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Gastrointestinal > Liver Pathology 2 > Flashcards

Liver Pathology 2 Flashcards

1
Q

describe viral hepatitis

A

may cause acute liver injury or chronic liver injury

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2
Q

types of viral hepatitis

A

hep A, B, C, E

delta agent

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3
Q

name of hepatitis A

A

ebstein-barr virus

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4
Q

name of hepatitis B

A

yellow fever virus

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5
Q

name of hepatitis C

A

herpes simplex virus

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6
Q

name of hepatitis E

A

cytomegalovirus

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7
Q

how is hepatitis A spread

A

faecal-oral

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8
Q

describe hepatitis A

A

short incubation period
sporadic or endemic
directly cytopathic
no carrier illness

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9
Q

what is meant by cytopathic

A

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

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10
Q

recovery from hepatitis A

A

mild illness

usually full recovery

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11
Q

how is hepatitis B spread

A

blood
blood products
sexually
vertically (in utero)

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12
Q

describe hepatitis B

A

long incubation period
liver damage via antiviral immune response
carriers exist

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13
Q

recovery from hepatitis B

A

variable

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14
Q

how is hepatitis c spread

A

blood
blood products
possibly sexually

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15
Q

describe hepatitis C

A

short incubation period
disease waxes and wanes
tends to be chronic

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16
Q

symptoms of hepatitis C

A

often asymptomatic

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17
Q

microscopy of chronic viral hepatitis

A 
dense portal chronic inflammation 
interface hepatitis (piecemeal necrosis)
lobular inflammation - councilman body and steatosis 
fibrosis 
cirrhosis
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18
Q

describe interface hepatitis

A

necrosis of the limiting plates, by inflammatory cells

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19
Q

outcomes of hepatitis B

A 
fulminant acute infection - death
chronic hepatitis 
cirrhosis 
hepatocellular carcinoma 
asymptomatic (patient becomes a carrier)
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20
Q

outcomes of hepatitis C

A

chronic hepatitis

cirrhosis

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21
Q

aetiology of chronic hepatitis - autoimmune disease

A

primary biliary cirrhosis
autoimmune hepatitis
primary sclerosis cholangitis

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22
Q

aetiology of chronic hepatitis - other causes

A

hep B
hep C
drug induced hepatitis

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23
Q

describe primary biliary cirrhosis

A

rare autoimmune disease

unknown aetiology - associated with autoantibodies to mitochondria

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24
Q

epidemiology of primary biliary cirrhosis

A

female

25
Q

pathology of primary biliary cirrhosis

A

granulomas

bile duct loss

26
Q

out come of primary biliary cirrhosis

A

unpredictable

27
Q

when would a biopsy be indicated for primary biliary cirrhosis

A

staging the disease

28
Q

microscopy of primary biliary cirrhosis

A

chronic portal inflammation
bile ducts inflamed
granuloma around duct

29
Q

outcomes of primary biliary cirrhosis

A

if untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis and cirrhosis

30
Q

epidemiology of autoimmune hepatitis

A

females

31
Q

pathology of autoimmune hepatitis

A

chronic hepatitis pattern
numerous plasma cells
autoantibodies to smooth muscle, nuclear or LKM, raised IgG

32
Q

epidemiology of autoimmune hepatitis

A

associated with other autoimmune diseases

may have triggers - including some drugs

33
Q

describe chronic drug-induced hepatitis

A

similar features to all other types of chronic hepatitis - chronic active process
may trigger autoimmune hepatitis

34
Q

describe the effects of drugs on the liver

A

innumerable drugs can damage liver - may be dose related or idiosyncratic
can mimic any liver disease

35
Q

outcomes of drugs on the liver

A 
hepatitis 
granulomas 
fibrosis 
necrosis 
failure
cholestasis 
cirrhosis
36
Q

pathology of primary sclerosis cholangitis

A

chronic inflammatory process affecting intra and extra hepatic bile ducts

37
Q

outcomes of primary sclerosis cholangitis

A

periductal fibrosis
duct destruction
jaundice
fibrosis

increased risk of malignancy in bile ducts and colon

38
Q

epidemiology of primary sclerosis cholangitis

A

males

39
Q

aetiology of primary sclerosis cholangitis

A

associated with ulcerative colitis

40
Q

microscopy of primary sclerosis cholangitis

A

peridcutal onion-skinning fibrosis

41
Q

storage diseases of the liver

A

haemochromatosis
Wilsons disease
alpha-1-antitrypsin deficiency

42
Q

what is haemochromatosis

A

excess iron within the liver

can be primary or secondary

43
Q

primary haemochromatosis

A

genetic condition - inherited autosomal recessive condition (worse in homozygotes, men)
increased absorption of iron

44
Q

secondary haemochromatosis

A

iron overload from diet
transfusion
iron therapy

45
Q

pathology of primary haemochromatosis

A

excess absorption of iron from intestine
abnormal iron metabolism
iron deposited in liver - asymptomatic for years -deposited in portal connective tissue and stimulates fibrosis

46
Q

outcomes of primary haemochromatosis

A 
untreated - fibrosis and cirrhosis 
predisposes to hepatocellular carcinoma 
diabetes 
cardiac failure
impotence
47
Q

microscopy of haemochromatosis

A

iron accumulates in hepatocytes - confirmed by Perls stain

48
Q

what is Wilson’s disease

A

inherited autosmal recessive disorder of copper metabolism

49
Q

pathology of Wilson’s disease

A

copper accumulates in liver and brain (basal ganglia)
Kasyer-Fleischer rings at corneal limbus
low serum caeruloplasmin

50
Q

outcomes of Wilson’s disease

A

chronic hepatitis

neurological deterioration

51
Q

describe alpha-1-antitrypsin deficiency

A

inherited autosomal recessive disorder of production of an enzyme inhibitor

52
Q

outcomes of alpha-1-antitrypsin deficiency

A

emphysema

cirrhosis

53
Q

pathology of alpha-1-antitrypsin deficiency

A

cytoplasmic globes of unsecreted globules of protein in liver cells

54
Q

primary tumours of the liver

A

rare;
hepatocellular adenoma
hepatocellular carcinoma (hepatoma)

55
Q

secondary tumours of the liver

A

common;
mutliple
metastases from colon, pancreas, stomach, breast, lung…

56
Q

describe hepatoceullar adenoma

A

bengin
seen mostly in females
may become large - rupture or bleed
may remain asymptomatic

57
Q

describe hepatocellular carcinoma

A

advanced unless discovered accidentally - poor prognosis

associated with HBV, HCV and cirrhosis

58
Q

symptoms and signs of hepatocellular carcinoma

A

mass
apin
obstruction

59
Q

microscopy of hepatocelllar carcinoma

A

multifocal (rare)
hepatocytic
cholangio-

Gastrointestinal (71 decks)

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