Hepatitis Flashcards
what can viral hepatitis be caused by?
acute liver injury or chronic liver injury
what are the common and rare causes of viral hepatitis
common: hepA HepB HepC hepE rare: delta agent ebstein-barr virus yellow fever virus herpes simplex virus cytomegalovirus
how is hepA spread and what is its effect on the human
faecal-oral spread short incubation period sporadic or endemic directly cytopathic no carrier state mild illness, usually full recovery
how is HepB spread
spread by blood, blood products, sexually, vertically (in utero)
long incubation period
liver damage is by antiviral immune response
carriers exist
outcome variable
how is hepC spread
spread by blood, blood products, possibly sexually short incubation period often asymptomatic disease waxes and wanes tends to become chronic
how does hepatitis progressively become malignant
hepatitis -> inflammation and scarring -> cirrhosis -> hepatocellular carcinoma or liver
what are the outcomes for hepB
fulminant acute infection (Death) chronic hepatitis cirrhosis hepatocellular carcinoma assymptomatic (Carrier)
what are the hepC outcomes
chronic hepatitis
cirrhosis
treated and cured
what is the aetiology of chronic hepatitis
autoimmune diseases hepB hepC primary biliary cirrhosis autoimmune hepatitis drug induced hepatitis primary sclerosing cholangitis
describe primary biliary cirrhosis
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
what does untreated bile duct loss lead to?
cholestasis liver injury, inflammation, fibrosis and cirrhosis
describe autoimmune hepatitis
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
describe chronic drug-induced hepatitis
similar features to the other types of chronic hepatitis
may trigger an autoimmune hepatitis
chronic active process
causes are too many to list
what can drugs do to the liver
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
what is primary sclerosing cholangitis
chronic inflammatory process affecting intra- and extra-hepatic bile ducts
what does primary sclerosing cholangitis lead to
leads to periductal fibrosis, duct destruction, jaundice and fibrosis
what is primary sclerosing cholangitis associated to
ulcerative colitis
who does PSC affect and what does it increase the risk of malignancy in?
males
bile ducts and colon
how does PSC look on histology
periductal onion-skinning fibrosis
what are the 3 storage diseases
haemochromatosis
wilsons disease
alpha-1-antitrypsin deficiency
what is haemochromatosis
excess iron in liver
what is primary haemochromatosis
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
what is secondary haemochromatosis
iron overload from diet, transfusions, iron therapy
what are the outcomes of primary haemochromatosis
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
what stain confirms presence of iron in hepatocytes
Perls stain
prussian blue
what is the outcome for haemochromatosis
outcome depends on genetics, therapy (venesection) and cofactors such as alcohol
cirrhosis
hepatocellular carcinoma
what is Wilson’s disease
inherited autosomal recessive disorder of copper metabolism
how does wilsons disease occur
copper accumulates in liver and brain (basal ganglia)
what are the signs of wilsons disease
kayser-fleischer rings at corneal limbus
low serum caeruloplasmin
what des wilsons disease cause
causes chronic hepatitis and neurological deterioration
what is alpha-1-antitrypsin deficiency and what does it cause
inherited autosomal recessive disorder of production of an enzyme inhibitor
causes emphysema and cirrhosis
cytoplasmic globules of unsecreted globules of protein in liver cells
what are the primary tumours of the liver
rare
hepatocellular adenoma
hepatocellular carcinoma (hepatoma)
what are the secondary tumours of the liver
common multiple
metastases from colon, pancreas, stomach, breast, lung others
describe the aetiology of hepatocellular adenoma
benign
females
may become large (can rupture or bleed)
most remain assymptomatic
describe the aetiology of hepatocellular carcinoma
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
what is a malignant primary liver tumour from biliary epithelium called
cholangiocarcinoma
