Hepatic Pathology Flashcards
What cells are in sinusoids
Kupffer cells
Hepatocytes
Stellate cells
What are kupfer cells
Macrophages that capture and break down, worn out RBCs
What are hepatocytes?
Cuboidal epithelial cells lining sinusoids
Most liver functions
What are stellate cells
Normally quiescent state
Store vitamin A, APC
When liver is damaged they are activated and secrete collagen, scar tissue, leading to cirrhosis
What are the functions of the liver (9)?
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
What can cause hepatitis?
Alcohol Viral Non alcoholic steatohepatitis (NASH) Drugs Autoimmune hepatitis
Which types of viral hepatitis are usually
- Acute
- Chronic
- A, B, B + D, E
2. C (rarer-B, B +D)
What is the route of transmission for
- Hep A
- Hep B
- Hep C
- Hep D
- Hep E
- Oral foecal
- Percutaeous/permucosal (blood, sex, mother to baby)
- Percutaneous/permucosal (blood)
- Like Hep B
- Oral like Hep A
What is the incubation time for
- Hep A
- Hep B
- Hep C
- Hep D
- Hep E
- 15-50 days
- 1-6 months
- 50 days - 6 months
- 1-6 months
- 15-50 days
Describe the progression of Hep…
- A
- B
- C
- D
- E
- 50-70% get symptoms
- Depends on age
- No symptoms but long term cirrhosis and liver cancer
- Hep B
- Like hep A, progression can be severe in women
In what type of hepatitis is reinfection possible?
Hep C
What viral hepatitis have vaccines?
A, B, D, E`
What types of hepatitis have no treatment?
A and E
What is the treatment for hep B?
Anti viral medications and interferon
<50% success
What is the treatment for hep C
Interferon and ribavirin
50-90% successful
What is the treatment for Hep D
Interferon and anti viral medication
Low success rate
Name other hepatotropic viruses?
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
What are the risk factors for hepatitis B (US)?
Heterosexual activity
Injecting drug use
Homosexual activity
Healthcare workers
What are the stages of hepatitis B?
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
How do you test for hepatitis C?
PCR test for active viral replication
What is non-alcoholic fatty liver disease (NAFLD)?
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.
What is the pathogenesis of cirrhosis?
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
What is the aetiology of cirrhosis?
Alcohol Viral hepatitis B, B+D, C Non alcoholic steatohepatitis Drugs Autoimmune liver disease Cholestatic liver disease Metabolic liver disease Hepatic venous congestion ‘Cryptogenic’
What are the complications of cirrhosis?
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
