Viral and Non-viral Liver Disease Flashcards
Cirrhosis
Scarred liver
End point to many chronic liver diseases
Compensated:
Functional
Decompensated:
Failing functions
-diffuse fibrous septation that divides liver parenchyma into nodules
Result of chronic recurring death of hepatocytes, deposition of extracellular matrix, and architectural and vascular reorganization
Liver has high
functional reserve and regenerative capacity
Liver functions
Lipid, carb, prot metab Coagulation factor produc Detox stores vit/glycogen Reticuloendothelial system Bile processing and secretion Albumin production
Bile flows in ___ direction of blood in liver
opposite
Portal tracts/triads
PV
HA
BD
Acute vs chronic injury
acute injury usually resolves
Chronic injury–> cirrhosis (scarred down)–> liver failure
Liver failure signs/sx
Jaundice (bilirubin buildup in tissues)
Ascites, peripheral edema (from hypoalbuminemia)
smell (sulfur metabolites)
spider angiomata (estrogen problem)
Palmar erythema
Hypogonadism and gynecomastia in men
Coagulapathy
Encephalopathy (derangements in consciousness, accum of ammonia in blood)
Hepatorenal syndrome (vascular perfusion abnormalities)
gross failed liver
Massive necrosis (death of most of liver: gray; yellow/green is alive)
**Cirrhosis: nodular, shrunken, scarred liver
Dysfunction without cirrhosis or necrosis (looks normal)
Cirrhotic liver gross
septation
parenchymal nodularity
Portal hypertension
Increase blood pressure in portal system
Result of vascular reorganization in liver
Increase in sinusoidal pressure (increased vascular resistance)
- abnormal portal- systemic shunts (large connections) Ex: esophageal varices; hemorrhoids; periumbilical caput medusae
- hepatic encephalopathy,
Jaundice and cholestasis
Bilirubin production > Bilirubin clearance
Excessive extrahepatic bilirubin production Reduced hepatocyte uptake Impaired conjugation Decreased hepatocellular excretion Impaired bile flow**
Most common chronic liver diseases in US adults
Viral hepatitis C Alcohol induced liver disease Non-alc fatty liver disease Viral hep B Other
Hepatitis
Necroinflammatory injury to hepatocytes
Inflammatory injury and death of hepatocytes
etiologies: Steatohepatitities: (Alcohol or not) Viral Common cause of chronic liver disease
Hepatitis on histology
swelling/degen apoptosis/lobular apo/interface bridging necrosis geographic coagulative necrosis
**look @ pics
Inflammation in hepatitis
Lymphocytes – many hepatitides; common in viral
Neutrophils – common in steatohepatitis (assoc w/ fat)
Eosinophils – common in drug injury
Plasma cells – common in autoimmune hepatitis
Acute hepatitis
New onset (
Chronic hepatitis
Long-standing, on-going hepatocyte injury and inflammation (>6 months)
Common causes: chronic viral hepatitis, autoimmune hepatitis, drug injury
Microscopic findings: less prominent inflammation and injury, preponderance of portal tract-based inflammation, fibrosis; looks “less severe” than acute; Spotty
General features of liver injury
Cytoplasmic accumulations
Degeneration, necrosis, and apoptosis
Inflammation
Regeneration, fibrosis, and cirrhosis
Cytoplasmic accumulation
*may be cause of disease or just seen due to disease
Fat – Steatosis
Bile – Cholestasis
Iron – Hemosiderosis/ genetic hemochromatosis
Copper – Wilson Disease / chronic cholestasis
Viral particles – Viral hepatitis
Histology of viral inclusion
“ground glass inclusion”
-cells filled with virions
Regeneration and fibrosis
- cycles of inj/regen
- activated stellate cells deposit collagen
- architectural and vascular reorganization
- leads to cirrhosis
Fibrosis histology
type I collagen (blue) (normally just in portal tract)
- lines wrapping around hepatocytes
- pericellular fibrosis
Portal fibrosis: larger, rounder portal tracts
Periportal fibrosis: stellate appearance of portal tracts
bridging fibrosis: connections of collagen (portal tract to tract or to central v.)
well defined septa w/ nodules: cirrhosis
what can you use to track chronic hepatitis?
biopsy surveillance (serial liver biopsies)
grade: amount of inflammation and injury
“Stage” = amount of fibrous tissue deposition
viral hepatitides
Hepatotropic viruses = hepatocyte is primary target
Hepatitis C Hepatitis B Hepatitis D Hepatitis A Hepatitis E
Other viruses also uncommonly cause hepatitis