Hepatitis C (2)

Question 1

• What is Hepatitis C?

Answer 1

• Inflammation that disrupts hepatocytes and small bile ductules caused by the Hepatitis C virus.
• Hepatitis C virus is a single-stranded RNA virus from family flaviviruses.
• Hepatitis virus causes acute hepatitis, which may progress to chronic hepatitis.

Question 2

What are the symptoms of acute and chronic hepatitis?

Answer 2

• Acute hepatitis presents as jaundice, fever, malaise, nausea, and elevated liver enzymes (ALT > AST).
• Chronic hepatitis is characterized by symptoms that last > 6 months with a risk of progression to cirrhosis and HCC.

Question 3

What is the pathological sequence in HCV?

Answer 3

1. Acute Hepatitis
2. Chronic Hepatitis
3. Liver cirrhosis & portal hypertension
4. Liver cell failure
5. HCC

Question 4

What are the most common risk factors for HCV infection?

Answer 4

• Intravenous drug abuse
• Multiple sex partners
• Having had surgery within the last 6 months
• Needle stick injury
• Multiple contacts with an HCV-infected individual
• Employment in the medical or dental field

Question 5

What is cirrhosis?

Answer 5

End-stage liver damage characterized by the disruption of normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes.

Question 6

What are the clinical features of cirrhosis?

Answer 6

• Portal hypertension
  
  • Ascites
  • Congestive splenomegaly/hypersplenism
  • Portosystemic shunts (esophageal varices, hemorrhoids, and caput medusae)
  • Hepatorenal syndrome (rapidly developing renal failure secondary to cirrhosis)
• Decreased detoxification
  
  • Mental status changes (due to raised serum ammonia)
  • Gynecomastia, and palmar erythema due to hyperestrinism
  • Jaundice
• Decreased protein synthesis
  
  • Hypoalbuminemia and edema
  • Coagulopathy due to decreased synthesis of clotting factors.
• Hepatocellular carcinoma

Question 7

What is the most common cause of cirrhosis in the UK?

Answer 7

Chronic Alcoholism

Question 8

What is the most common cause of death in cirrhosis?

Answer 8

Rupture esophageal varices

Question 9

What are the different types of necrosis?

Answer 9

• Coagulative necrosis: ischemic infarction of any organ except the brain
• Liquefactive necrosis: Brain infarction, Abscess, Pancreatitis
• Gangrenous necrosis: dry gangrene, wet gangrene
• Caseous necrosis: TB
• Fat necrosis: Traumatic in breast, Enzymatic in Pancreatitis
• Fibrinoid necrosis: Hypertension

Question 10

What type of necrosis is seen in HCV?

Answer 10

Coagulative

Question 11

What are the types of Candida?

Answer 11

• Oral
• Vaginal
• Cutaneous
• Invasive

Question 12

What is the most common type of Candida?

Answer 12

Oral candida albicans, which can grow as yeast, pseudohyphae, or true hyphae

Question 13

What are the stages and classification of venous leg ulcers?

Answer 13

• CEAP classification
  
  • C0 – No visible or palpable signs of venous disease
  • C1 – Telangiectasias or reticular veins
  • C2 – Varicose veins
  • C3 – Edema
  • C4a – Milder skin changes due to venous disorder (pigmentation, eczema)
  • C4b – Severe skin changes due to venous disorder (dermatosclerosis, atrophie blanche)
  • C5 – Healed ulcers
  • C6 – Skin changes with active ulcers

Question 14

What are the systemic and local causes of inguinal lymphadenopathy?

Answer 14

• Systemic
  
  • Neoplastic
    
    • Hodgkin’s and non-Hodgkin’s lymphoma (common)
    • Leukemia
  • Inflammatory
    
    • Tuberculosis
    • Sarcoid
• Local causes
  
  • Neoplastic
    
    • Metastatic disease
    • Malignant melanoma
  • Infective
    
    • Non-specific reactive lymphadenopathy from infection in groin or lower limb (very common)
    • Specific infections
      
      • Lymphogranuloma venereum

Question 15

What is seen microscopically in inguinal LN cut section in a patient with inguinal lymphadenopathy?

Answer 15

• Chronic non-specific reactive lymphadenopathy:
  
  • Follicular hyperplasia: predominantly B-cells response with germinal center hyperplasia which may be associated with marginal zone hyperplasia
    
    • systemic toxoplasmosis
    • syphilis
  • Paracortical hyperplasia: reactive changes within the T-cell region of LN with paracortical expansion caused by
    
    • viral infection e.g. infectious mononucleosis (EBV)
    • certain vaccination (e.g., smallpox)
  • Sinus histiocytosis: distension and prominence of lymphatic sinusoids,
    
    • LN draining cancers
    • immune response to tumor or its product