Pathology of Hepatitis

Question 1

Two structural/functional units of the liver:

Answer 1

Acinus

Lobule

Question 2

Where are bile canaliculi found?

Answer 2

Between adjacent hepatocytes

Question 3

What is the space of Disse?

Answer 3

Space between sinusoid and hepatocyte

Question 4

Bile canaliculi are found where?

Answer 4

Between adjacent hepatocytes

Question 5

What is the path of movement of bile from hepatocyte?

Answer 5

Canals of Hering to bile ductules to terminal bile ducts

Question 6

What cytokines causes proliferation of stellate cells?

Answer 6

Platelet-derived growth factor (PDGF)

Tumor necrosis factor (TNF)

Question 7

What stimulates contraction of stellate cells?

Answer 7

Endothelin-1 (ET-1)

Question 8

What stimulates fibrosis in the liver?

Answer 8

Transforming growth factor beta (TGF-B)

Question 9

What signals for chemotaxis of activated stellate cells?

Answer 9

PDGF

Monocyte chemotactic protein-1 (MCP-1)

Question 10

Four disease categories of liver abnormality:

Answer 10

Viral hepatitis
Alcoholic liver disease (ALD)
Nonalcoholic fatty liver disease (NALD)
Hepatocellular carcinoma (HCC)

Question 11

What can cause viral hepatitis?

Answer 11

Microbes
Autoimmune
Drug-toxin induced

Question 12

What occurs in chronic hepatitis that doesn’t in acute hepatitis?

Answer 12

Bridging necrosis and fibrosis between central vein and portal triad
Chronic has mononuclear infiltration acute has little

Question 13

What bacteria can form bacterial hepatitis?

Answer 13

S. aureus
S. typhi
T. pallidum

Question 14

How does bacteria cause hepatitis?

Answer 14

Obstruction allowing them to ascend from the gut (ascending cholangitis)

Question 15

What can fungi and mycobacterium cause?

Answer 15

Granulomatous inflammation

Question 16

What parasites can affect the liver?

Answer 16

Schistomsomiasis

Echiococcus (hydatid cysts)

Question 17

Three overlapping forms of ALD?

Answer 17

Hepatocellular steatosis
Steatohepatitis
Steatofibrosis

Question 18

What is true of hepatocellular steatosis?

Answer 18

It is reversible cell injury that reverses with complete abstinence

Question 19

What is Steatohepatitis?

Answer 19

Inflammation and recurrent fat deposition

Question 20

Difference between hepatocellular steatosis and steatohepatits?

Answer 20

Hepatocellular steatosis: fatty deposition

Steatohepatitis: fatty deposition with inflammation

Question 21

What is reversible liver damage?

Answer 21

Steatosis

Hepatitis

Question 22

What does early fibrosis affect first?

Answer 22

Space of Disse with collagen

Question 23

Are males or females affected more by cirrhosis?

Answer 23

Females

Question 24

How does steatosis occur?

Answer 24

Shunting of substrates to lipid biosynthesis due to increased NADH from alcohol dehydrogenase and acetaldehyde dehydrogenase; increased use of NADH leads to fatty acid synthesis

Question 25

In hepatitis what does acetaldehyde induce?

Answer 25

Lipid peroxidation

Question 26

What produces ROS’s?

Answer 26

Cytochrome P-450

Question 27

What can cause oxidative injury?

Answer 27

impaired glutathione

Question 28

What does induced cytochrome P-450 enzymes cause?

Answer 28

Increased production of toxic metabolites

Question 29

What does hepatitis cause?

Answer 29

Release of bacterial endotoxin from gut into circulation inducing inflammation of liver; also release of endothelins causing vasoconstriction leading to hypoxia and ischemia

Question 30

In acute alcoholic hepatitis what lab findings are present?

Answer 30

Aminotransferase enzymes elevated with a 2:1 ratio of AST>ALT

Question 31

How many grams of alcohol must be consumed daily for ALD?

Answer 31

80 grams