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Lecture 8

Pathology of the Liver

Blood supply of the liver (1) portal veins - venous blood from pancreas, spleen, stomach, small/large intestines (2) hepatic artery - usually supplied by celiac trunk
Venous drainage of the liver Hepatic vein
Components of the portal triad (1) hepatic artery branch (2) portal vein branch (3) bile duct
Lobule Histological organizational unit of the liver. The unit is bounded by the portal triads (tracts) and oriented about a central vein
Inflammation and hepatocyte injury with biochemical or serological evidence of hepatitis for < 6 months Acute hepatitis
Most common etiology of hepatitis Viral (Hepatitis A, Hepatitis B, Hepatitis C)
Inflammation and hepatocyte injury with biochemical or serological evidence of hepatitis for > 6 months Chronic hepatitis
Etiology of acute hepatitis (1) Viral (2) Drugs (3) Idiopathic
(T or F) Hepatitis A is a common etiological agent of chronic hepatitis False. Majority of chronic hepatitis is due to Hepatitis B and C. Hepatitis A is a more common cause of acute hepatitis.
A common cause of liver disease in the US. Common morphologic findings include: steatosis, hepatocyte necrosis, infiltrates of neutrophils, Mallory hyaline bodies, and sclerosing hyaline necrosis Alcohol-related liver disease
A form of chronic liver disease with morphologic features of steatosis, hepatitis, and firbrosis. A major risk factor is obesity. Non-alcohol-related fatty liver disease
Chronic, progressive inflammatory destruction of the extrahepatic biliary tract leading to fibrosis and cirrhosis. Higher incidence in males and strong association with uclerative colitis. Primary sclerosing cholangitis (PSC)
What inflammatory bowel disease is associated with Primary Sclerosing Cholangitis? Ulcerative colitis
The diagnostic feature of PSC found on ERCP Alternating strictures and dilatations and beading of intra and extraheptic bile ducts
Chronic progressive inflammatory destruction of intrahepatic biliary tract leading to fibrosis and cirrhosis. Primariliy affects middle-aged females. Characterized by the presence of antimitochrondrial antibodies Primary biliary cirrhosis (PBC)
Pathologic features found on biopsy samples of PBC (1) Portal chronic inflammatory infiltrate (2) Lymphocyte infiltration of bile duct epithelium (3) Bile duct necrosis and destruction (4) Portal-based non-necrotizing granulomas
Chemical agents that are directly toxic to some cellular components of the liver. Causes injury in virtually every exposed individual in a dose-related manner Intrinsic hepatotoxins
Chemical agents with unpredictable liver toxicity. Produces liver injury in a small proportion of exposed individuals and does not exhibit a dose-related response Idiosyncratic hepatotoxins
End-stage result of chronic injury to the liver. Diffuse process characterized by fibrosis and the conversion of the normal hepatic architecture into regenerative nodules Cirrhosis
(T or F) Portal hypertension is a common finding in end-stage liver disease True. Synthetic and metabolic capacity of the liver is also affected.
(T or F) The etiology of liver damage in a cirrhotic liver can be determined based on teh gross or microscopic appearance of the liver. False. Cirrhosis is ettiologically non-specific.
A bengin lesion characterized as a hamartoma of hepatocytes and bile ducts. Predominantly found in females. Exhibits "blushing" on angiographic studies. Focal nodular hyperplasia (FNH)
A solitary subcapsular liver mass composed of disorganized nodules of hepatocytes surrounded by fibrous septae that contain bile ductules and chronic inflammatory cells. Has a central scar that contains numerous thick-walled blood vessels. Focal nodular hyperplasia (FNH)
Benign neoplasm of the liver that predominantly occurs in females. Has a strong association with oral contraceptive use and anabolic steroid use. Hepatic adenoma
Why must all hepatic adenomas be excised? Hepatic adenomas have a propensity to hemorrhage which can be fatal.
Symptoms include abdominal pain, ascites, and hepatomegaly. Lab tests show elevated alpha-fetoprotein (AFP). Hepatocellular carcinoma
Risk factors of hepatocellular carcinoma (1) Cirrhosis (2) hepatotrophic viruses (3) hemochromatosis
What is the 5-yr survival of hepatocellular carcinoma? Overall 5-yr survival is 3% in the US
(T or F) Hepatocellular carcinoma is histolotically distinct from metastatic adenocarcinoma from a distant primary site False. Morphologic features of hepatocelluar carcinoma is nearly indistinguishable from adenocarinoma metastasis to the liver.
A variant of hepatocellular carcinoma found in young patients without cirrhosis. Typically has a better prognosis thatn routine hepatocellular carcinoma Fibrolamellar hepatocellular carcioma
May grossly resembles metastatic disease to the liver with diffusely scattered small whitish nodules. Usually an incidental finding consisting of a hamartomatous growth of bile ducts in the liver. Bile duct hamartoma (von Meyenburg complex)
Benign tumor of the bile ducts. Bile duct adenoma
A malignant tumor of hte intrahepatic bile cuts. An adenocarcinoma consisting of duct and gland-like structures lined by cuboidal-to-columnar cells with varying degrees of cytologic atypia. Poor prognosis. Cholangiocarcinoma
Most common benign tumor of the liver Hemangioma - a benign vascular tumor of the liver
Malignant vascular tumor of the liver Angiosarcoma
(T or F) Metastases occur with equal prevalence in both cirrohtic and non-cirrhotic livers False. Metastatic disease is rare in cirrhotic livers. Mass lesions arising within a cirrhotic liver are typically of hepatic origin.
Created by: UVAPATH2