CSIM 1.51: Liver Inflammation and Repair

Question 1

Describe hepatocytes

Answer 1

• Highly polarised (surfaces have different functions)
  
  • Large
  • Highly developed ER

Question 2

Describe the path taken by bile

Answer 2

1) Canaliculi
2) Canals of Hering (at limiting plate)
3) Cholangioles
4) Interlobular ducts
5) Septal ducts
6) Left and right hepatic ducts
7) Common bile duct

Question 3

What are the functions of the liver?

Answer 3

Synthesis:
• Bile acids
• Plasma proteins

Metabolism:
• Haem
• Lipids
• Toxins and drugs

Regulatory:
• Energy homeostasis
• Immune regulation

Question 4

What can cause acute liver injury?

What does it result in?

Answer 4

A single ‘hit’ causing apoptosis or necrosis of hepatocytes
• Toxins
• Viruses

Results in regenerative response driven by TGFα and HGF
• Suppuration
• Abscess formation
• Persistence of injury leads yo progression to chronic inflammation

Question 5

What can cause chronic liver disease?

Answer 5

• Alcohol
  
  • Viruses
  • Autoimmune disease
  • Cholestasis (biliary obstruction by gall stones)
  • Metabolic (haemachromatosis)

Question 6

Which viruses cause acute hepatitis?

Which viruses cause chronic hepatitis?

Answer 6

Acute:
  •  Hepatitis A  
  •  Hepatitis E
  •  Cytomegalovirus
  •  Epstein Barr virus

Chronic
• Hepatitis B
• Hepatitis C
• Hepatitis D

Question 7

How is hepatitis A and E spread?

Answer 7

Enteral spread

Question 8

Which hepatitis viruses are RNA viruses?

Answer 8

A, C, D and E

Question 9

Hepatitis E has a high mortality in which population?

Answer 9

Pregnant women

Question 10

How is hepatitis B transmitted?

Answer 10

• Blood products
  
  • Sexual activity
  • Mother-infant

Question 11

Which hepatitis is associated with hepatic cell carcinoma?

Answer 11

Hepatitis B

Question 12

In what proportion of people does hepatitis B persist and cause cirrhosis?

Answer 12

5%

Question 13

Describe the genetic structure of hepatitis B

Answer 13

DNA

Question 14

What hepatitis type can only occur alongside another? Which is it dependent on?

Answer 14

Hepatitis D can only occur when Hepatitis B is present as a coinfection

Question 15

How many of those infected with hepatitis C go on to chronic hepatitis and cirrhosis?

Answer 15

90%

Question 16

What is primary biliary/sclerosing cirrhosis?

What is it associated with

Answer 16

A non-suppurative autoimmune destructive cholangitis (cholangitis = inflammation of bile ducts)

Autoimmune disorders

Question 17

What is genetic haemochomatosis?

Answer 17

Progressive iron loading
• Activation of stellate cells
• Cytokine up-regulation causing liver damage

Question 18

What are the different pattern of liver cell necrosis?

Answer 18

Spotty necrosis
• Single cells

Confluent necrosis
• Groups of cell

Bridging necrosis
• Collapse between portal tracts

Massive necrosis
• Complete wipe-out

Interface hepatitis
• Loss and degeneration of (limiting plate) hepatocytes at the lobular-portal-interface, producing a moth-eaten irregular appearance

Question 19

What are hepatic stellate cells?

What do these do on injury? What does this lead to?

Answer 19

Facultative myofibroblasts of the liver which produce collagen and enzymes that turn over the matrix, found within the space of Disse

Upon injury, these upregulate collagen production massively
• The scar tissue causes progressive fibrosis
• This interferes with hepatic blood flow
• This ultimately leads to portal hypertension and is referred to as cirrhosis

Question 20

What are the signs and symptoms of hepatic failure?

Answer 20

• Jaundice
  
  • Impaired protein synthesis and clotting problems
  • Hepatic encephalopathy (hepatic flap)
  • Hepatorenal syndrome
  • Endocrine effects

Question 21

What does portal hypertension cause?

Answer 21

• Varices (oesophageal, umbilicus, anus, stomach - due to blood being redirected to these areas)
  
  • Ascites