Inflammatory & Infectious Diseases of the liver

Question 1

Causes of liver abscess

Answer 1

• Parasitic infections (developing countries)
• Complication of a bacterial infection elsewhere in body (Western world)

Question 2

Possible ways for organisms reaching the liver in liver abscess

Answer 2

• Ascending infection in the biliary tract (Ascending Cholangitis)
• Vascular seeding (portal or arterial), mainly from GI tract
• Direct invasion from an adjacent source
• Penetrating injury

Question 3

Clinical manifestations of liver abscess

Answer 3

Fever – Right upper quadrant pain – Tender Hepatomegaly – Jaundice (in cases of
biliary obstruction)

Question 4

Tx of liver abscess

Answer 4

Antibiotic therapy and Percutaneous or surgical drainage
Prognosis: Mortality rate for large abscesses with delayed treatment: 30-90% – Early
recognition and appropriate management: Survival of 90% of patients

Question 5

Pyogenic bacterial liver abscess
Macroscopic/micro features:

Answer 5

• Solitary or multiple lesions
• Size: From tiny (millimeters) to massive (many centimeters) lesions
  Microscopic findings:
• Liquefactive necrosis
• Abundant neutrophils

Question 6

Causes of autoimmune hepatitis

Answer 6

unknown

Question 7

Pathogenesis of autoimmune hep

Answer 7

1. T-Cell mediated autoimmunity
2. Hepatocyte injury caused by IFN-γ (produced by CD4 and CD8 T-cells) and by CD8 T-cell-mediated cytotoxicity
3. Defect in regulatory T-cells → Uncontrolled activation of pathogenic self-reactive lymphocytes

Question 8

Triggers of autoimmune hep

Answer 8

Viral infections, certain drugs (e.g. Atorvastatin, Simvastatin, Methyldopa,
Interferons etc.), herbal products

Question 9

Lab reports of autoimmune hep

Answer 9

Absence of serologic evidence of viral infection – Elevated
serum IgG – High titers of autoantibodies (80% of cases) – Autoantibodies: Detected by
Immuno-Fluorescence (IF) or Enzyme-Linked Immunosorbent Assays (ELISA) * Antinuclear
Abs - Anti-Smooth Muscle Abs * Liver/Kidney microsomal Abs * Anti-soluble Liver/Pancreas Abs

Question 10

Microscopic features of autoimmune hep

Answer 10

Severe hepatocyte injury Confluent necrosis – Simultaneous, marked inflammation and advanced scarring – Burned-out Cirrhosis (No histological hallmarks present) – Abundant plasma cells

Question 11

Clinical manefisataions of autoimmune hep

Answer 11

Mild to severe Chronic Hepatitis