Pathology of the liver II Flashcards
what are the DNAs of the hepatitis viruses? what is the exception?
ssRNA
exception - hepatitis B - dsDNA
which hepatitis viruses will present asymptomatically with recovery and serological evidence only?
A, B, C, D co, E
which hepatitis viruses will present symptomatically with recovery and serological evidence only?
A, B, C, D co, E
which hepatitis viruses will present as chronic hepatitis with or without progression to cirrhosis?
B, C mostly, D superinfection
which hepatitis viruses will present as fulminant hepatitis with massive to submassive hepatic necrosis?
D co and super, E pregnant
what is the most common form of viral hepatitis?
A
what is the transmission for hepatitis A?
fecal oral
is there a carrier or chronic state for hepatitis A?
no
which hepatitis virus is the most common cause of cirrhosis ad hepatocarcinoma worldwide?
hepatitis B
what are the transmission routes for hepatitis B?
parenteral
sexual
vertical
what is the immunopathogenesis of chronic hepatitis B?
CD4 T cells
CD8 T cells
CD8 cytotoxic cells kill hepatocytes
what are the extrahepatic mainfestations of HBV?
glumerulonephritis - children
polyarteritis nodosa - adults
what is required for HDV to replicate?
HBsAg
what is superinfection?
surface carrier for hepatitis B
IgG forms to B, then IgM forms to D
what is the most common chronic liver disease?
hepatitis C
what are the transmission routes for hepatitis C?
parenteral
sexual
vertical
what are the extrahepatic manifestations of hepatitis C?
cryoglobulinemia
thyroiditis
glomerulonephritis
thrombocytopenia
when does ALT peak for hepatitis E infection?
5-7 weeks
when are symptoms seen in hepatitis E infection? with what serum markers do they correlate?
5-8 weeks
ALT, IgM anti HEV, IgG anti HEV
hepatitis E is usually a benign condition unless you are in which demographic?
pregnant
what test is used to evaluate for viral hepatitis?
liver biopsy
what is a councilman body?
apoptotic hepatocytes (acidophilic)
in which condition are councilman bodies seen?
acute viral hepatitis
piecemeal necrosis is seen in what type of hepatitis?
chronic
ground glass hepatocytes are seen in what type of hepatitis? why?
B
loaded with viral particles and surface antigens
lymphoid aggregates are seen in what type of hepatitis?
C
viral hepatitis cirrhosis is what type of cirrhosis?
macronodular
what are the immunologic diseases affecting the liver?
primary biliary cirrhosis
primary sclerosing cholangitis
autoimmune hepatitis
primary biliary cirrhosis is characterized by what features?
granulomas affecting smaller bile ducts in portal tract
primary biliary cirrhosis is positive for what liver antibody?
antimitochondrial
presence of antimitochondrial antibodies indicates infection of what disorder?
primary biliary cirrhosis
what is the presentation for primary biliary cirrhosis?
female fatigue itching jaundice steatorrhea osteomalacia xanthomas
what are the lab values for primary biliary cirrhosis?
increased
AMA anti-M2 IgM 5-NT / GGT cholesterol
what will be seen histologically in primary biliary cirrhosis?
macrophages and granulomas (multinucleated giant cells)
what characterizes phase 2 of primary biliary cirrhosis?
cholestasis
primary sclerosing cholangitis is associated with what IBD?
ulcerative colitis
what is the presentation for primary sclerosing cholangitis?
male
itching
weight loss
abdominal pain
what are the lab values seen in primary sclerosing cholangitis?
increased
AP GGT 5-NT ALT/AST ANA, anti-SMAb pANCA
what test is used to evaluate for primary sclerosing cholangitis?
endoscopic retrograde cholangiography (ERCP)
primary sclerosing cholangitis patients are more at risk for development of what type of cancer?
cholangiocarcinoma
what is autoimmune hepatitis?
patient’s own immune systems attacks liver causing inflammation and liver cell death
which antibodies are seen in autoimmune hepatitis?
anti-LKM1, IgG
