Liver Lecture 2 Flashcards
A transmission
fecal-oral incubation 3-6 weeks no chronic state mild or asymptomatic 50% of people over 50 show previous exposure
B transmission
perinatal, sexual
- incubation period 4-26 weeks
1. Acute or chronic - fulminant .1-.5%
- chronic hepatitis
Histology: ground glass
C transmission
Source: IV drug use 60% Sexual 15% Transfusion 10% (before screening) Occupational (4%) incubation period 2-26 weeks 85% of patients with acute infection Fulminant -rare chronic 80-85%- 20-30% progress to cirrhosis -increased risk of hepatocellular cancer RNA
D transmission
-incubation period 4-26 weeks (same as in B)
Fulminant 3-4%*
Chronic
E transmission
Fecal-oral -contaminated water
incubation 6 weeks
fulminant .2-.3%
***20% in pregnancy
no carrier state
-unlikely risk of hepatocellular carcinoma
Endemic in tropical and subtropical countries
Histological difference between acute and chronic hepatitis
acute:
- ballooning degeneration
- macrophage aggregates
- apoptosis
- sometimes necrosis
- portal inflammation
sAG
eAG
cAB
sAB
surface AG: active infection -if greater than 6 months chronic eAG-infectivity cAB-way to tell chronic or acute, won't have if you were vaccinated without disease sAB-victory
Stage 3 fibrosis is..
bridging fibrosis
What causes fulminant hepatitis?
- viral hepatitis
- usually B or A
- rarely C, HSV, or dengue virus - drugs and chemical toxicity
- autoimmune hepatitis
- wilson’s disease
- budd chiari
- rare (ischemia, malignancy
- unknown (15%)
fulminant
B
Chronic
C
Acetaminophen-related liver injury
-leading cause of acute liver failure
-dose related toxin exceed 10gm/day
-very high aminotransferase levels
low t. bilirubin?
Build up of NAPQI
GIve NAC
What do you see in autoimmune hepatitis histology ?
Plasma cell
Interface Hepatitis
Hepatic Steatosis
-Reversible
short term ingestion of 80gm of alcohol
-6 beers or 8 oz of 80 proof
-10-15% of alcoholics develop fibrosis
macrovasicualr
Alcoholic hepatitis
fatty liver
inflammation
hepatocellular injury (hepatocyte swelling, apoptotic bodies), mallory hyaline often associated with neutrophils (proteinaceous debri)
-balloon and chicken wire fibrosis
How does alcohol cause Alcoholic Hepatitis
- acetaldehyde
- metabolite of Etoh
- disrupts the cytoskeleton membrane function - induction of cytochrome p450 and generation of reactive species
- damages membranes and hepatocyte function - decrease glutathione levels
- malnutrition and vitamin deficiencies
- bacterial endotoxins from gut inducing inflammatory responses
alcoholic cirrhosis
fibrosis
hyperplastic nodule
Non alcoholic fatty liver disease
Histology: identical to ETOH
Obesity and metabolic syndrome: dyslipidemia, hyperinsulinemia, and insulin resistance
*most common cause of chronic liver disease and cryptogenic cirrhosis
70% of obese individuals
hepatic steatosis
-minor nonspecific inflammation
non alcoholic steatohepatitis NASH
-hepatocyte injury
-can progress to fibrosis s
-can be asymptomatic or RUQ discomfort
-associated with cardiovascular disease and metabolic syndrome
-elevated transaminases
(simple steatosis does not progress to cirrhosis)
Hemochromatosis
Disease of iron overload
Hereditary: recessive (HFE gene chromosome 6)
-excessive absorption of dietary iron
Secondary: transfusions or hemolysis
-iron deposition in parenchymal tissue
Treatment: phlebotomy or chelation
****SIGNIFICANT risk of hepatocellular carcinoma 200x risk
Diagnosis: elevated serum iron elevated ferritin test for HFE gene liver biopsy for quantitative iron studies and histological examination
wilsons disease
copper accumulation -liver and brain -recessive -impaired copper excretion -symptoms start 6-20 years -neuropsychiatric -kayser fleischer ring -liver failure -hemolytic anemia Treatment: copper chelation
chameleon on biopsy?
Diagnosis:
- low ceruloplasmin
- increased urinary copper
- liver biopsy for quantitative copper analysis
- kayser-fleischer rings
Alpha 1 antitrypsin deficiency
- defective production of a1at in liver
- errors in coding sequence prevent export
- accumulation results in cell death, inflammation, fibrosis and cirrhosis
- pulmonary emphysema
- autosomal recessive chromosome 14
- PiZZ has only 10% of normal circulating levels
Can use PAS stain in histology
