Acute/chronic Liver Injury: Gupta

Question 1

What cell type is responsible for the fibrosis of liver injury?

Answer 1

Cells of Ito are converted to highly fibrogenic myofibroblasts.
PDGF and TNF released by macrophages at site of injury stimulate cells of Ito to proliferate—> fibrogenesis—> fibrosis.

Question 2

How does the liver regenerate, on a cellular level?

Answer 2

Hepatocytes multiply by mitotic divisions, kind of like stem cells.

Question 3

Is cirrhosis associated w/ end-stage liver disease?

Answer 3

Nope, remember cirrhosis is reversible!

Question 4

Distinguish acute from chronic hepatitis histologically.

Answer 4

Acute: Scant mononuclear infiltrates of portal tract, cholestasis

Chronic: Fatty change, Dense mononuclear infiltrates in portal tract, bridging necrosis/fibrosis between portal tract and central vein.

Question 5

How would you identify Hep B, just using histology?

Answer 5

Ground glass hepatocytes. (buzz word)

The rest of the dx is serology based. HBsAg, IgM, etc.

Question 6

Difference between alcoholic changes to liver and Hepatitis B, C changes to liver on histo?

Answer 6

Hepatitis B/C- periportal inflammatory infiltrates/damage.

EtOH- damage/changes around central vein (zone 3)

Question 7

Autoimmune hepatitis will have this feature on histology. Treat with?

Answer 7

Lympho(plasma)cytic infiltrate at interface btwn portal tract adn hepatocytes. Plasma cells creeping into hepatocyte territory.
Tx w/ corticosteroids, just like all autoimmune conditions.