14.7 Pathology: Pattern of liver injury 1, acute hepatitis

Question 1

What is the clinical definition of acute hepatitis?

Answer 1

Elevation of serum transaminase enzymes for less than 6 months in a patient with no history of chronic liver disease

Question 2

What are 3 signs of acute liver failure?

Answer 2

Encephalopathy, hypoglycaemia, coagulopathy

Question 3

What are 4 characteristics of acute hepatitis?

Answer 3

Malaise, nausea, jaundice, increased ALT

Question 4

What is the pathological definition of acute hepatitis?

Answer 4

Same pathological changes in the liver as acute viral hepatitis

Question 5

What are 5 causes of acute hepatitis?

Answer 5

Acute viral hepatitis (A, B, E)
DILI
Natural remedies
Autoimmune hepatits
Idiopathic

Question 6

What are 3 hallmark features of acute hepatitis?

Answer 6

Death of hepatocytes
Regeneration of hepatocytes
Absence of fibrosis

Question 7

Which zone is the ‘vulnerable zone’?

Answer 7

Zone 3

Question 8

What is the oxygen gradient of zones 1-3?

Answer 8

Increasing hypoxia

Question 9

Explain the microanatomy of the liver

Answer 9

Hepatocytes are bathed in plasma and the fluid exits via the central vein

Bile canaliculi transports bile from liver cells to bile ducts

Question 10

What happens if liver cells become swollen?

Answer 10

BC: bile obstruction and cholestasis

Question 11

What is the supporting scaffold of the liver?

Answer 11

Reticulin fibres

Question 12

What is the definition of apoptosis and necrosis (when referring to acute hepatitis)?

Answer 12

Apoptosis: single cell death

Necrosis: adjacent hepatocyte death

Question 13

What does an apoptotic body look like?

Answer 13

Shrunken, stained

Question 14

What kind of necrosis do you see in acute viral hepatits?

Answer 14

NOT coagulative necrosis but hepatoccellular encrosis (you only see the aftermath not the necrotic cells themselves)

Question 15

What is the hallmark feature of acute viral hepatitis?

Answer 15

Pan-lobular disarray

Question 16

What happen with paracetamol induced liver necrosis?

*What is paracetamol, what does it cause and where does necrosis occur?

Answer 16

• Paracetamol: intrinsic liver toxin
• Caused by NAPQI (toxic metabolite), causes depletion of glutathione
• Necrosis occurs in zone 3 preferentially (enzyme CPY2E1 is located here)

Question 17

What are 3 differences between paracetamol induced liver necrosis and acute hepatitis?

Answer 17

Paracetemol

• lobular disarray not seen
• coagulative necrosis
• minimal inflammation, zone 3

Acute hepatitis

• pan acinar
• lytic necrosis
• inflammation present, entire lobule