[07.20a] Pathology of the Liver (Part 1) V2.pdf

Right upper quadrant (RUQ) to left upper quadrant (LUQ)

What is the anatomical extent of the liver in the abdomen?

Hematopoietic organ (extramedullary hematopoiesis)

What is the primary function of the liver in neonates at birth?

~15-20 cm

What is the normal measurement for liver length?

1400-1600g

What is the normal weight range of an adult liver?

Portal vein

Which vessel provides 60-70% of hepatic blood flow?

Hepatic artery

Which vessel provides 30-40% of hepatic blood flow?

Nutrient-rich blood from the gut

What type of blood does the portal vein deliver to the liver?

Oxygenated blood

What type of blood does the hepatic artery deliver to the liver?

Tawny brown

What is the normal color of a healthy liver?

Pathologic

What does a yellow color or enlarged size typically indicate in a liver?

Underneath the liver

Where is the gallbladder located in relation to the liver?

Left side

Where is the spleen located in relation to the liver?

Right lobe

Which lobe of the liver is larger?

Stomach

The liver tails towards which organ near the left lobe?

Portal hypertension

Which condition involves an obstruction of blood flow affecting the liver and proximal organs?

8 segments

Into how many segments is the liver divided surgically and anatomically?

Blood supply

Liver segments are divided according to what factor to allow for the survival of other segments during resection?

Central vein (terminal hepatic venule)

Which structure is found in the middle of a hepatic lobule?

Portal tracts (canals)

What structures surround the central vein at the edges of the lobule?

Hepatic artery, Bile duct, and Portal vein

What are the three structures found in a normal portal triad?

1-2 cells thick

What is the normal thickness of liver trabeculae?

Lobule of Kiernan

Which configuration describes the liver as hexagonal lobules with a central vein in the middle?

Acinus of Rappoport

Which configuration describes the liver based on zones of oxygenation and microcirculation?

Zone 1 (Periportal area)

Which microcirculatory zone of the liver is the most oxygenated?

Zone 3 (Centrilobular/Perivenular area)

Which microcirculatory zone of the liver is the least oxygenated?

Zone 3

Which liver zone is the site of alcohol and cholesterol metabolism?

Cytochrome P450 (CYP450)

Which enzyme system is used by the liver to metabolize toxins like alcohol?

Increased alcohol tolerance

What is the clinical result of more efficient CYP450 production due to early alcohol introduction?

Masson-Trichrome stain

Which stain is used to show Type I collagen in the portal tract?

1:1

What is the normal ratio of the hepatic artery to the bile duct in the portal tract?

Portal fibrous stroma

The central vein is identified histologically by the absence of what structure?

Lipofuscin

Which light-brown or golden-brown "wear-and-tear" pigments increase in hepatocytes with age?

Reticulin stain

Which stain highlights the Type III collagen framework that holds up the hepatic parenchyma?

Type III collagen

Which type of collagen supports the central vein?

Bile canaliculi

Where is bile first collected after being produced by hepatocytes?

Canals of Hering

Which structures bridge bile canaliculi and bile ductules?

Gallbladder

What is the final storage destination for bile after it passes through the terminal bile duct?

Cholangiocytes

Which cuboidal cells line the bile ducts?

CK7 or CK19

Which immunohistochemical stains are used to identify cholangiocytes?

Sclerosing cholangitis

A loss of bile ducts in the context of cirrhosis most likely indicates which condition?

Biliary atresia

Abnormal proliferation of bile ducts in neonates may indicate which condition?

Bile canaliculi

What is the smallest unit of the biliary system?

CD10 and p-CEA

Which two immunohistochemical stains highlight bile canaliculi by sticking to glycoproteins?

Source of liver epithelial stem cells

What is the Canals of Hering thought to be the source of?

Hepatocytes or cholangiocytes

Hepatic stem cells can differentiate into which two types of cells?

Liver failure

What occurs if the rate of liver destruction or injury is faster than the rate of regeneration?

Living donors

Where are liver transplants in the Philippines usually obtained from?

Jaundice

What is the earliest and most common clinical manifestation of liver disease?

Yellowing of the mucosa under the tongue

What is usually the first manifestation of jaundice in the body?

Bilirubin

Jaundice occurs when the blood contains an excess of what substance?

Normal breakdown of red blood cells

Bilirubin is a natural product of what process?

0.3-1.2 mg/dl

What is the normal range for bilirubin levels?

Unconjugated (Indirect)

Which type of hyperbilirubinemia is associated with hemolysis and occurs before the liver?

Conjugated (Direct)

Which type of hyperbilirubinemia is water-soluble and often indicates an obstructive liver problem?

Cholestasis

What is the histological manifestation of jaundice in the liver?

Suppression of bile flow

How is cholestasis defined?

Bile

Yellow to brown pigments in hepatocytes surrounding the portal tract are consistent with what?

Bile plugs

What are darkly staining accumulations of bile within the canaliculi called?

Cholate stasis

Which pattern of cholestasis involves ballooned or enlarged hepatocytes containing bile salts?

Bile salts

What substance is contained within the ballooned hepatocytes of cholate stasis?

Phototherapy

What treatment is used for neonatal jaundice to convert unconjugated bilirubin into a water-soluble form?

Kernicterus

What condition involves the deposition of bile in the brain, potentially causing cerebral palsy?

Gilbert’s Syndrome

Which genetic cause of neonatal cholestasis involves a mutation in glucuronyl-transferase?

Dubin-Johnson syndrome

Which genetic syndrome involves transport dysfunction leading to cholestasis?

Gallstones

What is a common mechanical cause of cholestasis in adults?

Obese females around 40 years old

What is the typical epidemiological profile for patients with gallstones?

Ascending cholangitis

Which complication of large duct obstruction can cause infection and lead to sepsis?

Hepatocyte necrosis

Which mechanism of injury involves cell swelling and rupture due to defective osmotic regulation?

Ischemic or hypoxic injury

Hepatocyte necrosis is the predominant mode of death in which type of injury?

Macrophages

Which cells cluster at sites of necrosis to mark where dying cells burst and disappeared?

Hepatocyte apoptosis

Which active form of "programmed" cell death results from caspase cascades?

Councilman bodies

What is the specific name for apoptotic bodies/acidophilic bodies first described in yellow fever?

Deeply eosinophilic

How do apoptotic bodies characteristically stain on H&E?

Pyknosis

What is the term for nuclear chromatin fragmentation seen in apoptosis?

Spotty necrosis

Which pattern of necrosis is characterized by foci of inflammatory cell necrosis surrounding an acidophil body?

Bridging necrosis

Which pattern of necrosis involves confluent necrosis that connects adjacent structures like portal tracts?

Autoimmune, drug-induced, or severe acute hepatitis

Bridging necrosis is usually associated with which three conditions?

Confluent necrosis

Which pattern describes necrosis that mainly involves the area around central veins?

Zonal necrosis

Which pattern involves necrosis in specific portions of the acini, such as Zone 3?

Acetaminophen and alcohol

Which two substances typically cause Zone 3 (centrilobular) necrosis?

Yellow fever

Which disease causes Midzonal or Zone 2 necrosis?

Punched-out necrosis

Which pattern of sharply demarcated, random necrosis is seen in HSV and Adenovirus?

Piecemeal necrosis (Interface hepatitis)

Which pattern involves inflammatory cells crossing the limiting plate?

Limiting plate

What is the name of the border between the portal tract and the hepatocytes?

A, B, C, D, and E

What are the five classified types of viral hepatitis?

A and E

Which two types of viral hepatitis are self-limiting and transmitted via the fecal-oral route?

B, C, and D

Which three types of viral hepatitis are transmitted sexually or via blood and can become chronic?

Hepatitis D

Which virus can never exist without the presence of Hepatitis B?

Hepatitis B surface antigen (HBsAg)

The Hepatitis D virus is dependent on which specific component of Hepatitis B?

Portal inflammation

What is the chief histological manifestation of all viral hepatitis?

Mononuclear cells (lymphocytes)

What type of inflammatory cells predominantly fill the portal tract in viral hepatitis?

Grading

Which term refers to the degree of necro-inflammation and the aggressiveness of the liver disease?

Staging

Which term refers to the degree of fibrosis and architectural disruption?

Portal tract

Where does the degree of fibrosis (staging) typically begin in chronic hepatitis?

Ground-glass cells

Which Hepatitis B hepatocytes have finely granular eosinophilic cytoplasm surrounded by a clear halo?

HBsAg

The ground-glass appearance in hepatocytes corresponds to the presence of what in the endoplasmic reticulum?

Polypharmacy

Besides Hepatitis B, what other factor may be associated with ground-glass cells?

Sanded nuclei

Which term describes pale eosinophilic, finely granular nuclei containing Hepatitis B core antigen?

HBcAg

Which antigen is found within the "sanded nuclei" of hepatocytes?

Reticulin (Gomori) stain

Which stain identifies Type III collagen and helps highlight fibrous septa?