Liver Pathology

the liver is attached to the diaphragm by the

coronary ligament anterior and posteriorly

____ capsule covers the liver

glissons

caudate lobe is situated ___ and is ___ to the IVC

posteriorly and anteriorly

most common variant of the liver

ridiels lobe

primary functions of liver

digestion, storage, detoxification

liver digests:

secretes bile

releases bilirubin by breaking down red blood cells and separating from albumin

liver stores:

iron and vitamins

liver detoxify:

drugs, poison and metabolic waste products

liver function test: AST and ALT

liver damage

liver function test: ldh

tissue damage and disease

liver function test: alk phos and bilirubin

biliary obstruction or injury to bile ducts for bilirubin

liver function test: albumin and globulins

liver disease

liver function test: pt and inr

injury to bile ducts

prolonged extra hepatic bile duct obstruction, internal biliary fistula

liver function test: WBC

infection, bile duct damage

metabolic functions of the liver: dietary sugars

convert to glucose to use as fuel

metabolic functions of the liver: glucose

breakdown to form glucose and release into body

metabolic functions of the liver: dietary fats

metabolize and store

convert lipoproteins- body transports, stores and uses

metabolic functions of the liver: stored fats

transport and convert to energy

metabolic functions of the liver: plasma proteins/ nutrients

plasma proteins- manufactures

nutrients- remove from blood

metabolic functions of the liver: amino acids

convert excess AA to fatty acids and urea

metabolic functions of the liver: bacteria and worn out red blood cells

phagocytize

causes for hepatomegaly (over 15.5)

infection, hepatic tumors, congenital, or metabolic disorder

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what’s accumulation of triglycerides within hepatocytes

hepatic steatosis

NAFL;

non-alcoholic fatty liver- fat buildup in the liver with little or no inflammation of liver damage

NASH

non alcoholic steatohepatitis- more serious form of fatty liver disease that can cause cirhosis

due to people being sensitive, NAFLD is now known as

MASLD ( metabolic dysfunction-associated steatitic liver disease

what % of people have MASLD

30%

leading cause of liver transplants

MASH (more severe than MASLD)

leading causes of fatty liver are:

alcohol abuse and obesity

other causes of fatty liver could be

uncontrolled hyperlipidemia, diabetes, severe hepatitis, metabolic disorders, TPN, cystic fibrosis

is cirrhosis reversible

no

liver fibrosis:

has no symptoms until too late

can be reversed

restricts blood flow

glycogen storage disease:

inherited genetic disease

abnormal storage and accumulation of glycogen in the tissues, especially in the liver and kidneys

most common type of glycogen storage disease

type 1 or von gierke disease

von Gierke disease:

hepatomegaly due to fat and glycogen deposits

focal fatty infiltration/ sparing

focal nodular hyperplasia

hepatocellular carcinoma/ adenoma

recovery for acute hepatitis can take up to

six months, eventually regenerate

effects of acute hepatitis

mild disease to massive necrosis and liver failure

pathological changes regarding acute hepatitis

liver cell injury, swelling of hepatocytes, hepatocyte degeneration (may lead to cell necrosis)

etiologies of acute hepatitis:

alcohol, acetaminophen, NSAIDS, herbal supplements, herpes simplex virus, bacteria, fungi, various toxins

viral hepatitis:

infection caused by a group of viruses that specifically target hepatocytes

MOST COMMON; Hep A

how is HEP A spread

fecal contamination through ingested food and water

in developing countries, the disease is common and occurs early in life

acute infection, leads to either complete recovery or death from acute liver failure

HEP B and C exists in the:

bloodstream

spread by transfusions of infected blood/ plasma, contaminated needles, or sexual contact

HEP B is greatest risk for health care workers because of nature of transmission

sonographic appearance of acute hepatitis

portal vein borders more hyperechoic

liver parenchyma is edematous, more hypoechoic

attenuation may be present

hepatosplenomegaly is present

GB wall may be thickened

what’s chronic hepatitis:

hepatitis last longer than 6 months

pts may not have acute hep symptoms

discovered by lab work, elevated AST

symptoms of chronic hepatitis

nausea, anorexia, weight loss, tremors, jaundice, dark urine, fatigue and varicosities

chronic hep can develop to

cirrhosis and liver failure

(monitored by elastography)

cirrhosis (chronic degenerative disease of the liver):

general term for a diffuse process that destroys normal liver lobule architecture

causes of cirrhosis

related to alcohol, drugs or virus

fibrous tissue does not allow for…

normal liver cell functioning

with cirrhosis, parenchymal distortion may alter or compress….

biliary and vascular channels leading to jaundice and portal hypertension

with cirrhosis there may be new vascular channels like collateral shunts but that compromises…

liver function, producing hypoxia, necrosis, and atrophy that can lead to liver failure

Cirrhotic liver with increased echogenicity and ascites allowing for visualization of the

falciform ligament

with cirrhosis Lower frequency transducer may be needed due

to

attenuation of liver parenchyma

as cirrhosis progresses what happens to the different parts of the liver

rt lobe- shrinks

left and caudate- enlarge

echogenecity icnreases

surface nodular

coarse and hyperechoic

decreased ability to see vascular structures

potential side affects of cirrhosis

splenomegaly, ascites, portal hypertension

as the blood flow to the liver decreases due to cirrhosis, there is an increase in ____

hepatic artery, it will enlarge and have elevated velocities to maintain hepatic perfusion

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