Lecture 12: Liver Pathology Flashcards
define steatosis
fatty change within the liver - reversible cell injury
microvesicular - small fat droplets
macrovesicular - big fat droplets
name a common cause of steatosis
- NAFLD –> most common cause of unexplained LFTs; assc. w/ metabolic syndrome; risk factor for sudden cardiac death
define steatohepatitis
- accumulation of fat w/ accompanying inflammatory changes
- more assc. w/ alcohol than NAFDL but can be seen w/ both conditions or medications/drugs
what risk does inflammatory changes in the liver pose
smouldering low grade chronic inflammation (most often seen in NAFLD) or repeated bouts of hepatitis (often seen w/ alcohol abuse/addiction) can lead to fibrosis
name a histological feature present in steatosis
fatty deposits
name a histological feature present in steatohepatitis
- fatty deposits
- mallory bodies/hyaline
how might a radiologist measure liver stiffness
using an ultrasound probe (fibroscan) - elastography
why might a radiologist carry out an elastography
- measure liver stiffness as a surrogate marker of fibrosis
- to estimate degree of steatosis (expressed as CAP score)
define cirrhosis
- diffuse process
- presence of fibrous septa that subdivide liver parenchyma into structurally abnormal nodules
- end stage of many different types of progressive liver disease
- usually a loss of function due to loss of architecture –> scarring + regenerating nodules
what affects healing in the liver
nature of insult and amount of damage
name some complications of decompensated liver disease
- jaundice –> bilirubin accumulation
- coagulopathy –> impaired clotting factor synthesis
- encephalopathy –> hyperammonaemia
- ascites –> impaired albumin synthesis, portal hypertension
- splenomegaly –> portal hypertension
- GI bleeding –> oesophageal varices
name some signs of chronic liver disease
- Caput Medusa –> distended epigastric veins around umbilicus
- splenomegaly –> portal hypertension
- ascites -> low albumin, ^ portal hypertension
- leukonychia –> white fingernails
- flapping tremor
what type of virus is hepatitis
specific hepatotropic virus
what cell type does hepatitis target and infect
specialised parenchymal liver hepatocytes
how does most viral hepatitis present
presents as acute
describe some of the dominating clinical features of acute viral hepatitis
- accuse inflammation
- impaired liver function due to liver cell death
what types of hepatitis can present as chronic
Hep B and C (also D)
how does Hep A cause liver damage
through immune response to virus
what type of virus is Hep A specifically
RNA virus related to pico virus
how might Hep B present
- acute hepatitis w/ recovery
OR - acute fulminant hepatitis w/ massive necrosis
OR - chronic that develops into cirrhosis –> hepatocellular carcinoma
OR - asymptomatic carrier state
how is Hep A transmitted
faecal oral
how is Hep B transmitted
parenteral –> blood, sexual transmission
in acute hepatitis describe what happens to the level of HBeAg and anti-HBs
- HBeAg levels will rise and peak during active infection before then falling and disappearing entirely
- anti-has levels will begin to rise once HBeAg has nearly disappeared and then high levels will persist giving immunity
in a progression to chronic hepatitis describe what happens to the level of HBeAg and anti-HBs
- HBeAg levels will rise to a peak but then they won’t fall completely but will persist at a mid level
- anti-HBs won’t be present but instead anti-HBe may be present
How is Hep C spread
blood products; contamination
How might Hep C present
- often asymptomatic and unrecognised initial infection
- often produce chronic hepatitis –> cirrhosis
- interface hepatitis that kills hepatocytes
How is Hep B prevented
screening and vaccination
How is Hep C prevented
- prevention of sharing needles
- screening blood products
- treated by interferon
which Hep virus is most assc w/ fatty change
Hep C
what type of virus is Hep C specifically
RNA virus –> can be measured by PCR
what will be seen on the serology of acute Hep C
- rise in HCV to peak then a fall
- replaced by anti-HCV
- patient then recovers or is treated by interferon to stimulate immune reaction
what will be seen on the serology of chronic Hep C
- HCV remains detectable in bloodstream
- don’t develop anti-HCV
- fluctuations of serum transaminases due to ongoing inflammation
is autoimmune hepatitis acute or chronic
chronic
explain the difference in effect between primary biliary cirrhosis/sclerosing cholangitis and autoimmune hepatitis
PSC and PBC attack bile ducts while autoimmune attacks hepatocytes
- PSC both extra and intra hepatic bile ducts
- PBC intra hepatic bile ducts
what sex is most affected by autoimmune hepatitis
female
describe autoimmune hepatitis
a chronic hepatitis which may have an indolent or rapidly progressive course
name some features of autoimmune hepatitis
- elevated IgG
- +ve autoantibodies
- assc w/ other autoimmune disease e.g. rheumatoid arthritis
describe primary biliary cirrhosis (PBC)
chronic autoimmune progressive destruction of intrahepatic bile ducts
name some features of PBC
- +ve anti-mitochondrial autoantibodies >90%
- may be ANA or ANCA +ve
- assc w/ thyroid disease, scleroderma, Sjogren’s syndrome
describe primary sclerosis cholangitis (PSC)
chronic inflammatory destruction of extrahepatic and larger intrahepatic bile ducts w/ beading of bile ducts on MRI or ERCP
what sex does PBC affect more
female
what sex does PSC affect more
male
name some features of PSC
- assc w/ CIBD, autoimmune pancreatitis
- up to 2/3 +ve ANCA autoantibodies
