Chronic Liver Injury

Question 1

Liver has a unique way of scarring called

Answer 1

Cirrhosis

Question 2

Chronic viral hepatitis usually scars where?

Answer 2

Around Portal Triads

Question 3

What is the single layer of hepatocytes immediately adjacent to a portal triad called?

Answer 3

Limiting Plate

Question 4

Ground glass cytoplasmic appearance due to the presence of viral particles is seen most often in?

Answer 4

Hep B

Question 5

In some cases of chronic viral hepatitis, the inflammation moves out past the portal triads and obscures the limiting plate, what are the two terms for this that you may see?

Answer 5

Interface hepatitis and piecemeal necrosis

Question 6

Chronic active hepatitis?

Answer 6

Hepatitis featuring piecemeal necrosis and interface hepatitis

Question 7

Chronic persistent hepatitis/

Answer 7

Hepatitis where the inflammation is confined to the portal triad

Question 8

Remember that the course of chronic hepatitis fluctuates between periods of active disease and inactive disease. The presence of Piecemeal/interface necrosis simply means that you have biopsied during an active period.

Answer 8

It says nothing about the prognosis of the pt or the level of disease. ok

Question 9

Key cells in hepatic repair?

Answer 9

Stellate (Ito cells)

Question 10

How do stellate cells initiate repair?

Answer 10

They differentiate into myofibroblasts and secrete collagen and other extracellular matric substances into the space of disse

Question 11

Where does the initial deposition of fibrous tissue take place in viral hepatitis?

Answer 11

Periportal region…this is called fibrous portal expansion

Question 12

Where is the initial deposition of fibrous tissue in alcoholic hepatitis?

Answer 12

Centrolobular

Question 13

Major cytokine effector of liver injury due to alcohol?

Answer 13

TNF

Question 14

Eventually, the fibrosing repair
 process creates nodules of
 regenerating hepatocytes
 surrounded by fibrous tissue
 with loss of the normal lobular
 architecture and hence loss of
 the normal vascular and biliary
 hookups, so blood cannot get
 in properly and blood and bile
 cannot get out properly.

Answer 14

Important summary of chronic liver injury

THIS PROCESS = Cirrhosis

That’s what cirrhosis is, regeneration attempts surrounded by scarring leading to loss of normal architecture that impeded blood flow through and bile flow out

Question 15

What percentage of alcoholics get cirrhosis?

Answer 15

15%

Question 16

Remember Cirrhosis man and all the different physical effects of Cirrhosis

Answer 16

ok

Question 17

Also remember that Cirrhosis can lead to Dupuytren contracture of the palm genereally involving the 4th and 5th digits

Answer 17

ok