Patterns of Liver Injury 1 - Acute Hepatitis Flashcards
What is the key clinical feature of acute hepatitis?
Jaundice
What is the key liver enzyme test of acute hepatitis?
ALT
What is the clinical definition of acute hepatitis?
A significant elevation of ALT of less than 6 months duration in a patient with no history of liver disease
Why is ALT increased in acute hepatitis?
Because ALT is in the cytosol of hepatitis and is released with injury and death of hepatocytes
What causes the jaundice in acute hepatitis?
Liver cells swelling blocking the bile flow
What are the 3 patterns of acute hepatitis?
Acute viral hepatitis, zonal coagulative necrosis and acute alcoholic hepatitis
What are the features of acute viral hepatitis?
lobular disarray and apoptosis
What is lobular disarray?
Liver cells are not in an orderly arrangement, sinusoids compressed, hepatocytes are swollen, infiltrate surround the swollen hepatocytes - due to cell mediated immune function and ATP depletion
What immune cells are seen in acute viral hepatitis?
T cell lymphocytes- not neutrophils
What are councilman bodies?
Apoptotic bodies in the liver - shrunken cell with condensed cytoplasm and nuclear fragmentation
What causes zonal coagulative necrosis?
Liver toxins such as paracetamol and poisonous mushrooms
How is paracetamol toxic to the liver?
Forms a toxic metabolite which causes depletion of glutathione which leads to oxidative injury
Where do you see the coagulative necrosis?
In zone 3 of the acinar lobar model
What inflammatory cells are seen in zonal coagulative necrosis?
none
What are the features of acute alcoholic hepatitis?
fat vacuoles, neutrophils, hepatocellular ballooning, mallory bodies, fibrous tissue around the central vein
