Chapter 14: Liver autoimmune hepatitis Flashcards
A middle-aged woman presents with cirrhosis and a negative alcohol history.
She has a past medical history significant for thyroidits, rheumatoid arthritis, and ulcerative colitis. You’re suspicious about autoimmune hepatitis - what antibodies tests will you order?
Antinuclear and anti-smooth muscle antibodies. - Type I autoimmune hepatitis.
HLA-DRB1 gene.
A 10 year old with type I diabetes and thyroiditis presents with jaundice and elevated LFTs. You’re suspicious for autoimmune hepatitis. What tests will you order?
Antibodies to liver and kidney microsomes (anti-LKM.
Type II autoimmune hepatitis.
Target autoantigen is a P450-type drug-metabolizing enzyme (CYP 2D6).
What inflammatory infiltrate is a common feature in autoimmune hepatitis?
Plasma-cell rich infiltrate.
Give corticosteroids, liver transplants, azathioprine.
What is the general sequence of alcoholic liver disease?
Fatty liver
Acute alcoholic hepatitis
Cirrhosis
An asymptomatic alcoholic presents with vague upper abdominal pain. A biopsy of the liver is taken and reveals this benign finding. What is it?
Alcoholic fatty liver.
Steatosis = fat in hepatocytes. Ethanol increaess fatty acid synthesis, decreases mitochondrial oxidation of fatty acids, increases production of triglycerides, and impairs release of lipoproteins.
Mitochondria enlarged with occasional bizarre giant forms. Increased microsomal ethanol oxidizing systems P450-mixed function oxidases. Augments metabolism of hepatic toxins - such as acetaminophen.
A chronic alcoholic presents with malaise, anorexia, fever, RUQ pain, and jaundice. He has moderate elevations of LFTs. The AST:ALT ratio is 2:1.
A biopsy of the liver is taken and shows a neutrophilic infiltrate with eosinophilic inclusions in the cytoplasm of injured hepatocytes.
Alcoholic hepatitis.
Eosinophilic inclusions in the cytoplasm of injured hepatocytes called Mallory Bodies.
Collagen deposition seen around central veins. Activate hepatic stellate cells (Ito cells). Central hyaline sclerosis - dense fibrous tissue around perivenular sinuses. Portal hypertension.
A patient with a history of alcoholism presents with portal hypertension.
A liver biopsy is taken and the histological slide is stained with trichrome.
Central hyaline sclerosis - steatohepatitis shows central terminal venule obliterated by fibrous tissue (blue).
A middle aged female with a history of autoimmune disease presents with elevated LFTs. IgM and antimitochondrial antibodies are elevated. Alkaline phosphatase is elevated.
A liver biopsy is taken and shows portal tracts expanded by inflammatory infiltrates containing lymphocytes, plasma cells, eosinophils, and macrophages.
Primary biliary cirrhosis.
Stage I: Duct lesion. Epithelioid granulomas in portal tracts
Stage II: Scarring.
Stage III: Cirrhosis - dark green bile stained liver with nodularity.
Can see xdanthomas, steatorrhea, osteomalacia and osteoporosis.
Immune-mediated chronic progressive cholestatic liver disease with destruction of intrahepatic bile ducts (nonsuppurative destructive cholangitis).
DRB1*008 family of MHC complex-encoded genes. Other autoimmune disease. Mutations in TNF, cytotoxic T-lymphocyte antigen 4.
A 40 year old male with a past medical history of ulcerative colitis presents with jaundice.
Histology shows edematous, fibrotic, and inflamed portal tract. Inflammatory debris within the lumen of the bile duct.
Bridging fibrosis destroys bile ducts.
Primary sclerosing cholangitis
Significant risk for cholangiocarcinoma
Stage I: Periductal inflammation and fibrosis in portal tracts
Stage II: Bile ducts become obliterated, fibrous septa
Stage III: Secondary biliary cirrhosis develops.
