Hepatitis

Question 1

what can viral hepatitis be caused by?

Answer 1

acute liver injury or chronic liver injury

Question 2

what are the common and rare causes of viral hepatitis

Answer 2

common:
hepA
HepB
HepC
hepE
rare:
delta agent
ebstein-barr virus
yellow fever virus
herpes simplex virus
cytomegalovirus

Question 3

how is hepA spread and what is its effect on the human

Answer 3

faecal-oral spread
short incubation period
sporadic or endemic
directly cytopathic
no carrier state
mild illness, usually full recovery

Question 4

how is HepB spread

Answer 4

spread by blood, blood products, sexually, vertically (in utero)
long incubation period
liver damage is by antiviral immune response
carriers exist
outcome variable

Question 5

how is hepC spread

Answer 5

spread by blood, blood products, possibly sexually
short incubation period
often asymptomatic
disease waxes and wanes
tends to become chronic

Question 6

how does hepatitis progressively become malignant

Answer 6

hepatitis -> inflammation and scarring -> cirrhosis -> hepatocellular carcinoma or liver

Question 7

what are the outcomes for hepB

Answer 7

fulminant acute infection (Death)
chronic hepatitis
cirrhosis
hepatocellular carcinoma
assymptomatic (Carrier)

Question 8

what are the hepC outcomes

Answer 8

chronic hepatitis
cirrhosis
treated and cured

Question 9

what is the aetiology of chronic hepatitis

Answer 9

autoimmune diseases
hepB
hepC
primary biliary cirrhosis
autoimmune hepatitis
drug induced hepatitis
primary sclerosing cholangitis

Question 10

describe primary biliary cirrhosis

Answer 10

rare autoimmune disease, unknown aetiology
associated with autoantibodies to mitochondria
females 90%
indication for biopsy: stage the disease
may see granulomas and bile duct loss
outcome is unpredictable

Question 11

what does untreated bile duct loss lead to?

Answer 11

cholestasis liver injury, inflammation, fibrosis and cirrhosis

Question 12

describe autoimmune hepatitis

Answer 12

commoner in females
associated with other AL disease
chronic hepatitis pattern
numerous plasma cells
autoantibodies to smooth muscle, nuclear or LKM, raised IgG
may have triggers, including some drugs
plasma cells predominate

Question 13

describe chronic drug-induced hepatitis

Answer 13

similar features to the other types of chronic hepatitis
may trigger an autoimmune hepatitis
chronic active process
causes are too many to list

Question 14

what can drugs do to the liver

Answer 14

innumerable drugs can damage the liver
may be dose related or idiosyncratic
can cause hepatitis, granulomas, fibrosis, necrosis, failure, cholestasis or cirrhosis
can mimic any liver disease

Question 15

what is primary sclerosing cholangitis

Answer 15

chronic inflammatory process affecting intra- and extra-hepatic bile ducts

Question 16

what does primary sclerosing cholangitis lead to

Answer 16

leads to periductal fibrosis, duct destruction, jaundice and fibrosis

Question 17

what is primary sclerosing cholangitis associated to

Answer 17

ulcerative colitis

Question 18

who does PSC affect and what does it increase the risk of malignancy in?

Answer 18

males

bile ducts and colon

Question 19

how does PSC look on histology

Answer 19

periductal onion-skinning fibrosis

Question 20

what are the 3 storage diseases

Answer 20

haemochromatosis
wilsons disease
alpha-1-antitrypsin deficiency

Question 21

what is haemochromatosis

Answer 21

excess iron in liver

Question 22

what is primary haemochromatosis

Answer 22

a iron handling/storage disorder
inherited autosomal recessive condition
gene defect v.complex
excess absorbtion of iron from intestine, abnormal iron metabolism
worse in homozygotes, men 
increased absorption of iron

Question 23

what is secondary haemochromatosis

Answer 23

iron overload from diet, transfusions, iron therapy

Question 24

what are the outcomes of primary haemochromatosis

Answer 24

iron deposited in liver
eventually deposited in portal connective tissue and stimulates fibrosis

cirrhosis if not treated
predisposes to carcinoma
also causes diabetes, cardiac failure and impotence

Question 25

what stain confirms presence of iron in hepatocytes

Answer 25

Perls stain

prussian blue

Question 26

what is the outcome for haemochromatosis

Answer 26

outcome depends on genetics, therapy (venesection) and cofactors such as alcohol

cirrhosis
hepatocellular carcinoma

Question 27

what is Wilson’s disease

Answer 27

inherited autosomal recessive disorder of copper metabolism

Question 28

how does wilsons disease occur

Answer 28

copper accumulates in liver and brain (basal ganglia)

Question 29

what are the signs of wilsons disease

Answer 29

kayser-fleischer rings at corneal limbus

low serum caeruloplasmin

Question 30

what des wilsons disease cause

Answer 30

causes chronic hepatitis and neurological deterioration

Question 31

what is alpha-1-antitrypsin deficiency and what does it cause

Answer 31

inherited autosomal recessive disorder of production of an enzyme inhibitor
causes emphysema and cirrhosis

cytoplasmic globules of unsecreted globules of protein in liver cells

Question 32

what are the primary tumours of the liver

Answer 32

rare
hepatocellular adenoma
hepatocellular carcinoma (hepatoma)

Question 33

what are the secondary tumours of the liver

Answer 33

common multiple

metastases from colon, pancreas, stomach, breast, lung others

Question 34

describe the aetiology of hepatocellular adenoma

Answer 34

benign
females
may become large (can rupture or bleed)
most remain assymptomatic

Question 35

describe the aetiology of hepatocellular carcinoma

Answer 35

rare in europe
associated with HBV, HCV and cirrhosis due to any cause
fatty liver disease associated with obesity is now one of the commonest
usually presents as a mass, pain, obstruction
usually advanced unless discovered incidentally
poor prognosis

Question 36

what is a malignant primary liver tumour from biliary epithelium called

Answer 36

cholangiocarcinoma