Acute Liver Disease Flashcards
- viral, alcoholic, drug induced
- gradual onset, with prolonged duration
- hepatocyte damage is usually apoptotic
- normal PT
Immunologic Acute Hepatitis
- Toxic (acetominophen, poison mushroom) or ischemic
- quick change in liver enzymes, with quick return to normal
- hepatocyte damage is usually necrosis
- elevated PT (>15 sec)
Direct Injury Acute Hepatitis
- Red and swollen liver due to inflammation
- Hepatocytes are damaged, but the reticulin network architecture remains intact; allows regeneration of hepatocytes with normal architecture
- Inflammatory infiltrate: mostly lymphocytes and monocytes (exception: neutrophils for alcoholic hepatitis)
Morphology of Acute Hepatitis
- Viral: 10-40x normal
- alcoholic: < 10 x normal with increased LDH
- Toxic/Ischemic: >100x normal with increased LDH
Cytplasmic enzymes AST & ALT
- Elevation associated with bile duct obstruction
- Alcoholic hep: GGT > 3x normal
- Drug-induced: GGT > 3x normal
minimal elevation in all other cases
Alkaline Phosphatase (GGT)
Immunologic pattern: 4-5 weeks of jaundice and elevated ALT
- peak AST/ALT 10-40x normal
- PT normal (<14 sec)
Viral Hepatitis Labs
- Fecal-oral administration
- most common in travelers or children
Mech: virus itself is not toxic to hepatocytes; the immune response destroys infected liver cells
- Anti-HepA IgM: Diagnosistc for infection
- Anti-HepA IgG: Protective (prior infection or immunization)
Hepatitis A
- DNA virus
- most common form worldwide
- parenteral transmission (sex, serum, birth)
Children: less likely to be jaundiced, but more likely to develop chronic HepB
Markers:
- HBsAg: Key marker for infection
- HBV DNA: Key marker for infectivity
- HBcAb (IgM): Indicates an immune response against the virus
- HbsAb (IgG): protective
Hepatitis B
- parenteral transmission (IVDU, needle stick)
- chronic disease occurs in most cases
- even with infection, most patients remain anti-HepC negative; HCV-RNA test confirms infection
- treatable if recognized –> can prevent chronic HepC
- severity: mostly anicteric
- risk of developing hepatocellular carcinoma
Hepatitis C
- Commonly acquired from contaminated water or undercooked seafood
- HEV infection in preganant woman associated with fulminant hepatitis (20% mortality)
- HepEAg (IgM) is diagnostic
Hepatitis E
- AST & ALT 2x ALT
- PT normal
Fatty liver: marker of cell damage
Inflammatory infiltrate: mostly neutrophils (vs. lymphocytes/monocytes)
Mallory bodies: damaged/collapsed intermediate filaments
Alcoholic Hepatitis
Immunologic pattern- similar to viral (ALT>AST; greater than 10x normal), but more likely to have increase in alkaline phosphatase
- antibiotics are most common cause
Drug-Induced Liver Injury
- Direct injury pattern
- ALT > AST; both elevated 100x normal
- PT abnormal (>15 sec)
Toxic/Ischemic Hepatitis
- Toxic hepatitis
- depletes liver’s supply of defense mechanism Glutathione
- exacerbated by alcohol: increases toxic metabolite, and further depletes glutathione stores
Acetominophen liver injury
- direct injury pattern: ALT,AST >100x; PT elevation
- caused by shock, sepsis
- central portion of lobule affected first
Ischemic Hepatitis
