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86 Cards in this Set

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how is the liver divided up into lobes?
right lobe (quadrate and caudate lobes) and left lobe
what is the liver's blood supply like, and how much blood comes from each source?
1) portal vein: brings venous blood from intestine and spleen (2/3); 2) hepatic artery: coming from celiac axis and supplies liver with arterial blood
what structures contain radicles of the hepatic vein?
central veins (terminal hepatic veins)
what do portal triads contain branches from (3)?
1) portal vein; 2) hepatic artery; 3) bile duct
what is the limiting plate?
hepatocytes immediately abutting the portal tracts
what are the two concepts by which pathologists organize the liver?
1) lobular concept; 2) acinar concept
which is most used by pathologists to date, and how is it organized (what is in the center, and what is in the periphery)?
lobular concept - liver cells plates or cords radiate from central vein outward toward the periphery where portal tracts are located
what does the acinar concept use as the center?
uses the primacy of hepatic blood flow
what is the acinar concept useful for?
1) the pathogenesis of drug-related injuries; 2) problems of liver perfusion
what is each acini centered on in the acinar concept, and what do they interdigitate with?
functional acini, each centered on the portal triad and interdigitating with terminal hepatic vains (central veins) of adjacent acini
what varies between the three zones in the acinar concept?
varied oxygen and nutrient delivery
what are the zones in order of diminishing substrate delivery (3)?
1) zone 1: periportal; 2) zone 2; midzonal; 3) zone 3: centrilobular
what are the types of cells in the liver (7)?
1) hepatocytes; 2) bile duct epithelial cells; 3) sinusoidal endothelial cells; 4) Kupffer cells; 5) perisinusoidal (hepatic) stellate cells; 6) liver associated lymphocytes (pit cells); 7) progenitor cells (oval cells)
what are other names for perisinusoidal (hepatic) stellate cells (2)?
Ito cells, lipocytes
what are three functions of perisinusoidal (hepatic) stellate cells?
1) main storage site for vitamin A in the body; 2) may play role in sinusoidal blood flow (have features of smooth muscle); 3) contribute to collagen production in normal and fibrotic liver
what is the population of liver associated lymphocytes like?
heterogeneous (T lymphocytes and natural killer cells)
MORPHOLOGIC PATTERNS OF HEPATIC INJURY
what are the two patterns of fatty change (steatosis) and what are two causes of each?
1) macrovesicular: alcohol, nonalcoholic fatty liver disease (NAFLD); 2) microvesicular: acute fatty liver of pregnancy, valproic acid
what are four patterns of necrosis that can occur in the liver?
1) individual cell necrosis (apoptosis); 2) focal ("spotty", random) necrosis; 3) zonal necrosis; 4) submassive or massive necrosis
what structures are seen in individual cell necrosis?
acidophil (Councilman) bodies
how is zonal necrosis further subdivided (3)?
1) centrilobular necrosis; 2) midzonal necrosis; 3) periportal necrosis
which one of these divisions has many causes mentioned for it, and what are four important causes?
centrilobular necrosis - caused by: 1) ischemia ("shock liver"); 2) drugs (Tylenol, cocaine); 3) congestive heart failure; 4) sepsis; other causes include veno-occlusive disease (VOD) and Budd-Chiari syndrome (hepatic vein thrombosis)
what is it called when the liver is damaged, but damage is short of outright necrosis?
degeneration
what types of degeneration were mentioned (2) and what is a cause of each?
1) ballooning degeneration (viral hepatitis); 2) feathery degeneration (cholestasis)
what kind of inflammation (location and cell types) is seen in acute viral hepatitis?
lymphocytic inflammation in the lobule
what type is seen in chronic viral hepatitis?
portal lymphocytic inflammation
what type of inflammation is seen in alcoholic hepatitis?
neutrophilic reaction in the lobule
what happens in piecemeal necrosis (a.k.a interface change) (2)?
1) chronic inflammatory infiltrate spills out from portal tracts into adjacent lobules; 2) associated necrosis of hepatocytes in the limiting plate
what is regeneration signifed by?
thickening of the hepatocyte cords as a result of hepatocyte proliferation
what is fibrosis formed in response to (2)?
1) inflmamation; 2) direct toxic insult to the liver
what types of fibrosis can occur (3)?
1) periportal; 2) perivenular; 3) bridging
CIRRHOSIS
what is the most common cause of cirrhosis in Western countries?
alcoholic cirrhosis
what is cirrhosis characterized by?
fibrosis and the conversion of normal architecture into structurally abnormal nodules - the end stage of a variety of liver diseases
what are the morphologic classifications of cirrhosis (2) and what does each mean?
1) micronodular (most nodules less than 3mm); 2) macronodular (most nodules are greater than 3mm)
what are two causes mentioned for micronodular cirrhosis?
1) alcoholic liver disease; 2) hemochromatosis
what are three causes mentioned for macronodular cirrhosis?
1) viral hepatitis; 2) autoimmune hepatitis; 3) Wilson's disease
how can the micronodular pattern progress to macronodular pattern?
by continued regeneration and expansion of existing nodules
besides viral and autoimmune hepatitis and alcoholic liver disease, what are other causes of cirrhosis?
1) biliary diseases; 2) hemochromatosis; 3) Wilson's disease; 4) alpha-1-antitrypsin deficiency; 5) cryptogenic: NAFLD
what % are cryptogenic?
10-15%
how can an etiologic diagnosis be made once cirrhosis is established?
it is usually impossible on morphologic grounds alone
what happens to weight and strength in cirrhosis?
anorexia, weight loss, weakness, frank debilitation
what hormone is increased, and why?
hyperestrogenemia, due to impaired hepatic metabolism of estrogens
what problems occur due to hyperestrogenemia (6)?
1) palmar erythema; 2) spider angiomas; 3) gynecomastia; 4) gonadal atrophy; 5) amenorrhea; 6) changes in body hair distribution
what else happens to the hands in cirrhosis (2)?
1) Dupuytren's contracture; 2) clubbing of fingers
what can happen to the kidneys besides hepatorenal syndrome (2)?
1) nephrotic syndrome; 2) glomerular lesions
according to this lecture, what is hepatic encephalopathy a consequence of?
portal hypertension
what are the ultamite mechanisms of death (3)?
1) progressive liver failure; 2) complications related to portal hypertension; 3) development of hepatocellular carcinoma
ALCOHOLIC LIVER DISEASE
what are the three morphologic and clinical entities spanned by alcoholic liver disease (and in what sequence do they typically occur)?
1) fatty liver; 2) alcoholic hepatitis; 3) cirrhosis - they typically occur in this sequence, but can also coexist in any combination and may be independent entities
how do alcoholism and alcohol related diseases rank in the top health problems of the United States?
third largest health problem in the United States
what lesions are seen in fatty liver (steatosis), and is it a reversible diease?
intracellular fat vacuoles, usually no fibrosis, reversible
what is the pathogenesis?
not precisely understood hepatotoxic effects of ethanol and its metabolites, and nutritional factors
what symptoms may occur (may be asymptomatic also)?
1) malaise; 2) anorexia; 3) abdominal discomfort
what happens to hepatocytes in alcoholic hepatitis?
swelling and necrosis
where does fibrosis occur in alcoholic hepatitis (2)?
1) perivenular; 2) sinusoidal
what type of inflammatory response occurs?
neutrophilic inflammatory response
what structures are seen on histology of alcoholic hepatitis?
Mallory bodies
what are mallory bodies?
alcoholic hyalin - intermediate filaments of prekeratin (cyotkeratin) and cytoplasmic hyaline inclusions
where else are Mallory bodies seen?
1) NAFLD; 2) primary biliary cirrhosis; 3) Wilson's disease; 4) Indian childhood cirrhosis; 5) hepatocellular carcinoma - (incomplete list)
what symptoms are seen in alcoholic hepatitis (5)?
1) fever; 2) malaise; 3) anorexia; 4) RUQ abdominal pain; 5) jaundice
what happens to blood liver enzymes in alcoholic hepatitis?
elevated aminotransferrase (AST > ALT)
what other lab value changes, and how?
mild leukocytosis (increased WBC count)
what is the mortality of alcoholic hepatitis?
10-20%
what % of alcoholic hepatitis cases progress to cirrhosis?
30%
what % of alcoholics eventually develop cirrhosis?
15%
besides hepatitis, what else does alcohol cause that leads to cirrhosis?
zone 3 fibrosis
what are all of the hepatobiliary effects of alcoholic abuse (list)?
fatty change, hepatitis, zone 3 fibrosis, pancreatitis, hepatocellular carcinoma, enhance hepatitis B and C, enzyme inducer (enhances drug toxicity)
what can pancreatitis lead to?
altered biliary structure
NON-ALCOHOLIC FATTY LIVER DISEASE
what do pathologic findings resemble?
alcoholic liver disease (but no history of heavy drinking)
what are other names for NAFLD?
nonalcoholic steatohepatitis, metabolic fatty liver disease, metabolic syndrome steatohepatitis
what % of the adult population has NAFLD?
24%
what problems occur in NAFLD (3)?
1) fatty liver; 2) steatohepatitis; 3) cirrhosis
what are the two most important risk factors for NAFLD?
1) obesity; 2) diabetes
what % of NAFLD sufferers are obese?
50-90%
what are other risk factors for NAFLD (2)?
1) dyslipidemia (hypertriglyceridemia, hypercholesterolemia, or mixed); 2) drugs (amiodarone)
what problem can occur in some cases of end-stage, burnt out NAFLD?
cryptogenic cirrhosis