Pathology of the liver 2 Flashcards
Common causes of viral hepatitis
Hep A
Hep B
Hep C
Hep E
Rare causes of viral hepatitis
Delta agent Ebstein-Barr virus Yellow fever virus Herpes simplex virus Cytomegalovirus
Summary of Hep A
faecal oral spread short incubation period sporadic or endemic directly cytopathic no carrier state mild illness, usually full recovery
How is Hep B spread
Blood, sexually, vertically Long incubation period carriers exist outcome is variable increases risk of carcinoma
Outcomes of Hep B infection
Acute hepatitis with resolution
Acute hepatitis with liver failure
Chronic hepatitis
Asymptomatic carrier
Types of chronic hep
Non-progressive-stays the same but doesn’t go away
Progressive - gets worse until cirrhosis develops
How is Hep C spread
blood, sexually, virtically
What doesn’t Hep C have a vaccine
Does not have a constant antigen and can exist in many forms
Hep C has a long incubation period true/false
False
Short
Hep C tends to become chronic true/false
true
What does acute hep look like
ballooning degeneration -slightly clear cytoplasms
Chronic Inflammatory cells - mainly lymphocytes
Inflam cells infiltrate the portal triad
globular inflammation
What does cirrhosis look like
Scarring between the portal triads splitting up the hepatocytes and isolating them from each other and vasculature
What are the two types of cirrhosis
macro >3mm
micro <3 mm
Outcomes of hep c
chronic hep
cirrhosis
Other causes of chronic hepatitis (not viral)
Primary biliary cirrhosis
Autoimmune hepatitis
Drug induced hepatitis
Primary Sclerosing cholangitis
What is primary biliary cirrhosis
Rare autoimmune disease- unknown aetiology
mainly females affected
associated with auto antibodies to mitochondria
What does PBC look like histologically
Granulomas
Bile duct loss
Granuloma around bile duct while lymphocytes attack bile duct
What is the outcome of PBC
unpredictable
What is the definition of a granuloma
A collection of histocytes surrounded by lymphocytes
If untreated what does PBC lead to
Cholestatis (reduction of bile flow) liver injury inflammation fibrosis cirrhosis
What is autoimmune hepatitis
Autoimmune disease common in females Associated with other AI diseases Autoantibodies to smooth muscle raised IgG May have triggers including drugs
What is drug induced hepatitis
similar features to all other types of chronic hep
may trigger autoimmune hep
chronic adverse process
too many causes to list
Is drug induce hep always dose related
No
sometimes idiosyncratic
What is primary sclerosis cholangitis
chronic inflammation affecting intra and extra hepatic bile ducts
Leads to duct destruction, jaundice and fibrosis
Primary sclerosis cholangitis is more common in males true/false
True
What other GI condition is primary sclerosisng cholangitis associated with
Ulcerative colitis
PSC increases/decreases risk of malignancy in liver/bile ducts
Increases
Bile ducts
What are the main storage diseases
Haemochromatosis
Wilson’s disease
Alpha-1-antitripsin deficiency
What is haemochromatosis
Excess iron in the liver
What is the difference between primary and secondary haemochromatosis
Primary - genetic condition, increases absorption of iron
Secondary- iron overload from diet, transfusions, iron therapy
Describe primary haemochromatosis
Inherited autosomal recessive condition
Gene defect
Excess iron absorption from intestine
Worse in homozygotes, men
Primary haemochromatosis gives a variety of symptoms
False, asymptomatic for years
Where is iron eventually deposited in primary haemochromatosis
Portal connective tissue
this stimulated fibrosis
What happens if primary haemochromatosis is not treated
Cirrhosis
Predisposed to carcinoma
Causes diabetes, cardiac failure, and impotence
How is iron confirmed to have accumulated in hepatocytes
Perls stain
What is Wilsons disease
Inherited autosomal recessive disorder of copper metabolism
Copper accumulates in liver and brain
What does Wilson’s disease cause
chronic hep
neurological deterioration
Sign of Wilsons disease
Kayser-Fleischer rings at corneal limbus
What is alpha 1- antitrypsin deficiency
inherited autosomal recessive disorder of production of an enzyme inhibitor
What does alpha 1- antitrypsin deficiency cause
emphysema
cirrhosis
What are the primary (rare) liver tumours
Hepatocellular adenoma
Hepatocellular carcinoma
What are the secondary (common) liver tumours
Multiple
metastases from colon, pancreas, stomach, breast, lung, others
What is a hepatocellular adenoma
Benign Females get it May become large- can rupture or bleed Most remain assymptomatic Poor prognosis
What is a hepatocellular carcinoma
Rare in Europe
Associated with HBV, HVC, and cirrhosis
How does hepatocellular carcinoma present
Mass
Pain
obstruction
usually advanced unless discovered incidentally
