Viral and Non-Viral Liver Disease

Question 1

The liver has a high _____________ reserve.

Answer 1

functional (meaning that you have to destroy a large proportion of the liver to see functional deficits)

Question 2

What does the story of Prometheus reveal?

Answer 2

That the liver has a good regenerative capacity –his liver was destroyed every morning by a bird, but always regrew before the next day

Question 3

The lobules are divided into three zones. Which is closest to the central vein?

Answer 3

3 (think of C as the third letter in the alphabet)

Question 4

What are some clinical signs of liver failure?

Answer 4

• Icterus, both scleral and otherwise
• Spider telangiectasia
• Palmar erythema
• Coagulopathy (and related signs)
• Ascites
• Gynecomastia

Question 5

What pathologic appearance does cirrhosis present with?

Answer 5

Fibrotic scarring with regenerative nodules separated by fibrous septation

Question 6

After massive necrosis, the ___________ areas are alive and the ____________ areas are dead.

Answer 6

yellow; gray/brown

Question 7

Cirrhosis of the liver leads to _____________.

Answer 7

portal hypertension

Question 8

Why does liver disease lead to splenomegaly?

Answer 8

Portal hypertension leads to blood congestion in the spleen.

Question 9

The most common cause of chronic liver disease in the U.S. is _______________.

Answer 9

Viral hepatitis C (more than half)

Alcohol-induced liver disease is second (at roughly 1/3)

Question 10

There are four different leukocytes that can be found in a liver with hepatitis. List them and give the type of disease in which they are most commonly found.

Answer 10

• Lymphocytes: viral
• Neutrophils: steatohepatitis
• Plasma cells: autoimmune hepatitis
• Eosinophils: drug reactions

Question 11

Describe the histologic presentations of acute and chronic hepatitis.

Answer 11

Acute: widespread lobular disarray

Chronic: patchy necrosis and fibrosis

Question 12

What time frame is associated with chronic and acute hepatitis?

Answer 12

Less than 6 months = acute

Greater than 6 months = chronic

Question 13

What is steatosis?

Answer 13

Fat accumulation in hepatocytes

Question 14

Cholestasis is ____________.

Answer 14

bile accumulation in hepatocytes

Question 15

What liver pathology presents with ground-glass inclusions?

Answer 15

Viral infection

Question 16

What overall pattern can you notice in the progression of fibrosis?

Answer 16

Fibrosis (that is, collagen deposition) proceeds from a basic circular stage to bridging, with the “islands of regeneration” being the final state.

Question 17

How are grades and stages different in terms of liver diagnosis?

Answer 17

Grade: amount of inflammation and injury
Stage: amount of fibrosis

Question 18

All of the hepatitis viruses are _______ viruses with the exception of _________.

Answer 18

RNA; HBV, which is DNA

Question 19

Give the method of transmission for each of the hepatitis viruses.

Answer 19

A and E: fecal-oral
B, C, and D: parenteral (B can also be transmitted sexually)

Think of this: A and E are on the opposite ends of the alphabetically arranged list, just like the mouth and butt are on the opposite ends of the body.

Question 20

True or false: all of the hepatitis viruses can cause chronic liver disease.

Answer 20

False. A and E never cause chronic liver disease.

Question 21

Which hepatitis strain most frequently causes chronic liver disease?

Answer 21

C

Question 22

Multiple things increase risk for HCV: _______________.

Answer 22

IV drug use, promiscuity, and recent surgery

Question 23

Chronic hepatitis presents with ________ aggregates.

Answer 23

lymphoid

Question 24

Which hepatitis has the most likelihood to increase risk for hepatocellular carcinoma?

Answer 24

B, because it is a DNA virus and can integrate into the genome

Question 25

______________ is completely dependent on hepatitis B for replication.

Answer 25

Hepatitis D

It also potentiates the effects of HBV, leading to greater hepatic damage.

Question 26

_____________ and ____________ cause acute hepatitis only.

Answer 26

Hepatitis A; hepatitis E

Question 27

Autoimmune hepatitis presents with what autoantibodies?

Answer 27

ANA, ASMA, anti-LKMB

Question 28

Anti-mitochondrial antibodies are present in what autoimmune disease?

Answer 28

Primary biliary cirrhosis

Question 29

What specific structure is attacked in primary biliary cirrhosis?

Answer 29

Intrahepatic small-caliber bile ducts

Question 30

Uniquely, __________ are more commonly affected by primary sclerosing cholangitis.

Answer 30

men

Question 31

Primary sclerosing cholangitis mainly affects the ____________ bile ducts.

Answer 31

larger caliber

Question 32

What disorder presents with periductal onion-skin fibrosis?

Answer 32

Primary sclerosing cholangitis; this can ultimately turn into fibrous obliteration.

Question 33

True or false: the liver normally has fat deposition along the bile duct epithelium.

Answer 33

False. Healthy livers do not store fat.

Question 34

What can cause steatohepatitis?

Answer 34

Alcohol abuse
Metabolic syndrome
Drug injury

Question 35

Wilson disease results from _______________ and presents with ______________.

Answer 35

autosomal recessive defect in the ATP7B protein, which pumps copper into the bile duct; psychiatric and liver dysfunction

Question 36

There are two main alleles for the alpha-1 antitrypsin gene: PiZZ and PiMM. Which is the harmful one?

Answer 36

PiZZ

Question 37

Most adenomas have a non-negligible risk of transitioning to adenocarcinoma. _____________ is unique in this regard, because it carries an extremely low risk of transition.

Answer 37

Hepatocellular adenoma

Question 38

Bile can accumulate in which parts of the liver?

Answer 38

Hepatocytes
Bile canaliculi
Bile ducts
Kupffer cells

Question 39

Cytoplasmic bile leads to what kind of cell death?

Answer 39

Ballooning degeneration

Question 40

Hepatocyte disarray with infiltrate, but without fibrosis is characteristic of _____________.

Answer 40

acute viral hepatitis

Question 41

The staging of liver fibrosis goes from ______ to ________.

Answer 41

0 (no fibrosis) to 4 (cirrhosis)

Question 42

Elevated IgG indicates ____________.

Answer 42

autoimmune hepatitis

Question 43

The histology of autoimmune hepatitis is almost indistinguishable from ___________.

Answer 43

viral hepatitis

Question 44

Often ______________ is the only sign or symptom of primary sclerosing cholangitis.

Answer 44

elevated alkaline phosphatase

Question 45

What disease should you think of when you hear “onion-skin fibrosis”?

Answer 45

Primary sclerosing cholangitis

Question 46

Excess acetaminophen causes ___________ necrosis.

Answer 46

coagulative

Question 47

Chicken-wire fibrosis is a characteristic of ______________.

Answer 47

steatohepatitis

Question 48

What is the triad of steatohepatitis findings?

Answer 48

Lobular inflammation
Ballooning degeneration
Steatosis

Question 49

HFE is found on chromosome ____.

Answer 49

6 (you need two copies knocked out: HFE + HFE = six letters)

Question 50

Histologically, how can you differentiate between primary and secondary hemochromatosis?

Answer 50

In primary hemochromatosis, the iron accumulates in hepatocytes, while in secondary hemochromatosis, the iron accumulates in Kupffer cells.

Question 51

True or false: the majority of people with alpha-1-antitrypsin deficiency have liver disease.

Answer 51

False. Only about 10%

Question 52

______________ is usually asymptomatic and is thought to arise from a vascular anomaly.

Answer 52

Focal nodular hyperplasia

Question 53

Chronic hepatitis leads to inflammation and fibrosis centered around the ________________.

Answer 53

portal tracts

Question 54

The DNA hepatitis virus results in chronic disease in what percent of cases?

Answer 54

5%

Question 55

What happens to the nuclei of those with HBV infection?

Answer 55

It can become “sanded,” meaning it gets washed out.