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GIR Test 2 > B5.026 - Liver Disorders 2 > Flashcards

B5.026 - Liver Disorders 2 Flashcards

(80 cards)

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1
Q

causes of viral hepatitis

A

EBV

CMV

Yellow fever

herpes

viral hepititis

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2
Q

herpes hepatitis features

A

immunocompromised pts

patchy coagulative necrosis, no particular zonal distribution

eosinophilic intranuclear inclusions

3 M’s of Herpes

Multinucleation

Molding

Margination

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3
Q

CMV hepatitis features

A

mostly after renal and liver transplant

immunocompetent people - mono with mild hepatitis

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4
Q

histo of CMV hepatitis

A

focal hepatocyte necrosis, microabscesses, occasional sinusodal lymphocytic infiltration, owls eye

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5
Q
A

CMV hepatitis

intranuclear inclusions

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6
Q
A

microabscesses in CMV hepatitis

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7
Q

feature of EBV hepatitis

A

immunocompetent and compromised

diffuse sinusoidal lymphocytic infiltrate with varying degrees of portal inflammation “string of pearls”

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8
Q
A

sinusoidal lymphoctytosis in EBV hepatitis

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9
Q

hepatitis A features

A

endemic in countries with substandard sanitation

sporadic

fecal oral

1992

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10
Q

hepatitis B features

A

1/3 world pop infected

chronic or acute

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11
Q

transmission of HBV

A

perinatal

sexual contacts

IV drugs

transfusion

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12
Q

natural history of HBV

A
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13
Q

injury from HBV

A

injury caused by CD8+ cytotoxic T cells attacking infected cells

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14
Q

HBV histo

A

ground glass hepatocytes

cells with endoplasmic retuculum swollen with HSsAg

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15
Q
A

HBV ground glass hepatocytes

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16
Q

most common blood bourne infection in US

A

HCV

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17
Q

HCV transmission

A

inoculations and blood transfusions

IV drug use - 60%

transfusions

hemodialysis and healtcare workers

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18
Q

natural history of HCV

A
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19
Q

HDV features

A

unique RNA virus that is replication defective

only causes infection when encapsulated by HBsAg

Dependent on HBV for multiplication

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20
Q

HEV features

A

enterically transmitted, water bourne

mostly self limiting, except in high mortality in pregnant women

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21
Q
A

sinusodal lymphocytes and kupffer cells top

apoptotic hepatocyte bottom

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22
Q
A

acute hepatitis

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23
Q
A

normal liver

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24
Q

clinically chronic hepatitis

A

presistent inflammatory reaction of the liver with more than 6 months of linical signs and symptoms

maked patchy expansion of the portal tracts by predominantly lymphocytes, interface hepatitis, varying degrees of bile duct damage, steatosis, lobular inflammation

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25
grade and stage for chronic hepatitis C
grade - activity stage - fibrosis
26
what is harvoni
treatment of genotype 1 of hepatitis C one pill, once a day in clinical studies 96-99% of patients who had no prior treatment were cured in 12 weeks of therapy combo of sofosbuvir, ledipasvir
27
what are sofosbuvir and ledipasvir
sofosbuvir - nucleotide polymerase inhibitor ledipasvir - NS5A inhibitor
28
what are factors that are taken into account in activity (grade) of chronic hepatitis C
portal inflammation interface hepatitis confluent necrosis apoptosis
29
portal inflammation
30
interface hepatitis
31
confluent necrosis
32
apoptosis and lobular inflammation
33
apoptotic hepatocyte
34
fibrosis
35
fibrosis
36
a finding in cirrhosis seen when fibrosis crosses from one structure to another
37
fibrosis
38
describe autoimmune hepatitis
young and middle aged women ANA or anti SMA usually present chronic disease, progressive and fatal without treatment
39
treatment of autoimmune hepatitis
steroid therapy leads to symptomatic improvment but doesnt prevent progression
40
diagnostic criteria for autoimmune hepatitis
female polyclonal hypergammagolbulinemia circulating autoAb (ANA, ASMA) absence of viral infection, drugs, EtOH favorable response to immunosuppression hepatic rather than cholestatic liver enzyme profile
41
autoimmune hepatitis features during flare
marked interface hepatitis, lymphoplasmacytic infiltrate, hepatocyte rosettes, emperipolesis lobular activity
42
autoimmune hepatitis features during quiescent phase
no lobular activity/no to minimal interface activity mild portal inflammation
43
interfacing inflammation
44
plasma cells
45
Interface inflammation
46
interface inflammation
47
plasma cells
48
hepatocyte rosettes
49
emperipolesis
50
resolved inflammation
51
describe alcohol induced liver disease
steatoiss, production of excess reducing equivalents (NADH + H+) due to metabolism of alcohol
52
describe hepatic steatosis
small and large fat droplets initially centrilobular; progresses to entire lobule fatty change is reversible with abstinence
53
steatosis
54
steatosis
55
describe histo of alcoholic hepatitis
hepatocyte swelling and necrosis (ballooning) mallory hyaline (ubiquinated cytokeratin intermediate filaments) neutrophilic reaction fibrosis
56
ballooned hepatocyte
57
mallory hyaline in ballooned hepatocyte
58
chicken wire fibrosis
59
causes of NAFLD
obesity dyslipidemia, hyperinsulinemia, insulin resistance
60
what is macrovesicular / large droplet fat defined as
fat droplets occupying greater than 1/2 of hepatocyte
61
what is a small droplet defined as
a fat droplet occupying \<1/2 of hepatocyte not as bad as large droplet
62
what is true microcesicular steatosis
very small uniform fat globules packed within hepatocytes visible at least as patches at 10x in fatty liver of pregnancy
63
microvesicular steatosis
64
causes of microvesicular steatosis
acute fatty liver of pregnancy drugs toxins TPN reye syndrome infection
65
what is reye syndrome
acute post viral illness in children who are given aspirin for fever microvesicular steatosis encephalopathy due to widespread mitochondrial injury
66
what is fulminant hepatitis
hepatic insufficiency progresses from onset of sx to hepatic encephalopathy in 2-3 weeks
67
centrilobular necrosis in acetaminophen OD
68
describe acetaminophen OD effect on hepatocytes
centrilobular hepatocytes (zone 3) contain more microsomal biotransformation enzymes than the peripheral zone (1) hepatocytes
69
where are most HCC found
asia
70
etiology of HCC
viral infection alcohol food contaminants hemochromatosis
71
what are aflatoxins
found in regions where HBV is endemic from aspergillus flavus carcinogenic toxins in moldy grains and peanuts toxins cause mutations in tumor suppressor genes (p53) carcinogenesis only occurs in mitotically active liver
72
describe characterisics of HCC
unifocal, multifocal, diffuse green tinge invade vascular channels, intrahepatic mets well differentiated anaplastic trabecular, acinar, solid, scirrhous
73
HCC
74
Endothelial cells wrapped around expanded hepatic plates
75
expanded trabeculae HCC
76
HCC
77
HCC
78
features of fibrolamellar HCC
young women 20-40 no risk factors no cirrhosis better prognosis potentially
79
fibrolamellular HCC Thick hyalinized fibrous bands
80
HSV hepatitis Note - purple ring on outside of cell is chromatin - margination

GIR Test 2 (17 decks)

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