbohydrates and glycoproteins.

Impt for dx alpha1-AT deficiency (hepato-cytoplasmic granules of accumulated AAT protein!!!)

Front 15

Acetaminophen results in Zone ___ necrosis.

Back 15

Zone 3

Front 16

This cells are the predominant infiltrators of alcoholic hepatitis.

Back 16

Nphils

Front 17

This cells are the predominant infiltrators of drug-induced hepatitis.

Back 17

Ephils

Front 18

This cell is responsible for liver fibrosis.

Back 18

Stellate Cells

Front 19

What is capillarization of sinusoids?

When does it occur?

Back 19

Capillerization occurs in cirrhosis; sinusoids become more like capillaries:

-inc'd sinusoidal resistance
-abnormal septal vasculature which results in blood shunting

Front 20

Histologic characteristics of cirrhosis.

Back 20

DIFFUSE; involves entire liver parenchyma

Bridging fibrosis

Regenerative nodules encircled by fibrosis

Front 21

Extrahepatic signs of hepatic failure.

Back 21

Palmar erythema
Spider angiomas
Hypogonadism
Gynecomastia

Front 22

3 causes of hepatic failure.

Back 22

1) Acute liver failure w/massive necrosis--ex: fulminant viral hepatitis

2) Chronic liver dz (MOST COMMON)

3) Hepatic dysfn w/o overt necrosis--viable but no fnal hepatocytes--Reye syndrome, acute fatty liver of pregnancy

Front 23

Biologic cutoff for jaundice.

Back 23

Bilirubin >2.0 mg/dL

Front 24

This immunoglobulin is a sign of acute infeciton.

Back 24

IgM

Front 25

This immunoglobulin is a sign of past infection.

Back 25

IgG

Front 26

Histologic features of acute viral hepatitis.

Can you distinguish specific viral types?

Back 26

Lymphocytes are predominant cells

Panlobular with balloon degeneration, necrosis (cytolysis), macrophage aggregates, portal inflammation, LOBULAR DISARRAY

NO FIBROSIS

ALL viral hepatitis has same features

Front 27

How can you distinguish fibrosis from necrosis?

Back 27

Trichrome stain

Front 28

Serologic values of HBV infection for:
Acute infection
Recovery
Chronic infection
Vaccinated

Back 28

Front 29

Chronic HBV infection:
Histologic features

Back 29

Ground glass hepatocytes

Front 30

Acute vs Chronic HCV infection:
Serologic markers

Back 30

Acute:
HCV-RNA disappears after 1-3 weeks (inoculation)
Anti-HCV Abs

Chronic:
HCV-RNA
Anti-HCV Abs

Front 31

Chronic HCV infection:
Histologic features

Back 31

Lymphoid aggregates
Mild steatosis

Front 32

Coinfection vs Superinfection HDV:
Serologic markers

Back 32

Coinfection (with HBV):
IgM anti-HDV
IgM anti-HBcAg

Superinfection (person already has HBV):
HBsAg
IgM and IgG anti-HDV

Front 33

Chonic viral hepatitis:
General histologic features

Back 33

Portal, periportal inflammation
Apoptosis
BRIDGING FIBROSIS

Front 34

The stage of chronic hepatitis depends on ________.

Back 34

degree of fibrosis

Front 35

Autoimmune hepatitis is pathologically ____________ from viraal hepatitis.

Back 35

INDISTINGUISHABLE BY PATHOLOGY

need clinical hx!

Front 36

Autoimmune hepatitis:
Serologic markers

Back 36

Elevated serum IgG
Auto-abs x ANA, ASMA, Anti-LKM

Front 37

These liver abscesses are present in developed nations.

Back 37

Bacterial abscesses
Ex:
Biliary obstruction/infection (ascending cholangitis)
Systemic bacteremia
Direct extension from contiguous infection
Penetrating trauma

Front 38

These liver abscesses are present in developing nations.

Back 38

Parasitic--amebic, echinococcal, protozoal, helminthic

Front 39

Pyogenic liver abscesses usually affect ________.

Back 39

Immunocomp'd individuals

Front 40

How does ethanol metabolism result in steatosis?

Back 40

EtOH decreases NAD
NAD required for FA oxidation

Thus EtOH consumption-->impaired assembly and secretion of lipoproteins-->inc'd peripheral catabolism of fat

Front 41

Alcoholic hepatitis:
Histologic features

Back 41

Steatosis with ballooning degeneration
Mallory bodies
Nphilic infiltrate
Perivenular, perisinusoidal fibrosis

Front 42

Alcoholic cirrhosis:
Histologic features

Back 42

Bridging fibrosis

Front 43

How can drug-induced liver disease be distinguished from viral liver disease?

Back 43

Must use serology!!

Not pathologically distinguishable.

Front 44

What drugs can cause acute liver failure?

Back 44

*****Acetaminophen*****
Halothane
Anti-Tb drugs (rifampin, INH)