CB570 - Module 8 Liver and Pancreas Pathology

Liver Overview

Located in the upper right abdominal quadrant, organized into lobules with chords of hepatocytes.

All drains into the Terminal Hepatic Venule, then blood returns via the vena cava to the heart.

Should be soft on palpation, hardness can indicate damage or cirrhosis.

Alkaline phosphatase

Key enzyme that is release when hepatocytes are damaged, can be measured in clinical settings.

Portal Tract

Blood vessels in the liver, liver damage can cause portal hypertension.

Jaundice (Icterus)

Buildup of bilirubin that causes yellowing of the skin and eyes when the liver is damaged or excess blood is being processed.

Often seen in neonates as the liver is still developing.

Cholestasis

Retention of bile salts in the liver, can cause salts to dump into the blood stream. Major symptoms are systemic itching (pruritis) and malabsorption.

Bile “lakes” form in the liver.

Types of Hyperbilirubemia (2)

1. Conjugated - post-hepatic, liver is still functioning to conjugate bilirubin but transport is impaired

2. Unconjugated - pre-hepatic, liver is unable to process bilirubin at all

Intrahepatic Biliary Obstruction

Can be caused by certain drugs, pregnancy, liver damage and cause blockages in the liver. Typically cause conjugated hyperbilirubemia.

Extrahepatic bile duct obstruction

Can be caused by tumors, autoimmune diseases, and strictures. Prevents bile from draining into the gut.

Hepatic Failure

Characterized by jaundice and encephalopathy. Can be chronic or acute.

Symptoms can include renal failure, bleeding in the skin, estrogen- related phenotypes in males.

Liver Cirrhosis

Scarring of the liver from repeated damage and healing.

Causes of Liver Cirrhosis (5)

1. Viruses (Hep A, B, and C)

2. Hemochromatosis

3. Autoimmune diseases

4. Alpha-1-antitrypsin deficiency

5. Alcohol

Which two Hepatitis viruses are capable of chronic disease?

Hepatitis B (10% chronic) and Hepatitis C (80% chronic with recurring symptoms)

Hepatitis A is typically self-limited, most common Hepatitis infection.

Hepatitis B or C Worst Case Scenario Progression (4)

1. Acute Hep B or C

2. Chronic Hep B or C

3. Liver Cirrhosis

4. Hepatocellular Carcinoma

Fatty Liver Disease

Excessive alcohol consumption causes fatty buildup in the liver, this is reversible.

Complications of Liver Cirrhosis (5)

1. Portal hypertension

2. Encephalopathy (from high ammonia levels)

3. Esophageal Varices

4. Ascites

5. Splenomegaly and hypersplenism

Hemochromatosis

Excessive iron uptake, causes s buildup of iron in various organs.

Treated by phlebotomy.

Diabetes and hepatocellular carcinoma are potential complications.

Hepatocellular carcinoma

Primary liver cancer, can be caused by cirrhosis or iron overload.

Metastatic liver cancer

Most common liver tumor, as the high blood flow through he liver makes this a likely place for metastasis.

Hepatic adenoma

Linked with high estrogen levels. Benign but could lead to dangerous bleeds.

Hemangioma

Most common benign tumor of the liver, blood vessel tumor.

Kaposi sarcoma

Linked with HHV-8 infection, typically seen in immunodeficient individuals.

Malignant tumor with multiple cutaneous and visceral lesions.

Gallstone Types (2)

1. Pigmented - made of precipitated bilirubin

2. Non-pigmented - made of precipitated cholesterol

Pigmented Gallstones

Can be related to sickle cell anemia or bilirubin anemia, causes pigmented gallstones.

Non-pigmented Gallstones

Cholesterol stones, can be related to hypercholesteremia and high estrogen levels. Most common type of gallstone.

Primary sclerosing cholangitis

Probably autoimmune, affects larger bile ducts which coalesce to form the hepatic duct

Primary biliary cirrhosis

Autoimmune disease, anti-mitochondrial antibodies are a marker

Exocrine and Endocrine Functions of the Pancreas

Exocrine - secrete enzymes that end up in the common bile duct for digestion

Endocrine - make hormones like insulin, glucagon.

Acute Pancreatitis

Amylase and ligase are released, which can cause widespread damage.

Caused by acinar cell injury and duct obstruction.

Risk Factors of Acute Pancreatitis (6)

1. Ethanol

2. Gallstones

3. Viruses (mumps, HIV, cytomegalovirus)

4. Shock

5. Blunt trauma

6. Therapeutic drugs (immunosuppressives)

Signs of Pancreatitis

1. Hemorrhage in the pancreas

2. Fat necrosis/saponification of the pancreas

Chronic Pancreatitis

Associated with calcification and intestinal malabsorption.

Complications involve pseudocysts, pain from fibrosis, stone in the duct, diabetes

Pancreatic Carcinoma

Extremely deadly cancer due to its tendency to metastasize quickly to the liver and spleen.

Pancreatic Islet Cell Neoplasia

Insulinoma, tumors produce insulin and cause hypoglycemia. Clonal proliferation of beta cells.

Glucagonoma

Pancreatic tumor that secretes glucagon.

Zollinger-Ellison syndrome

Unrelenting peptic ulcer disease due to gastrin from a pancreatic tumor.