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