Adult liver disease Flashcards
lymphocyte inflammation in hepatitis
can be present in many hepatitides; common in VIRAL
neutrophil inflammation in hepatitis
common in steatohepatitis
eosinophil inflammation in hepatitis
common in drug injury
plasma cell inflammation in hepatitis
autoimmune hepatitis
most common cause of chronic liver disease
hep C
Labs: evidence of hepatocyte injury
causes: acute viral infection and drug injury
histology: lobular disarray, marked inflammation throughout, widespread hepatocyte injury, NO FIBROSIS
acute hepatitis
Causes: chronic viral hepatitis, autoimmune hepatitis, drug injury
histology: less inflammation and injury, portal tract-based inflammation, FIBROSIS
long-standing ( > 6 mo)
chronic hepatitis
can accumulate in hepatocyte cytoplasm during liver injury
fat = steatosis
bile = cholestasis
iron = hemosiderosis/genetic hemochromatosis
copper = wilson disease/chronic cholestasis
viral particles = viral hepatitis
ground glass hepatocytes
viral infection
process of fibrotic change in hepatocytes
chronic cycles of injury/regeneration –> activated stellate cells deposit collagen –> architectural and vascular reorganization –> cirrhosis
On biopsy, “stage” refers to:
amount of fibrous tissue deposition
On biopsy, “grade” refers to:
amount of inflammation and injury
transmitted fecal-oral
hep A, hep E
transmitted through parenteral, sexual contact, perinatal routes
hep B
transmitted through parenteral route
hep C, hep D
viruses that can cause chronic liver disease
hep C > 80%
hep B = 10%
hep virus diagnosed via PCR
hep C
hep virus diagnosed by presence of surface antigen or antibody to core antigen
hep B
what percent of patients who develop cirrhosis secondary to hep C go on to die?
50%
major cause of chronic liver disease WORLDWIDE
hep B
areas with highest prevalence of chronic HBV
northern canada, alaska, northern amazon, africa, SE asia
what percent of patients infected with HBV go on to develop chronic hepatitis?
less than 5%
presence of serum HBeAg, HBV-DNA and IgM anti-HBc would signify:
acute, active HBV infection
presence of serum IgG anti-HBs and IgG anti-HBc
chronic HBV infection
effect of hep D coinfection with HBV
potentiates effects of HBV –> increased risk of fulminant hepatitis, faster progression to end-stage liver disease
woman presents with a history of other autoimmune diseases
autoimmune hepatitis
serology of autoimmune hepatitis
autoantibodies (ANA, ASMA, anti-LKMB), elevated IgG
plasma cell-rich chronic hepatitis
autoimmune hepatitis
middle-aged woman presents with pruritus, jaundice; elevated alk phos, GGT, bilirubin
primary biliary cirrhosis
serology of primary biliary cirrhosis
anti-mitochondrial antibody, elevated IgM
prognosis of primary biliary cirrhosis
25% with liver failure in 10y
patient presents with progressive fatigue, pruritus and jaundice. elevated alk phos. history of ulcerative colitis
primary sclerosing cholangitis
diagnosis of primary sclerosing cholangitis
cholangiography –> stenosis of ducts
histology: periductal “onion skin” fibrosis
primary sclerosing cholangitis
what lobule zone is affected by acetaminophen toxicity
zone 3 = centrilobular necrosis
causes of hepatic steatosis
metabolic syndrome (T2DM), alcohol, drugs, Wilson disease, viral infection
mechanism of steatosis
lipid influx > lipid clearance
steatosis with associated hepatocellular injury
steatohepatitis
mechanism of alcohol steatosis/steatohepatitis
increased liplysis and de novo lipogensis from carbs; blocked B oxidation and VLDL generation
histology: neutrophilic infiltrates, Mallory bodies
alcohol steatosis
genetic iron overload disease, throughout the body –> liver disease, diabetes, heart failure
hereditary hemochromatosis
hereditary hemochromatosis genetics
autosomal recessive HFE gene mutations (C282Y and H63D) –> abnormal regulation of Fe absorption
genetic copper overload throughout the body –> liver disease, neuropsych sx
Wilson disease
Wilson disease genetics
autosomal recessive mutation in ATP7B gene –> disrupted bile excretion of copper
autosomal recessive disease that most often presents with pulmonary emphysema, but can also involve liver disease
a1-antitrypsin deficiency
normal/abnormal genotypes for alpha-1-antitrypsin
normal = PiMM abnormal = PiZZ
histology: PASD stain –> pink globules
alpha-1-antitrypsin deficiency
malignant liver masses in adults
hepatocellular carcinoma, cholangiocarcinoma
benign liver masses in adults
hemangioma, focal nodular hyperplasia, hepatocellular adenoma
