Systemic Path, Unit 1

Front 1

What types of animals have a higher percentage of their body weight consumed by the liver?

Back 1

Younger animals

Carnivores

Front 2

Blood going to the liver makes up what percent of cardiac output?

Back 2

25-33%

Front 3

The volume of blood in the liver makes up what percentage of the total blood volume?

Back 3

10%

Front 4

a. Where does the blood come from that supplies the liver

b. What % of oxygen does the liver consume?

Back 4

a. 25% from the hepatic artery, 75% from the intestines, stomach and spleen

b. 20%

Front 5

Describe the Venous Blood flow through the lobules of the liver.

Describe the Bile flow

Back 5

Blood- flows from sinusoids -> central vein -> sublobular vein -> hepatic vein -> caudal vein

Bile- runs opposite. From the center of the lobule to the outside

Front 6

What is a Kupffer cell?

What is the consequence of a liver lobe torsion in relation to the Kupffer cell?

Back 6

The specialized Phagocytic cell of the liver

If a lobe of the liver gets twisted (the left lateral lobe being the most common), you get a very quick death due to clostridia overgrowth in that animal.

Front 7

Identify the cells the arrows are pointing to

Back 7

Kupffer Cells, found in the liver

Front 8

Name the parts of the liver lobule that the arrows are pointing to

Back 8

(From top to bottom)

Bile Duct

Hepatic Artery

Central Vein

Front 9

What is the normal function of the Ito cell? How does it change in injury?

Where are they normally located?

Back 9

Normally, it stores Vitamin A

In injury, they make collagen which can lead to hepatic fibrosis

They are located in the space of Disse

Front 10

Explain why the liver is the "shock organ" in the dog

Back 10

In anaphylaxis, there is a small amount of muscles in a dogs veins that constrict. This constriction leads to a massive pooling of blood in the liver. If left un-treated, this blood pooling can lead to shock and then eventually death.

Front 11

How is bilirubin different from bile?

Back 11

Bilirubin is a component of bile

Front 12

What are the four general functions of the hepatocytes?

Back 12

Synthesis

Storage

Secretion

Detoxification

Front 13

What are the three functions of the liver that we talked about in class?

Back 13

Metabolize- carbs, lipids and proteins

Xenobiotic Metabolism

Bilirubin Metabolism

Front 14

Define Xenobiotic metabolism

Back 14

The metabolism of drugs and other metabolic end products. They are normally circulating bound to plasma proteins and cannot be excreted by the kidneys. Therefore, the liver is needed to break down these compounds so that they can be excreted.

Front 15

What are the three steps done by the zone 3 hepatocytes in Xenobiotic metabolism?

Back 15

1. Biotransformation

2. Conjugation- Form H2O soluble particles

3. Excretion into the bile caniculi

Front 16

Describe the process in which bilirubin is broken down

What clinical symptom develops if too much bilirubin is in the system?

Back 16

Bilirubin comes from the breakdown of hemoglobin and circulates bound to albumin.

The liver is responsible for conjugating bilirubin with glucuronic acid

Jaundice

Front 17

Name the 7 basic symptoms associated with liver disease

Back 17

Jaundice

Ascites

Hemorrhage

Dependent Edema

Hemolysis

Photosensitivity

Hepatic Encephalopathy

Front 18

Describe the pathogenesis for Jaundice

Back 18

1. Decreased uptake

2. Decreased conjugation

or 3. Decreased excretion of bilirubin

Front 19

Describe the pathogenesis for Ascites

Back 19

Primary cause: Hepatoportal hypertension

Secondary cause: hypoproteinemia

Front 20

Describe the pathogenesis for Hemorrhage in the liver

Back 20

1. Increased consumption

or 2. Decreased production of clotting factors

Front 21

Describe the pathogenesis for Dependent edema and liver disease

Back 21

Hypoproteinemia

Front 22

Describe the pathogenesis of liver disease leading to Hemolysis

Back 22

Hypercuprosis (accumulation of copper)

Front 23

Describe the pathogenesis of photosensitivity in relation to liver disease

Back 23

Decreased secretion of photoactive molecules

(secondary cause- ingestion of toxic plants)

Front 24

Describe the pathogenesis of liver disease and Hepatic encephalopathy

Back 24

Decreased clearance of amines from the GI tract

Front 25

The liver uses high amounts of energy, leading it to susceptible to what two things?

Back 25

Toxemia and Anemia

Front 26

If you were to see this in a liver, how would you describe this condition?

Back 26

Macrovacuolar hepatic lipidosis due to accumulation of lipid in the liver

Front 27

If this was a liver from a cat seen on necropsy, how would you describe the liver and what disease would cause this?

Back 27

Grossly tan, friable, rounded edges liver

Hepatic lipidosis

Front 28

If these were given to you and you were told that these were specimens from a dog with diabetes mellitus, what would you suspect happened in this liver?

Back 28

Too much glycogen accumulated in the liver

(REMINDER- this doesn't happen in cats)

Liver is MOTTLED, which is different from grossly tan as seen in hepatic lipidosis

Front 29

What are the 4 general reactions to injury you see in the liver?

Back 29

Cell swelling

Cell death/necrosis

Regeneration- as long as the architecture is retained

Fibrosis and ductule/arteriolar proliferation

Front 30

What reaction to cellular injury is displayed in this picture?

Back 30

Fibrosis and Regeneration

(Severe fibrosis = cirrhosis)

You're seeing shrunken lobules and connective tissue between them

Front 31

If you looked under a slide and saw this, what disease would you suspect going on in the liver?

Back 31

Hepatitis

(look for inflammatory cells)

Front 32

Describe what you see in this liver slide?

What is staining in the hepatocytes?

What is the name of the stain?

Back 32

This is copper in the hepatocytes. In certain breeds such as westies, labrador retrievers and betlington terriers, this happens leading to widespread hepatitis.

Rubeanic Acid Stain

Front 33

Explain how doberman copper accumulation is different from the other breeds

Back 33

Dobermans seem to get hepatitis first and then get copper accumulation from the hepatitis. In the other breeds, the copper accumulation comes first which then leads to the hepatitis.

Front 34

If this was something you saw from a liver sample, what reaction to injury is this?

What disease commonly causes this?

Back 34

Ateriolar proliferation

Hepatic Encephalopathy

Front 35

The center area is a spot of what in the liver

As mentioned in class, this is a common seen occurrence with what disease?

Back 35

Focal Necrosis

Tyzzers Disease (in foals)

INFECTIOUS AGENTS!

Front 36

The presence of what response to injury is seen here in this liver section?

Back 36

Hemorrhage

Front 37

What response to injury is seen here?

As mentioned in class, this is a common presentation of what disease?

If left alone, this can lead to what in the liver

Back 37

Dissociation of the hepatic cords

Leptospirosis in dogs

Can lead to extensive fibrosis and cirrhosis

Front 38

Name the three developmental anomalies that happen in the liver

Back 38

Cysts

Biliary Atresia

Vascular shunts

Front 39

This is a histological example of what developmental anomaly in the liver?

Back 39

Vascular shunt

Look for many small vessels but no large obvious ones

Front 40

What are the three general causes of glycogen accumulation seen in animals?

Back 40

1. Diabetes Mellitus

2. Glycogen Storage disease

3. Steroids (accumulation can be seen for up to 12 weeks after steroid use)

Front 41

Describe the different mechanisms (5) that can lead to lipid accumulation in the liver

Back 41

Lipids -> liver = free fatty acids = triglycerides

1. Excessive caloric uptake, more FFA

2. Excessive entry of FFA from fat deposits

3. Increased Esterification of FFA = more triglycerides

4. Decreased oxidation of FFA due to decreased hepatocyte function

5. Interference with lipoprotein synthesis and excretion

Front 42

What are the two circulatory changes that result in liver disease?

Back 42

Passive Congestion

Canine Anaphylaxis

Front 43

You are presented a liver that looks like this. What change happened to lead to a liver that looks like this?

Histologically, what would you expect to see?

Back 43

This is an example of passive congestion, typically happening from R sided heart failure.

The liver is mottled, firmer and larger than normal

Histologically, you would see engorged vessels and hemorrhage

Front 44

This is an example of what change in the liver?

Back 44

This is circulatory change, caused by canine anaphylaxis.

Notice diffuse congestion and hemorrhage

Front 45

Name the 5 different patterns of necrosis seen in the liver.

Back 45

1. Focal random necrosis

2. Centrilobular Necrosis

3. Periportal Necrosis

4. Paracentral Necrosis

5. Massive necrosis

Front 46

Describe what abnormality you see in this liver.

What could have caused this?

Back 46

This is centrilobular necrosis, caused by TOXINS. Common toxins include acetaminophen, pine-oil based cleaning, aflatoxins and copper

Front 47

Grossly, this picture displays what in this liver?

Back 47

Centrilobular Necrosis- as seen by TOXINS

Notice areas of dark red, mottled appearance

Front 48

This type of necrosis is classified as what?

What are the causes of this type?

Back 48

This is periportal necrosis (necrosis on the edge of the lobules)

This is caused by iron and phosphorous toxicity and cocaine

Front 49

Pericentral necrosis is necrosis centered around what?

Back 49

The Central Vein

Front 50

Define Massive Necrosis

Back 50

In one individual lobule of the liver, 100% of the hepatocytes are necrotic.

Often this is an extension of centrilobular necrosis

Front 51

Histologically, this is a slide that is displaying what?

Back 51

Bacterial Hepatitis, in Tyzzer's Disease

Front 52

This mottled liver is an example of what type of disease?

What causes it?

Back 52

Bacterial Hepatitis

Caused by salmonella, listeria or tularemia

Front 53

Knowing that this is a liver from a cow, what is this?

What is its cause?

Back 53

Liver abscesses, a bacterial hepatitis in cattle.

Abrupt change from a high roughage to a high concentrate diet, clumps rumen papilla

Front 54

Name the 6 different viruses that can cause hepatitis

Back 54

Infectious canine hepatitis

Herpesvirus

Equine Herpesvirus 1

Infectious Bovine Rhinotraceitis

Canine herpesvirus

Pseudorabies virus

Front 55

Along with this image, you also had ecchymoses and petechia on all organ surfaces. What disease are you suspective of?

Back 55

Canine infectious hepatitis, a viral hepatitis

Front 56

Along with this kidney, you find necrosis on the liver and this was in a young puppy. What disease are you suspective of?

Back 56

Herpesvirus, an infectious viral hepatitis that happens when puppies get hypothermic

Front 57

Name the 4 general kinds of Cirrhosis seen in the liver

Back 57

1. Post-necrotic

2. Biliary necrosis

3. Glission Cirrhosis

4. Parasitic Cirrhosis

Front 58

Describe What Billiary necrosis is in the liver

Back 58

Chronic inflammation of bile ducts and surrounding parenchyma

Front 59

What is the cause of Glission Cirrhosis?

Back 59

Right sided heart failure, leading to chronic passive congestion and then cirrhosis

Front 60

Name the 5 possible causes of cirrhosis in the liver

Back 60

1. Drugs that cause hepatitis

2. Infectious agents

3. Toxins

4. Chronic Hepatitis

5. Idiopathic

Front 61

cirrhosis in horses are normally from what cause?

How does the liver appear different in compared to canine hepatitis

Back 61

From plant toxins, pyrrolizidine alkaloid consuming plants

Liver is not nodular

Front 62

This liver from a horse could be described as a "dishcloth liver". What disease is this?

What are the 4 possible causes of this disease?

Back 62

"Equine serum hepatitis" or "Theiler's Disease"

Non-primate hepacivirus

Equine Pegivirus

Equine Parvo (maybe the actual cause?)

Theiler's disease associated virus

*NONE have been experimentally reproduced

Front 63

Most commonly, when does a horse become infected with Theiler's disease?

Back 63

within 30-90 days of receiving a vaccine with equine cells in it (with tetanus toxoid becoming the most common)

Front 64

Commonly seen in older dogs, this is a what in this liver?

Back 64

Hyperplastic Nodule of the liver (benign)

Front 65

Identify the lesion seen in this liver

Back 65

Hepatocellular Carcinoma

(Note sheets of hepatocytes but no clear cords)

Front 66

Identify the lesion seen in this liver

Back 66

Bile duct carcinoma (gross image left)

Note loss of lobules

Front 67

Identify the lesion seen in this liver

Back 67

Hemangiosarcoma

*Probably a metastasis from another cancer in the body, the liver is a common place for metastasis to occur