Pathology & Virology of Hepatitis & Liver CA

Question 1

Acute Hepatitis

Answer 1

1. Active hepatocellular damage & necrosis
2. infrequently biopsied b/c diagnosis is usually made by clinical/lab data
3. Histology: lobular disarray & hepatocyte necrossi of variable severity, regenerative features
4. Usually of short and/or self-limited duration

Question 2

Chronic hepatitis

Answer 2

Persistent, often a progressive inflammatory process w/ elevated transaminases of >6 mo duration

Histo: portal tract-based chronic inflammation, generally milder lobular activity

Chronicity judged by: clinical, lab, morphology

Question 3

Hepatitis Etiology

Answer 3

Viral
Autoimmune: T-cell mediated liver injury in genetically susceptible individuals, assoc w/ circulating autoantibodies
Drug-associated

Question 4

Viral Hepatitis

Answer 4

1. Hepa viruses (A/B/C/D/E)
2. EBV, CMV, HSV, adenoviruses

Question 5

Autoimmune Hepatitis

Answer 5

T-cell mediated liver injury in genetically susceptible individuals, assoc w/ circulating autoantibodies

Question 6

Drug-associated

Answer 6

1.Necroinflammatory: acetaminophen, phenytoin, sulphonamides

2. Cholestatic: abx, steroids

3.Granulomatous: allopurinol, abx, phenytoin

4. Autoimmune hepatitis-like syndrome: minocycline, nitrofurantoin, infliximab

Question 7

Hepatitis Symptoms

Answer 7

Many asymptomatic

Constitutional sx: fever, fatigue, malaise

Jaundice: signs & sx of liver failure

Nausea, anorexia, abd pain

Question 8

Hepatitis Lab findings

Answer 8

Elevated transaminases

Alkaline phosphatase may be mildly elevated

Viral serologies + in viral hep; autoimmune serologies + in autoimmune hep

Urinary copper, ceruloplasmin, a1-antitrypsin → may be helpful

Question 9

Hep B Micro

Answer 9

Ground-glass hepatocytes

Question 10

Hepatitis C
Sx

Answer 10

85% asymptomatic
-fatigue, nausea, anorexia, depression
-Scleral icterus (d/t hyperbilirubinemia)
-Persistent infection & chronic hepatitis

Question 11

Hep C

Extrahepatic manifestions

Answer 11

-Mixed cryoglobulinemia: systemic vasculitis d/t deposition of immune complexes in microvasculature

-Skin → leukocytoclastic vasculitis

-Nervous system: mononeuritis multiplex

-Kidney: membranoproliferative glomerulonephritis

-Non-Hodgkin B-cell lymphoma

Question 12

Risk of Hep C

Answer 12

Cirrhosis higher in men, older people, alcoholics, infected with HIV or HBV

Question 13

Classification of
Hep C

Answer 13

Acute infection subclinical; fulminant rare
Persistent (chronic) infection in 85% of persons → failure to clear virus w/in 6 mo

Question 14

Histology of Hep C

Answer 14

Dense portal based predominant infiltrates
Periportal interface activity → lymphocytes disrupt limiting plate & surround nearby lymphocytes → hepatocyte injury/necrosis

Mild bile duct injury +/- lymphocytic infiltrate (Poulsen lesions)

Question 15

Lab Tests of Hep C

Answer 15

anti-HCV antibodies → indicate exposure

HCV RNA → indicates virus persistence
–> Need close clinical follow-up

Normal transaminases → risk for developing permanent liver damage

Question 16

Genetics of Hep C

Answer 16

HCV genotype 3 –> strong assoc w/ metabolic syndrome

Can give rise to insulin resistance & nonalcoholic fatty liver disease

Question 17

Prognosis Hep C

Answer 17

Progressive disease, usually slow (decades) & clinically silent–> cirrhosis & liver failure

Risk of HCC (in background of cirrhosis)

Question 18

Ddx of Hep C

Answer 18

1. HepB serologic testing, +/- ground glass hepatocytes