Patterns of Chronic Hepatitis Flashcards
What symptoms and signs are seen in patients with chronic hepatitis?
Jaundice Hepatosplenomegaly Ascites Caput medusae Spider naevi Palmar erythaema Gynaecomastia Dupuytren's contractures
What is the clinical definition of chronic hepatitis?
Persistence of liver injury with raised serum aminotransferase for >6 months
What are the characteristic histological features of chronic hepatitis?
Interface hepatitis: apoptosis of hepatocytes at the interface between portal tracts and lobular parenchyma associated with lymphoplasmacytic inflammation (i.e. periportal inflammation)
Ground glass hepatocyte
How is chronic hepatitis graded?
Degree of interface hepatitis
How is chronic hepatitis staged?
Degree of fibrosis
What are the different stages of chronic hepatitis?
1: enlarged portal tracts (increased collagen)
2: septa
3: septa with portal-to-portal bridging
4: cirrhosis (networks of nodules separated by bands of fibrous CT)
Distinguish between the histological features of acute and chronic hepatitis
Acute: apoptosis, lobular disarray, inflammation of entire lobule and portal tracts
Chronic: apoptosis, portal/periportal inflammation, fibrosis
What Abs are present in AI hepatitis?
Anti-nuclear
Anti-smooth muscle
Liver-kidney microsomal Abs
What are the characteristics of NAFLD?
Steatosis +/- steatohepatitis and fibrosis
What causes NAFLD?
Metabolic syndrome
Drugs and chemicals
How are ASH and NASH distinguished?
On clinical basis only
What is steatosis? What is the most common type?
Accumulation of abnormal amounts of lipid in hepatocytes
Macrovesicular
What is the histological hallmark of steatohepatitis?
Hepatocellular ballooning degeneration
How is macrovesicular steatosis distinguished from NASH?
Macrovesicular: minimal inflammation and hepatocellular ballooning, minimal fibrosis
NASH: inflammation, hepatocellular ballooning, may be Mallory bodies, fibrosis and risk of progression to cirrhosis
