22 - Chronic Liver Disease Flashcards
time minimum for chronic liver disease
6 mo
vertical transmission of hep B
leads to chronic dz in 90% of cases (as opposed to 5% in adults)
antibody assoc w/ immunity to Hep B (either cleared past infxn or got vaccine)
Anti-HB surface
antibody assoc w/ current or past infxn w/ Hep B
Anti-HB core
how many chronic Hep C pts get cirrhosis? hepatocellular CA?
cirrhosis - 20-30%
CA - 1-5% of those w/ cirrhosis
anti HCV ab significance
present during active infection, does not confer immunity, will go away in pts that get over acute infection and dont become chronic carriers
basically if they have it, they probably have (or just recently had) hep C
path processes occurring in acute hepatitis
necrosis of hepatocytes ballooning degen, lobular disarray kupffer cell hyperplasia/hypertrophy portal inflammation (lymphs) regeneration in recovery phase
differences in chronic hepatitis path compared to acute
mostly the same, but in chronic more inflammation (lymphs) including interface hepatitis
also develop fibrosis which can progress to cirrhosis
ground glass cytoplasmic change in liver
HbSurface Antigen or any prolif of smooth ER (due to drugs, w/e)
autoimmune hepatitis
T cell attack on hepatocytes
looks like chronic viral hepatitis
mostly affects young females
often presents as aggressive disease
lab findings in autoimmune hepatitis
elevated IgG and transaminases
elevated autoantibodies - ex ANA
primary biliary cirrhosis
destruction of intrahepatic interlobular bile ducts > eventual cirrhosis and liver failure
unk etiology but may be autoimmune
clues to dx primary biliary cirrhosis
elevated alk phos
pruritis often early symptom
mostly affects middle age women
antimitochondrial antibodies in 95%
primary sclerosing cholangitis
mostly males
70% have ulcerative colitis
inc risk for cholangioCA
concentric peri-bile duct fibrosis > obstruction
alcoholic liver disease - more often macro or microvesicular steatosis?
macro
