Liver

Question 1

Causes of acute and chronic hepatitis?

Answer 1

Acute:
Viral infections (Hep. A-E/ Non A-E infections)
Alcohol
Drug
Auto-immune

Chronic:
Hep B +/- Hep D virus
Hep C
AI hep
alcohol
Hyperlipidaemia
Drugs (methyldopa/nitrofurantoin)
Metabolic disorders such as Wilson's, alpha- 1-antitrypsin deficiency, haemochromatosis

Question 2

If you suspect hepatitis, what should you do?

Answer 2

Microbiology viral screen
CLincial chemistry for ferritin, transferrin, lipids, caeruloplasmin, AFP, alpha-1 antitrypsin
Immunology: autoantibodies
Abdo USS

Question 3

Which Heps tend to be clincially grouped together?

Answer 3

A and E

B and D

Question 4

What is Hep A?

Answer 4

RNA picorna virus
Transmitted feco-orally
Incubation period of 2-6 weeks
Notifiable disease
most common world wide
80% asymptomatic and naturally cleared
does not lead to chronic, no carriers
no specific treatment, low mortality

Question 5

Hep E?

Answer 5

RNA calcivirus, feco-oral transmission
simialr clinically to Hep A, leads to acute epidemics, but no progression, chronic diseae
common in indo-china- thus consider recent travel
alarm bells in pregnant women

Question 6

Hep B?

Answer 6

Hepa-DNA virus: blood semen, saliva, skins breaks or mucous membranes
Vertical transmission is the most common cause of transmission worldwide
incubation 1-6 mo
virus has an inner core and an outer envelope
around 10% into chronic, 1% fulminant liver disease

Question 7

Hep D

Answer 7

incomplete RNA virus, can only cause infection in presense of B
body fluids
acute or chronic

Question 8

Hep C

Answer 8

RNA flavi virus, clincally similar to B
common in IVDUs, body fluids
rare vertical and sexual
85% chronic infection, 30% cirrhosis within 20 yrs

Question 9

Vaccines for Hep?

Answer 9

A and B, but not C

10-15% cant be typed

Question 10

What other viruses than Hep A-E can cause acute hep?

Answer 10

CMV, yellow dever, and HSV in immunocompromised

Question 11

Describe the pathophysiological process of acute hepatitis

Answer 11

hepatocytes swell and undergo vacuolisation before they necrose and are rapidly removed
this is usually maximal in zone 3, as this is centrilobular and thus receives the least oxygenated blood
the extent can vary from scattered necrosis to multiacinal necrosis leading to fulminant hepatic failure

Question 12

Reminder: which zone most likely to undergo degenerative changes in acute hep?

Answer 12

the centrilobular area: zone 3

Question 13

Describe the pathophysiological process of chronic hepatitis

Answer 13

Any hep lasting more than 6 months- the principle cause of CLD, cirrhosis and hepatocellular carcinoma.
Chronic inflammatory cell infiltrates are present in portal tracts
There may be a loss of definition of the portal/periportal limiting plate, confluent necrosis and fibrosis
eventually, cirrhosis
the overal severity is judged by grade: inflammation, and stage: fibrosis/cirrhosis, using various scoring systems
(child-pugh)