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Block 15 > Hepatic Pathology > Flashcards

Hepatic Pathology Flashcards

1
Q

What cells are in sinusoids

A

Kupffer cells
Hepatocytes
Stellate cells

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2
Q

What are kupfer cells

A

Macrophages that capture and break down, worn out RBCs

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3
Q

What are hepatocytes?

A

Cuboidal epithelial cells lining sinusoids

Most liver functions

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4
Q

What are stellate cells

A

Normally quiescent state
Store vitamin A, APC
When liver is damaged they are activated and secrete collagen, scar tissue, leading to cirrhosis

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5
Q

What are the functions of the liver (9)?

A

Store glycogen, release glucose and gluconeogenesis
Protein synthesis
Catabolism of amino acids and urea production
Detoxification of nitrogenous molecules from GIT
Drug and steroid metabolism
Lipoprotein synthesis
Conjugation and excretion of bilirubin
Production and excretion of bile salts
Immune processes

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6
Q

What can cause hepatitis?

A 
Alcohol
Viral 
Non alcoholic steatohepatitis (NASH)
Drugs 
Autoimmune hepatitis
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7
Q

Which types of viral hepatitis are usually

  1. Acute
  2. Chronic
A
  1. A, B, B + D, E

2. C (rarer-B, B +D)

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8
Q

What is the route of transmission for

  1. Hep A
  2. Hep B
  3. Hep C
  4. Hep D
  5. Hep E
A
  1. Oral foecal
  2. Percutaeous/permucosal (blood, sex, mother to baby)
  3. Percutaneous/permucosal (blood)
  4. Like Hep B
  5. Oral like Hep A
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9
Q

What is the incubation time for

  1. Hep A
  2. Hep B
  3. Hep C
  4. Hep D
  5. Hep E
A
  1. 15-50 days
  2. 1-6 months
  3. 50 days - 6 months
  4. 1-6 months
  5. 15-50 days
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10
Q

Describe the progression of Hep…

  1. A
  2. B
  3. C
  4. D
  5. E
A
  1. 50-70% get symptoms
  2. Depends on age
  3. No symptoms but long term cirrhosis and liver cancer
  4. Hep B
  5. Like hep A, progression can be severe in women
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11
Q

In what type of hepatitis is reinfection possible?

A

Hep C

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12
Q

What viral hepatitis have vaccines?

A

A, B, D, E`

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13
Q

What types of hepatitis have no treatment?

A

A and E

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14
Q

What is the treatment for hep B?

A

Anti viral medications and interferon

<50% success

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15
Q

What is the treatment for hep C

A

Interferon and ribavirin

50-90% successful

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16
Q

What is the treatment for Hep D

A

Interferon and anti viral medication

Low success rate

17
Q

Name other hepatotropic viruses?

A

CMW, EBV, HSV, varicella, Reo virus, mumps, yellow fever, cocksackie B, echovirus, marbourg virus, lasa fever virus, syncytial giant cell hepatitis, adenovirus, rubella, Rift Valley fever

18
Q

What are the risk factors for hepatitis B (US)?

A

Heterosexual activity
Injecting drug use
Homosexual activity
Healthcare workers

19
Q

What are the stages of hepatitis B?

A 
Immune tolerance 
Immune clearance 
Inactive carrier state
Reactivation 
Lives within genome of hepatocyte (hence good at escaping the immune response), however daughter virus which swim around body can be treated by antiviral (tenofovir or entecavir)-suppresses virus
20
Q

How do you test for hepatitis C?

A

PCR test for active viral replication

21
Q

What is non-alcoholic fatty liver disease (NAFLD)?

A

Liver fills up with fat -> causes inflammation -> inflammation leads to scarring -> scaring can lead to cirrhosis
Fat causing inflammation and scaring only affects 5-10% of patients who have extra fat in their liver.

22
Q

What is the pathogenesis of cirrhosis?

A 
Development of fibrosis 
Formation of nodules 
Loss of hepatocyte microvilli 
Activated stellate cells 
Deposition of scar matrix
Loss of scar matrix
Loss of fenestrae 
Kupffer cell activation
23
Q

What is the aetiology of cirrhosis?

A 
Alcohol
Viral hepatitis B, B+D, C
Non alcoholic steatohepatitis 
Drugs 
Autoimmune liver disease 
Cholestatic liver disease
Metabolic liver disease
Hepatic venous congestion
‘Cryptogenic’
24
Q

What are the complications of cirrhosis?

A

Hepatic encephalopathy-confusion -> drowsiness -> somnolence -> coma
Portal hypertension puts pressure on GI tract veins which may rupture and bleed
Hepatorenal syndrome
Ascites-liver failure

Cirrhosis can be reversible

25
Q

Describe hepatocellular cancer?

A

Painless until large
Diagnosis-AFP + USS/CT etc
Incidence rising
Treatable with chemoembolisation, RFA, excision, OLT

26
Q

How does hepatic failure prevent normal liver function?

A 
Unable to filter toxins and drugs 
Metabolism of nutrients reduced 
Reduced immunity
Reduced production of clotting factors 
Unable to store nutrients 
Reduced protein production 
Reduced bile production
27
Q

What are the clinical consequences of hepatic failure?

A 
Cerebral oedema
Bleeding and bleeding disorders 
Infections 
Kidney failure 
Jaundice 
Ascites 
Melena 
Hypotension and tachycardia-due to reduced systemic vascular resistance

Block 15 (11 decks)

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