1. Hepatic lesions caused by circulatory disorders. Nonviral inflammatory diseases of the liver. Drug hepatopathies

Weight of liver?

1100-1300g

Subgroups of hepatic lesions caused by circulatory disorders?

- Impaired blood into the liver

- Impaired blood flow through the liver

- Impaired blood flow out of the liver

Impaired blood flow into the liver?

- Hepatic artery infarct

- Portal vein obstruction and thrombosis

Why are infarcts to the liver rare?

Because of the dual blood supply

- retrograde arterial flow through the accessory vessels and portal venous supply is enough

Hepatic artery infarct?

Rare

- interruption of the main hepatic artery wont cause ischaemic necrosis

Which scenarios can cause extrahepatic portal vein obstruction?

- Pancreatitis, which cause a thrombosis in the splenic vein that moves into the portal vein

- Thrombogenic disease

- Postsurgical thrombosis

- Cirrhosis

How can cirrhosis cause portal vein obstructions?

Does not obstruct directly, but slows down the blood flow which increase the risk for thrombus formation

Symptoms of portal vein obstruction?

- Abdominal pain

- Ascites

- Portal hypertension

What will an obstruction of the portal vein lead to in the liver?

Infarct of Zahn

Infarct of Zahn?

Sharply demarcated area of red-blue discoloration

- no necrosis but congestion in the sinusoids and atrophy of hepatocytes

Impaired blood flow through the liver?

- Nutmeg liver

- Central haemorrhagic necrosis

What is nutmeg liver?

Chronic passive congestion of liver

- due to right-sided heart failure

What is central haemorrhagic necrosis?

death of liver cells near central vein

due to: toxins; alcohol, drugs or due to acute right sided HF

Hepatic vein outflow obstructions?

- Hepatic vein thrombosis

- Sinusoidal obstruction syndrome

Another name for hepatic vein thrombosis?

Budd-Chiari syndrome

What does hepatic vein thrombosis cause?

Congestion of the liver

- Hepatomegaly

- Ascites

- Portal hypertension

Sinusoidal obstruction syndrome is caused by?

Caused by damage to the sinusoidal epithelium

- most commonly due to chemotherapy or radiation

What will happen to the sinusoidal epithelium in sinusoidal obstruction syndrome?

The damaged endothelium cells will slough and form thrombi

- which block the sinusoidal flow

Non-viral inflammatory diseases of the liver?

- Neonatal hepatitis

- Cholangitis

- Liver abscess

- Echinococcus cyst in the liver

What is neonatal hepatitis?

A group of disorders in neonates, which are characterized by;

- hepatocellular dysfunctions

- cholestasis

- conjugated hyperbilirubinemia

What can cause neonatal hepatitis?

- TORCH infections

- Metabolic causes

- Bile duct anomalies

- Progressive familiar intrahepatic cholestasis

Morphology of neonatal hepatitis?

- Balloonisation or focal necrosis of hepatocytes

- Multinucleated hepatocytes

- Lymphocytic infiltration

- Proliferation of bile ducts

What is progressive familiar intrahepatic cholestasis?

Condition which cause cholestasis due to defects in the biliary epithelial transporters

Examples of metabolic causes?

- Fructosaemia

- Galactosemia

- Alpha-1 antitrypsin deficiency

What is cholangitis?

Inflammation in the biliary tree

Causes of cholangitis?

Usually caused by anything that can obstruct the bile flow

- choledoclithiasis

- surgery of the biliary tree

- tumors

- acute pancreatitis

Stasis = good place for bacteria to grow

Where does the bacteria enter in cholangitis?

Usually enter the biliary tract via the Sphincter of Oddi rather than the blood

- results in an ascending cholangitis

What are usually the pathogens in cholangitis?

- E. Coli

- Klebsiella

What usually cause liver abscesses in the western world? where does it come from?

Bacterial infection;

- Ascending infections from the biliary tract

- Spreading of bacteria from GI through portal vein

- Systemic bacteraemia

Morphology of liver abscesses?

Pyogenic abscess

- liquefactive necrosis with neutrophil infiltration

Echinococcus cysts in the liver?

Cysts in the liver that develops as a consequence of consuming something contaminated by Echinococcal tapeworms eggs

What happens after consuming Echinoccocal tapeworm eggs?

The eggs hatch in the intestines and the adult tapeworms penetrate the intestinal wall

- often end up in the liver, where they die and form a hydatid cyst

Drug hepatopathies?

Drugs are an important cause of liver damage

How can we classify the drugs that cause liver damage?

- Direct hepatotoxic substances

- Indirect hepatotoxic substances

Direct hepatotoxic substances?

Their metabolites cause direct damage to the liver

- their toxicity is dose dependent

Some examples of direct hepatotoxic substances?

- Anabolic steroids

- Paracetamol

- Contraceptives

Indirect hepatotoxic substances?

Can cause damage because their substances can serve as haptens, initiating and immune reaction

- can also alter the metabolism of the liver

- their toxicity is not dose dependent, so its hard to predict the dose and how an individual will react to the drug

Some examples of indirect hepatotoxic substances?

- Anabolic steroids

- Contraceptives

- Antibiotics