Liver Pathology 2 Flashcards
describe viral hepatitis
may cause acute liver injury or chronic liver injury
types of viral hepatitis
hep A, B, C, E
delta agent
name of hepatitis A
ebstein-barr virus
name of hepatitis B
yellow fever virus
name of hepatitis C
herpes simplex virus
name of hepatitis E
cytomegalovirus
how is hepatitis A spread
faecal-oral
describe hepatitis A
short incubation period
sporadic or endemic
directly cytopathic
no carrier illness
what is meant by cytopathic
refers to structural changes in host cells that are caused by viral invasion
the infecting virus causes lysis of the host cell or when the cell dies without lysis due to an inability to reproduce
recovery from hepatitis A
mild illness
usually full recovery
how is hepatitis B spread
blood
blood products
sexually
vertically (in utero)
describe hepatitis B
long incubation period
liver damage via antiviral immune response
carriers exist
recovery from hepatitis B
variable
how is hepatitis c spread
blood
blood products
possibly sexually
describe hepatitis C
short incubation period
disease waxes and wanes
tends to be chronic
symptoms of hepatitis C
often asymptomatic
microscopy of chronic viral hepatitis
dense portal chronic inflammation interface hepatitis (piecemeal necrosis) lobular inflammation - councilman body and steatosis fibrosis cirrhosis
describe interface hepatitis
necrosis of the limiting plates, by inflammatory cells
outcomes of hepatitis B
fulminant acute infection - death chronic hepatitis cirrhosis hepatocellular carcinoma asymptomatic (patient becomes a carrier)
outcomes of hepatitis C
chronic hepatitis
cirrhosis
aetiology of chronic hepatitis - autoimmune disease
primary biliary cirrhosis
autoimmune hepatitis
primary sclerosis cholangitis
aetiology of chronic hepatitis - other causes
hep B
hep C
drug induced hepatitis
describe primary biliary cirrhosis
rare autoimmune disease
unknown aetiology - associated with autoantibodies to mitochondria
epidemiology of primary biliary cirrhosis
female
pathology of primary biliary cirrhosis
granulomas
bile duct loss
out come of primary biliary cirrhosis
unpredictable
when would a biopsy be indicated for primary biliary cirrhosis
staging the disease
microscopy of primary biliary cirrhosis
chronic portal inflammation
bile ducts inflamed
granuloma around duct
outcomes of primary biliary cirrhosis
if untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis and cirrhosis
epidemiology of autoimmune hepatitis
females
pathology of autoimmune hepatitis
chronic hepatitis pattern
numerous plasma cells
autoantibodies to smooth muscle, nuclear or LKM, raised IgG
epidemiology of autoimmune hepatitis
associated with other autoimmune diseases
may have triggers - including some drugs
describe chronic drug-induced hepatitis
similar features to all other types of chronic hepatitis - chronic active process
may trigger autoimmune hepatitis
describe the effects of drugs on the liver
innumerable drugs can damage liver - may be dose related or idiosyncratic
can mimic any liver disease
outcomes of drugs on the liver
hepatitis granulomas fibrosis necrosis failure cholestasis cirrhosis
pathology of primary sclerosis cholangitis
chronic inflammatory process affecting intra and extra hepatic bile ducts
outcomes of primary sclerosis cholangitis
periductal fibrosis
duct destruction
jaundice
fibrosis
increased risk of malignancy in bile ducts and colon
epidemiology of primary sclerosis cholangitis
males
aetiology of primary sclerosis cholangitis
associated with ulcerative colitis
microscopy of primary sclerosis cholangitis
peridcutal onion-skinning fibrosis
storage diseases of the liver
haemochromatosis
Wilsons disease
alpha-1-antitrypsin deficiency
what is haemochromatosis
excess iron within the liver
can be primary or secondary
primary haemochromatosis
genetic condition - inherited autosomal recessive condition (worse in homozygotes, men)
increased absorption of iron
secondary haemochromatosis
iron overload from diet
transfusion
iron therapy
pathology of primary haemochromatosis
excess absorption of iron from intestine
abnormal iron metabolism
iron deposited in liver - asymptomatic for years -deposited in portal connective tissue and stimulates fibrosis
outcomes of primary haemochromatosis
untreated - fibrosis and cirrhosis predisposes to hepatocellular carcinoma diabetes cardiac failure impotence
microscopy of haemochromatosis
iron accumulates in hepatocytes - confirmed by Perls stain
what is Wilson’s disease
inherited autosmal recessive disorder of copper metabolism
pathology of Wilson’s disease
copper accumulates in liver and brain (basal ganglia)
Kasyer-Fleischer rings at corneal limbus
low serum caeruloplasmin
outcomes of Wilson’s disease
chronic hepatitis
neurological deterioration
describe alpha-1-antitrypsin deficiency
inherited autosomal recessive disorder of production of an enzyme inhibitor
outcomes of alpha-1-antitrypsin deficiency
emphysema
cirrhosis
pathology of alpha-1-antitrypsin deficiency
cytoplasmic globes of unsecreted globules of protein in liver cells
primary tumours of the liver
rare;
hepatocellular adenoma
hepatocellular carcinoma (hepatoma)
secondary tumours of the liver
common;
mutliple
metastases from colon, pancreas, stomach, breast, lung…
describe hepatoceullar adenoma
bengin
seen mostly in females
may become large - rupture or bleed
may remain asymptomatic
describe hepatocellular carcinoma
advanced unless discovered accidentally - poor prognosis
associated with HBV, HCV and cirrhosis
symptoms and signs of hepatocellular carcinoma
mass
apin
obstruction
microscopy of hepatocelllar carcinoma
multifocal (rare)
hepatocytic
cholangio-
