viral and non viral liver diseases [7] Flashcards
Portal HTN can manifest as what things
increase BP in portal system due to cirrhosis → back up of blood →
- esophageal varices
- hemorrhoids
- caput medusae
- hepatic encephalopathy
- ascites
- splenomegaly
ground glass
viral inclusion
Which hepatitis is the only dsDNA?
Hep B
the rest are ssRNA
Which Hep is transmitted via F-O route?
Hep A, Hep E
Which Hep is transmitted sexually?
Which Hep is transmitted mother to child?
Hep B, (Hep C minor)
Hep B
Which Hep results in chronic liver disease the most?
Hep C - 80%
- cocaine is risk factor
(Hep B is #2 with 10%)
Of the acute HCV infxns, how many of them get resolved, and how many go on to develop chronic Hep? How many of those go on to develop cirrhosis? How many of those with cirrhosis die?
85%
20%
50%
Of the acute HBV infxns, how many go on to develop into chronic hep and how many resolve?
90% → recover
Hep ____ is replication incompetent and depends on Hep ____ coinfection.
Hep D needs Hep B
potentiates the effects of Hep B and causing faster progression to end stage liver disease
Primary Biliary Cirrhosis (PBC)
autoimmune liver disease
- immune mediated attack of intrahepatic SMALL caliber bile ducts.
Presentation of PBC
- Pop
- test/dx
insidious onset + pruritus before jaundice
middle aged women
elevated GGT, bili, ALT
serology: anti-mitochondrial Ab (90%)
25% will get liver failure after 10 years
Histo of PBC
Ductopenia (small-no bile duct) - duh, PBC is immune med atk of bile ducts Lymphocytes - atk bile ducts Granulomas - atk bile ducts
Primary sclerosing cholangitis (PSC)
autoimmune mediated obliterative fibrosis of intrahepatic and extrahepatic LARGE bile ducts
(similar to PBC of small bile ducts)
Presentation of PSC
- Pop
- Test/dx
Asymptomatic Persistent alkaline phosphatase elevation progressive fatigue pruritus jaundice
Men + UC
(PBC is middle aged women)
Cholangiography → alternating biliary strictures + dilatation
Does PBC or PSC have increased risk for cholangiocarcinoma?
PSC
Histo of PSC
onion skin fibrosis around bile duct → late fibrous obliteration of bile duct
Autoimmune hepatitis
- pop
- dx
immune mediated attack directed at hepatocytes
(PBC and PSC are autoimmune against bile ducts)
Women
Serology BIG role
- ANA, ASMA, Anti-LKMB
- ↑ elevated IgG
Toxins (drugs) affect which zone?
zone 3
centrilobular necrosis
Alcohol steatosis/steatohepatitis
characteristic histo
large load of carbohydrates into liver →
de novo lipogenesis + modifies oxidative state of hepatocytes →
impedes beta oxidation + prevent lipid escapes + impedes packaging
Neutrophil infiltrates and Mallory bodies
(inclusion in hepatocytes due to abnormal accumulation of cytoskeleton in injured hepatocytes)
Hereditary hemochromatosis
generic iron overload disease throughout body
Autosomal recessive inheritance of HFE gene mut
malignant tumors commonly found in the liver
hepatocellular carcinoma or cholangiocarcinoma
- most common malignant tumor is actually mets from other areas
Most common malignant tumor of the liver
- occurs with which diseases?
Hepatocellular carcinoma
- occurs in cirrhosis and those with chronic liver disease
(HCV, HBV, alcohol)
Cholangiocarcinoma
malignant neoplasm of bile ducts
PBC + PSC are autoimm dmg against bile ducts
Benign neoplasms of liver
hemangioma
focal nodular hyperplasia
hepatocellular adenoma
