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Liver pathology - Coggle Diagram
Liver pathology
Portal hypertension
Pre-hepatic
Compression / obstruction of portal vein
Tumour ; cyst ; thrombosis
Increased resistance blood flow to sinusoids
Acquired portosystemic shunting
Systemic circulation hypertension
Cirrhosis / biliary fibrosis
Intra-hepatic
Loss of normal lobular architecture
Chronic hepatic disease
Post-hepatic
Thrombosis
Subjacent vessels
Portal vein hypoplasia
Adaptations + intracellular accumulation
Hepatocytes vacuolar changes
Hydropic degeneration
Toxic injury , hypoxia
Influx of water and Na
Cellular expansion
Glycogen accumulation
Steroid induced
Genetic - Maltese puppies
Fatty degeneration - hepatic lipidosis
Acute condition of Obese cats
Anorectic
Reduced protein
Excess intake of fat / carbohydrate
Increased mobilisation of fatty acids to liver
Impaired oxidation of fatty acids
High demand - starvation , lactation
Clinical signs
Liver enlarged, jaundiced, friable, greasy
Amyloidosis
Over production of Amyloid A
Acute phase protein
Amyloid accumulation
Space of Disse
Pressure atrophy of hepatocytes
Copper storage diseases
Sheep susceptible
Excessive dietary supplementation
Soils deficit in molybdenum
Increased pasture copper
Hepatotoxins - cholestasis
Impaired biliary excretion
Irreversible hepatocellular damage
Apoptosis
Programmed cell death
No cell leakage
Requires ATP
Necrosis
Membrane failure and rupture
Cell leakage
Released hepatic enzymes
Hypoxia - deoxygenated
Lack of ATP
Patterns
Focal / random
Scarring outcome - fibrosis
Infectious agents of disease
Degenerate hydatids and abscesses
Zonal
Centrilobular (zone 3)
Highest [cytochromes P450]
Detoxification - cell injury
Most common lesion site
Least oxygen tension
Severe anaemia
Passive venous congestion
Mid-zonal (zone 2)
Specific toxin target
Eg. Aflatoxicosis from fungal feed contaminant
Perilobular (zone 1)
Toxins not requiring metabolism by P450
Bridging necrosis
Preludes fibrosis and cirrhosis
Piecemeal
Immune-mediated
Inflammatory response to necrosis
Epithelium
Sinusoidal lining
Haemorrhage
Early toxicities
Paracetamol
Bile duct epithelium
Sporidesmin intoxication
Inflammation
Infectious agents
Bacterial
Clostridium piliforme (Tyzzer's Disease)
Leptospirosis
Parasitic
Hepatic fascioliasis
Toxoplasmosis
Fungal
Viral
Adenovirus - Infectious canine hepatitis
Herpes virus
Intra-nuclear inclusions
Cholangitis / cholangiohepatitis
Bacteria entry route
Intestine: Bile stasis (obstruction)
Haematogenous
Descending
Suppurative
Lymphocytic (non-suppurative)
Bridging fibrosis
Regeneration
Hypercellular
Ductular reaction
Repeated injury
Framework collapse
Space of Disse hyperplasia
Extensive bridging fibrosis
Nodular regeneration
Progressive fibrosis
Parenchyma entrapment
Excessive fibrous tissues
Fibrosis
Progression into cirrhosis
End-stage diffuse hepatic disease
Chronic insults
Pyrrolizidine alkaloidosis
Alkaloid plant poisoning
Sheep most resistant
Increased deposition of ECM
Activated myofibroblasts
Closure and crowding sinusoids
Lowered nutrient exchange rate
Loss of hepatocyte microvilli