Week 4: Pathology of acute/chronic viral hepatitis

Question 1

type of liver injury by liver enzyme pattern

Answer 1

(ALT/ULN) / (AST/ULN) 
where ULN is upper limit of normal
-ratio>5 hepatocellular type
-ratio >2 cholestatic
-AST is not liver specific, use ALT as marker for hepatocyte injury. AST found in mitochondria mostly. ALT primarily stored in cytosol.

Question 2

ALP principles

Answer 2

• alk phos is localized within hepatocytes and in canalicular membrane
• also in different tissues: osseous, renal, small intestine
• In cholestasis -retention of bile acid and bilirubin - bile acids increase permeability of intercellular tight junctions (solubilizing features), increase detachment of membrane bound alk pos and passage of the enzyme into sinusoidal blood

Question 3

Pathology of acute viral hepatitis

Answer 3

• prominent infiltration of portal tracts by lymphocytes
• Kupffer cell hyperplasia
• hydropic change of hepatocytes (accumulation of water in the cell)
• cholestasis may be seen

Question 4

Pathology of chronic viral hepatitis

Answer 4

-inflammatory infiltrate of portal tracts, confined to portal structures. Limiting plate by hepatocytes
WITH CIRRHOSIS
-fibrous bands and regenerative nodule formation
-fibrous septa, mild lymphocytic infiltrate
-lymphocytes circling the liver cells in the periseptal zone
-“ground glass” cells, from ER synthesizing HBsAg particles