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Gastrointestinal System > EXAM #2: LIVER PATHOLOGY II > Flashcards

EXAM #2: LIVER PATHOLOGY II Flashcards

(60 cards)

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1
Q

Which Hepatitis viruses are transmitted via the fecal-oral route?

A

1) HAV

2) HEV

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2
Q

How is HAV commonly acquired?

A

Traveling

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3
Q

How is HEV commonly acquired?

A

1) Contaminated water

2) Undercooked seafood

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4
Q

What is the clinical manifestation of HAV or HEV infection?

A

Acute hepatitis; no chronic state

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5
Q

What marks active infection with HAV or HEV?

A

anti-HAV or HEV IgM

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6
Q

What marks prior exposure (or immunization) to HAV/ HEV?

A

anti-HAV or HEV IgM

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7
Q

In a patient with anti-HAV IgG antibodies, what are the possible interpretations?

A

1) Prior infection

2) Immunization

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8
Q

In what patient population can HEV infection lead to fulminant hepatitis?

A

Pregnant women

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9
Q

How is HBV transmitted?

A

Parenterally

  • Childbirth
  • Unprotected intercourse
  • ID drug abuse (IVDA)
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10
Q

What is the clinical manifestation of HBV infection?

A

Acute hepatitis (only 20% chronic)

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11
Q

How is HCV transmitted?

A

Parenterally

  • IVDA
  • Unprotected sex
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12
Q

What is the clinical manifestation of HCV infection?

A

BOTH acute and chronic hepatitis

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13
Q

How is HCV infection diagnosed?

A

HCV-RNA

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14
Q

In evaluating a patient with HCV, what do declining HCV-RNA level indicate? What is levels remain the same?

A

Recovery vs. persistence/ chronic infection

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15
Q

How does then HBV virus differ from the other hepatitis viruses?

A
  • dsDNA virus vs. ssRNA

- Hepadnavirus vs. picorna virus

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16
Q

What is HDV infection dependent on? Why?

A

HDV infection requires infection with HBV

- Requires HBsAg to infect (Hepatitis B Surface Antigen)

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17
Q

What is HDV coinfection?

A

HBV + HDV infect at the same time

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18
Q

What is HDV superinfection?

A

Pre-existing HBV infection THEN HDV infection

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19
Q

Which is worse, coinfection of superinfection with HDV?

A

Superinfection–chronic hepatitis and cirrhosis are common complications

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20
Q

What are the extrahepatic manifestations of Hepatitis B? How do these differ in adults and children?

A

Children= glomerulonephritis

Adults= polyarteritis nodosa

*Antigen/antibody complexes are deposits in the nephrons or medium sized vessels.

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21
Q

What are the extrahepatic manifestations of Hepatitis C?

A

1) Cryoglobulinemia (cold temperature induced agglutination of RBCs)
2) Thyroiditis
3) Glomerulonephritis
4) Thrombocytopenia

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22
Q

Which genotype of HCV is associated with more severe inflammation?

A

HCV-2

Note that HCV-1 in the US is associated with resistance to treatment

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23
Q

What happens with HCV and Alcoholism?

A

Accelerated progression to cirrhosis

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24
Q

What factors predispose HCV infection to HCC?

A
  • Cirrhosis
  • Age
  • Male sex
  • Alcohol
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25
How does Acute Viral Hepatitis appear microscopically?
- Swelling of hepatocytes - Cholestasis (jaundice) - Lobular disarray (with impaired blood flow and bile flow)
26
What is a Councilman Body?
Apoptotic hepatocyte
27
How does Chronic Viral Hepatitis appear microscopically?
- Piecemeal necrosis - Bridging fibrosis - Nodules/ cirrhosis
28
What is the classic appearance of HBV histologically?
"Ground-glass"
29
What histologic feature is associated with HCV?
Lymphoid aggregates in portal tracts
30
What are the serologic markers for HBV infection?
1) HBsAG | 2) HBcAB (core antibody) --IgM
31
What serologic marker will be present in the window period of HBV infection?
HBcAB--IgM
32
What serologic marker indicates resolution of HBV infection?
HBsAB--IgG
33
What are the serologic markers for chronic HBV infection?
1) HBsAG 2) HBeAG (envelope) or HBV DNA 3) HBcAB--IgG
34
What serologic markers indicate infectivity in HBV infection?
HBeAG or HBV DNA
35
What serologic marker is indicative of HBV immunization? How can you tell the difference between immunization and resolved infection?
Immunization= HBsAB--IgG Resolved infection= HBcAB AND HBsAB--IgG
36
How does acute Hepatitis present?
1) Mixed UCB and CB jaundice 2) Dark urine 3) Fever 4) Malaise 5) Nausea 6) Elevated liver enzyme
37
What is the classic elevation of AST and ALT in Hepatitis?
ALT is more elevated than AST
38
What time period is characteristic of acute Hepatitis? Chronic?
Less than 6 months vs. more than 6 months
39
Outline the etiology of Hepatitis.
1) Viral infection 2) Presentation of viral antigen on MHC class I 3) CD8+ T-cell activation Cytotoxic effects of CD8+ T-cells mediate the inflammation seen in Hepatitis.
40
Why is there an elevation of both CB and UCB in Hepatitis?
Inflammation of BOTH: 1) Hepatocytes--> UCB 2) Small bile ducts--> CB
41
What is Primary Biliary Cirrhosis?
Autoimmune disorder that causes inflammation of the small bile ducts - Referred to as "granulomatous cholangitis" - Granulomas affecting the small bile ducts
42
Describe the etiology of Primary Biliary Cirrhosis.
Etiology is unclear, but there is T-cell mediated cytotoxicity
43
What are the clinical associations with Primary Biliary Cirrhosis?
- More frequent in middle-aged females - Seen in patients with other autoimmune disorders - Anti-mitochondiral antibodies present (AMA)
44
What type of cancer are patients with Primary Biliary Cirrhosis more susceptible to?
Hepatocellular Carcinoma
45
What are the clinical features of Primary Biliary Cirrhosis?
Patient presents with FATIGUE and PRURITUS that progresses over 10-15 years, and then presents with JAUNDICE. Other symptoms include: 1) Steatorrhea 2) Xanthomas 3) Portal HTN 4) Hepatic failure 5) Osteoporosis/osteomalacia
46
What lab findings are associated with Primary Biliary Cirrhosis?
- AMA, anti-M2, anti PDH-E2 - IgM - ALP/5-NT/GGT - Cholesterol
47
What are the buzzwords for the four stages of Primary Biliary Cirrhosis?
1) "Florid ductal inflammation" i.e. bile duct inflammation 2) Ductular proliferation 3) Cholestasis 4) Cirrhosis
48
What is Primary Sclerosing Cholangitis?
Fibrosis of the large bile ducts
49
What are the clinical associations with Primary Sclerosing Cholangitis?
1) More common in males | 2) Ulcerative colitis
50
What is pathognmeomic for Primary Sclerosing Cholangitis on ERCP?
"Beads on a string" bile duct | Endoscopic Retrograde Cholangiography
51
What lab findings are associated with Primary Sclerosing Cholangitis?
Elevations in: - ALP - GGT - 5'-NT - ALT/AST
52
What antibody is most specific to Primary Sclerosing Cholangitis?
p-ANCA
53
What cell type initially mediates the Fibrosis seen in Primary Sclerosing Cholangitis?
Neutrophils
54
What carcinoma is associated with Primary Sclerosing Cholangitis?
Cholangiocarcinoma i.e. carcinoma of the bile duct epithelium
55
What is autoimmune hepatitis?
Autoimmune "attack" of hepatocytes
56
What antibodies are specific to autoimmune hepatitis?
ANA SMA LKM1
57
What is Type I autoimmune hepatitis?
- Most common - Autoimmune hepatitis seen from 10-elderly - SMA and ANA antibody association
58
What is Type II autoimmune hepatitis?
- Less common - Seen in young patients, 2-14 - Anti-LKM1 antibody - Poor prognosis
59
What is Type III autoimmune hepatitis?
- Less common - 30-50 - Anti-SLA/LP
60
What is the typically progression seen in autoimmune hepatitis?
Very quick progression to cirrhosis - Initially managed with corticosteroids - If unable to manage with corticosteroids, patient will require liver transplant

Gastrointestinal System (42 decks)

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