Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal 1 > Pathology of Hepatitis > Flashcards

Pathology of Hepatitis Flashcards

1
Q

What is viral hepatitis?

A
  • inflammation (lymphocytes destroy antigen-expressing hepatocytes; remember Kupfer cells are the macrophages of the liver, which will engulf injured cells) of the liver parenchyma, usually due to hepatitis virus or EBV or CMV.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does hepatitis cause?

A
  • acute hepatitis, which may progress to chronic hepatitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do patients with ACUTE hepatitis present?

A
  • with jaundice (mixed CB and UCB) with DARK URINE (due to CB), fever, malaise, nausea, and elevated LFTs (ALT > AST).
  • symptoms usually last less than 6 months.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What specific areas does inflammation occur in ACUTE hepatitis?

A
  • LOBULES of the liver and PORTAL TRACTS, and is characterized by apoptosis (pyknosis= shrunken nucleus; remember caspase involvement also) of hepatocytes (via CD8 cytotoxic T cells).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is CHRONIC hepatitis characterized?

A
  • by symptoms that last > 6 months.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What specific area does inflammation occur in CHRONIC hepatitis?

A
  • predominantly PORTAL TRACT.

* risk of progression to cirrhosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are hepatitis A (HAV) and hepatitis E (HEV) viruses transmitted?

A
  • fecal-oral transmission
  • HAV= via travelers
  • HEV= contaminated water or undercooked seafood.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is similar between HAV and HEV?

A
  • both cause ACUTE hepatitis only (no chronic state).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What marks active infection and what marks prior infection (or immunization) in both HAV and HEV, respectively?

A
  • anti-virus IgM= ACTIVE infection
  • anti-virus IgG= PRIOR infection (or immunization).
  • NOTE immunization is only available for HAV.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

** With what is HEV infection associated in pregnant women?

A
  • fulminant hepatitis= liver failure with massive liver necrosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is hepatitis B (HBV) transmitted?

A
  • parenterally (childbirth, unprotected intercourse, IVDU, and needle stick).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what does HBV result?

A
  • ACUTE hepatitis and sometimes CHRONIC hepatitis (20%).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 possible stages of HBV?

A
  1. Acute
  2. Window
  3. Resolved
  4. Chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

** What is the first KEY marker of HBV infection?

A

Hepatitis B surface antigen (HBsAG)= first serological marker to arise (1 week-2 months after exposure) during the ACUTE phase.
*This will disappear during the window and resolved periods (convalescent stage) of the infection, but will reappear if infection lasts longer than 6 months!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

** What is the KEY immunoglobulin against the acute marker for HBV infection?

A
  • IgM against the CORE (HBcAB= hepatitis B core antibody).

* It will actually knock out the virus (creating the window phase) and IgM is the only thing present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What will be the only marker present during the resolved phase of HBV infection?

A

IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the sign of victory against HBV infection?

A

presence of IgG against the SURFACE antigen (HBsAB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What specific marker indicates infection of HBV?

A 
ENVELOPE antigen (HBeAG) and the important point here is that whenever it is present, it means it can be transmitted!
*remember if you want to MAIL a letter to a friend, you need an ENVELOPE (thus transmitted).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Will the HBeAG (envelope antigen) be present during the window and resolved phases?

A

NO

20
Q

How is hepatitis C (HCV) transmitted?

A
  • parenterally
21
Q

In what does HCV result?

A
  • ACUTE hepatitis and CHRONIC disease occurs in MOST cases (look for MACROnodular changes and fibrosis).
22
Q

What test confirms infection of HCV?

A
  • HCV-RNA

* thus decreased RNA levels indicate recovery

23
Q

What is important to know about hepatitis D (HDV) infection?

A
  • it cannot infect by itself. Rather it is dependent on HBV (HBsAG) for infection.
  • This can occur by a patient already having prior-HBV infection and then getting HDV infection on top of that (superinfection), or pt gets both HBV and HDV at the same time (co-infection)..
24
Q

*** Is superinfection of HDV upon a pre-existing HBV infection more or less severe than a co-infection of HBV and HDV at the same time?

A

MORE SEVERE

25
Q

What will you see as a result of extracellular insult, due to degeneration and intracellular accumulation of the liver?

A
  • hepatocyte swelling (remember this is a sign of reversible cell damage).
  • ballooning degeneration
  • feathery degeneration: cholestasis, swollen foamy hepatocytes.
  • steatosis: microvesicular, macrovesicular
  • iron and/or copper accumulation
26
Q

What type of necrosis can the liver undergo?

A
  • coagulative necrosis (from ischemia)
  • lytic necrosis= cells swell, rupture, leave debris
  • focal necrosis
  • interface necrosis= between periportal parenchyma and portal tracts.
  • bridging necrosis= portal-portal, portal-central, central-central.
27
Q

Is HBsAg immunogenic but NOT infectious?

A

YES and is the basis for vaccination

28
Q

How is HBV associated with hepatocellular carcinoma?

A

X gene activates viral transcription

29
Q

What is the pathogenesis of HBV?

A

Not directly cytopathic.

- CD8 T cells recognize HLA molecules and viral antigens on the surface of infected hepatocytes.

30
Q

If you get FULMINANT hepatitis (rare; think hepatic encephalopathy) what virus usually causes it?

A

HBV

*mortality can be high :(

31
Q

Do most patients with acute HBV have self limited disease with lifelong immunity?

A

YES, but the virus has a long incubation period (up to 6 months) before pt becomes symptomatic. Meaning they can shed the virus for 6 months.

32
Q

Does the core antigen of hep B (HBcAg) circulate in the serum of pts with acute hepatitis?

A

NO, but anti-HBcAg (IgM) will appear after the surface antigen (HBsAg)

33
Q

What does HBcAg presence mean?

A
  • marker of previous infection
34
Q

When does HBV-DNA and DNA polymerase appear?

A
  • soon after HBsAg (SURFACE antigen).

* signfies active viral replication.

35
Q

What does the cytoplasm of infected hepatocytes with HBsAg look like?

A

ground glass appearance with sanded nuclei

36
Q

Will you see HBsAB (antibody against the SURFACE antigen) in CHRONIC HBV?

A

NO. Most concerning of the hepatitis viruses.

37
Q

** With what is CHRONIC HBV associated? (BOARD QUESTION)

A 
polyarteritis nodosa (vasculitis of medium-sized arteries).
*Or if a pt has polyarteritis nodosa, they are likely a carrier of HBV!
38
Q

Can some pts with HBV develop antibodies over years and clear the virus?

A

YES :)
*some pts however will never produce antibodies and suffer from relentless chronic hepatitis, which can progress to cirrhosis and hepatocellular carcinoma.

39
Q

Is the entire genome of HBV integrated into the host cells?

A

NO, but fragments of it may be integrated leading to production of antigens.

40
Q

Is there currently a vaccine for HCV?

A

NO (too many strains), but there are good treatments available.

41
Q

Can HCV IgG clear the infection?

A

NO

42
Q

With what is HCV sometimes associated?

A
  • lymphoma
  • MPGN
  • Sicca syndrome
  • porphyria cutanea tarda
43
Q

With what hepatitis virus will you likely see fatty changes in the liver?

A

HBV and HCV (more common)

44
Q

Is the clinical course of viral hepatitis variable?

A

YES

45
Q

What is autoimmune hepatitis?

A
  • autoantibodies against hepatocytes with no serological markers of virus.
  • increased HLA B8 or HLA DRw3
  • resembles viral hepatitis histologically, but inflammation is rich in PLASMA CELLS.
46
Q

What are the 2 types of autoimmune hepatitis?

A
  • type I= most common, females under forty and 25% develop cirrhosis.
  • type II= children, target autoantigen is CYP2D6, and most have T1DM and thyroiditis.

Gastrointestinal 1 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions