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SYSTEMIC PATHOLOGY > Hepatobiliary - non-neoplastic liver conditions > Flashcards

Hepatobiliary - non-neoplastic liver conditions Flashcards

1
Q

hepatic diseases (6)

A
  1. Infectious disorders
    - Viral hepatitis
    - Bacterial, parasitic and helminthic
  2. Drug- and toxin induced liver injury (DILI)
    - Alcoholic liver disease
  3. Cholestatic / biliary diseases
    - Large bile duct obstruction
    - Neonatal cholestasis
    - Autoimmune cholangiopathies
  4. Autoimmune hepatitis
  5. Metabolic diseases
    - Non-alcoholic fatty liver disease (NAFLD)
    - Haemochromatosis
    - Wilson disease
    - a1-antitrypsin deficiency
    - Neonatal hepatitis
  6. Circulatory disorders
    - Hepatic venous outflow obstruction
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2
Q

acute hepatitis symptoms

A
  • Jaundice
  • Poor appetite
  • Dark-coloured urine
  • Nausea and vomiting
  • Fever
  • Abdominal pain
  • Fatigue
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3
Q

causes of viral hepatitis

A

Hepatotropic: Hepatitis A, B, C, D, E

Non-hepatotropic (no effect on liver): EBV, CMV

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4
Q

hepatitis A

  • mode of transmission
  • where does it affect
  • malignancy
A
  • fecal-oral transmission
  • affects countries w/ poor hygiene/ sanitation, close quarters
  • consumption of raw shellfish
  • benign: self-limiting,
    gives lifelong immunity
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5
Q

hepatitis B

  • modes of transmission **
  • pathogenesis
  • diagnosis
  • malignancy
  • carrier state
  • histo features
A

global health problem:

  • Vertical transmission
  • Horizontal transmission esp. early childhood
  • Sexual and IV drug abuse
  • injury to hepatocytes caused by immune response -> CD8+ cytotoxic T cells attacking infected cells
  • HBsAg (acute), HBcAg (chronic) postive**
  • risk of causing hepatocellular carcinoma
  • healthy carrier w/ no inflammation -> normal ALT/AST
  • ‘ground-glass’ hepatocyte
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6
Q

hepatitis C

  • modes of transmission **
  • pathogenesis
  • carrier state
  • histo features
  • diagnosis**
A
  • IVDA, sexual, needle-stick injury, vertical
    but 1/3 have no identifiable risk factors
  • HCV is genomically unstable + has multiple strategies to evade host anti-viral immunity
  • > causes hepatic damage (persistent infection and chronic hepatitis)
  • no carrier state - all presents as chronic hepatitis
  • no lifelong immunity - HCV RNA (RT-PCR) very persistent **
  • histo features:
    lymphoid follicle
    fatty change
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7
Q

hepatitis D

  • mode of transmission
  • where does it affect
  • pathogenesis
  • diagnosis
  • vaccine/ treatment
A
  • blood-borne (IVDA, blood transfusions)
  • prevalence highest in Amazon basin, Middle East, Mediterranean and central Africa
  • Superinfection:
    severe acute hepatitis in a HBV carrier/
    exacerbation of preexisting chronic Hep B infection
  • diagnosis: IgM anti-HDV antibody
  • vaccine: prevent HBV infection also prevents HDV cause HDV is developed from HBV
    self-limiting (like HBV)
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8
Q

hepatitis E

  • mode of transmission
  • who should take special caution
  • diagnosis
  • vaccine/ treatment
A
  • fecal oral transmission
  • zoonosis: monkeys, cats, pigs, dogs
  • immunocompromised pts - chronic infection
  • pregnancy: high mortality rate
  • diagnosis: HEV RNA and virions can be detected by PCR in stool and serum
  • self-limiting disease
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9
Q

acute vs chronic viral hepatitis

A

difference is the pattern of injury
both are mononuclear T cells
acute: lobular hepatitis
chronic: portal hepatitis

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10
Q 
lobular hepatitis (acute) 
histo features
A
  • Hepatocyte degeneration (hydropic swelling)
  • Apoptosis, spotty necrosis with hepatocyte dropout to confluent necrosis
    (perivenular, bridging)
  • Kupffer cell (macrophage) hypertrophy
  • Lymphoplasmacytic infiltrate
  • Cholestasis (cause of bile duct obstruction)
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11
Q

portal hepatitis (chronic) histo features

A
  • Lymphoplasmacytic portal infiltration
  • Portal and periportal (interface) hepatitis to bridging hepatic necrosis
  • Fibrosis to cirrhosis; regression may occur
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12
Q

grading and staging of liver disease

A

grading: extent of injury and inflammation
staging: progression of fibrosis

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13
Q

Non-hepatotropic viral hepatitis

- viral types

A

multi organ involvement

  • opportunistic infection:
  • CMV, HSV, EBV, adenovirus
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14
Q

localised diseases caused by bacterial, parasitic and helminthic infections (2)

A
  • Abscess (bacterial or amoebic)

- Hydatid cyst

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15
Q

diffused diseases caused by bacterial, parasitic and helminthic infections (3)

A
  • Mild hepatic inflammation w/ varying hepatocellular cholestasis
  • Granulomatous disseminated disease (Schistosoma – ‘pipe stem fibrosis’, miliary TB)
  • Dilated intrahepatic ducts (liver flukes: high rate of cholangiocarcinoma)
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16
Q

amoebic abscess (localised liver disease)

A

Large cavity lined by necrotic shaggy tissue

  • Abscess contents have lack of inflammatory cells due to process of liquefactive necrosis
  • caused by protozoa
17
Q

miliary TB of liver

  • histo features
  • diagnosis
A
  • granuloma: Epithelioid histiocytes, lymphocytes and multinucleated giant cells
  • Ziehl-Neelsen stain for acid-fast bacilli
  • Culture and sensitivity for Mycobacterium tuberculosis
18
Q

autoimmune hepatitis

  • antibodies present
  • affect who more
A

Chronic progressive disease

  • autoantibodies: ANA, SMA, anti-SLA/LP, AMA, anti-LKM1

genetic association: HLA genotype
affects females more

19
Q

autoimmune hepatitis

  • diagnosis
  • histo features
A
  • presence of autoantibodies
  • elevated IgG level

histo:
1. interface hepatitis with lymphoplasmacytic predominance
2. Emperipolesis
3. Hepatic rosette formation

20
Q

Drug- and toxin induced liver injury (DILI)

- pathogenesis

A
  • Direct toxicity
  • hepatic conversion of xenobiotic -> active toxin
  • immune-mediated mechanisms
21
Q

DILI (Drug- and toxin induced liver injury) diagnostic criteria

A
  • temporary liver damage upon drug/toxin exposure

- recovery upon stopping the drug

22
Q

alcoholic liver disease

- factors determining severity of ALD

A
  • Dosage and duration: 6 beers/day + > 10-20 yrs
  • Gender: females more susceptible
  • Ethnic and genetic differences (in production of detoxifying enzymes)
  • Comorbid conditions (viral hepatitis)
23
Q

alcoholic liver disease

- complications

A
  • steatosis
  • Dysfunction of mitochondrial and cellular membranes
  • Hypoxia and oxidative stress
  • increase in inflammatory response
  • decrease hepatic sinusoids perfusion
24
Q

alcoholic liver disease

- histo features (6)

A
  • Centrilobular steatosis (reversible with abstention)
  • Hepatocyte swelling (ballooning degeneration) and necrosis
  • Mallory-Denk bodies
  • Neutrophilic reaction
  • Pericellular/perisinusoidal fibrosis (“Chicken-wire fence” pattern)
  • Cirrhosis (micronodular)
25
Q

Non-alcoholic fatty liver disease (NAFLD) [metabolic disease]
- progression

A

only for individuals who drink very little alcohol

healthy -> steatosis -> NASH (steatohepatitis) -> NASH w/ fibrosis -> cirrhosis

NASH: hepatocyte injury

26
Q

2 causes of NAFLD

A

metabolic diseases:
- Insulin resistance -> decreased lipid metabolism + increased production of inflammatory cytokines

  • Oxidative injury -> liver cell necrosis
    as fat laden cells are highly sensitive to lipid peroxidation products
27
Q

haemochromatis definition

A

Caused by excessive iron absorption, depositing in parenchymal organs (liver, pancreas, heart, joints, endocrine organs, skin)

28
Q

wilson’s disease definition

A

Autosomal recessive disorder caused by ATP-7B gene mutation (chr 13)

  • > impaired copper excretion into bile + failure to secrete copper into blood
  • > accumulation of copper in the tissues and organs
29
Q

A1-antitrypsin deficiency

A

Autosomal recessive:
disorder of protein folding
-> impaired secretion and very low serum α1AT
(α1AT is important in inhibition of proteases, particularly those released from neutrophils)
-> so high protease activity

SYSTEMIC PATHOLOGY (27 decks)

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