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

B5.026 Liver Disorders II Flashcards

(59 cards)

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1
Q

diseases affecting hepatocytes

A

hepatitic diseases- viral, autoimmune
fatty liver disease- NASH and alcohol
DILI
hepatocellular carcinoma

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2
Q

causes of viral hepatitis

A 
EBV
CMV
yellow fever
herpes
Hep A, B, C, D, E
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3
Q

features of herpes hepatitis

A

immunocompromised pts
patchy coagulative necrosis, no particular zonal distribution
eosinophilic intranuclear inclusions
3 Ms: multinucleation, molding, margination

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4
Q

features of CMV hepatitis

A

mostly after renal and liver transplant
immunocompetent people- infectious mono with mild hepatitis
focal hepatocyte necrosis, microabscesses, and occasional sinusoidal lymphocytic infiltration
owl’s eye intranuclear inclusions

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5
Q

features of EBV hepatitis

A

immunocompetent and immunocompromised people

diffuse sinusoidal lymphocytic infiltrate (string of pearls) with varying degrees of portal inflammation

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6
Q

overview of hep A

A

endemic in countries with substandard sanitation
fecal-oral contamination- food industry, school, nurseries, raw shellfish
vaccine developed in 1992
no carrier or chronic state

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7
Q

hep A symptoms

A

sporadic febrile illness with jaundice, fatigue, loss of appetite

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8
Q

what is problematic about how hep A spreads?

A

it can be shed in feces before an individual shows symptoms, they don’t know they’re transmitting it

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9
Q

epidemiology of hep B

A

1/3 of world pop have been infected
5% have chronic infection (400 million)
75% of carriers in asia and west pacific

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10
Q

modes of transmission of hep B

A

high prevalence areas- perinatal transmission during childbirth accounts for 90% of cases
low prevalence areas (US)- sexual contact and IV drugs
vaccination induces protective anti-HBs antibody response in 95%

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11
Q

outcomes of hep B by frequency

A

65% subclinical disease
25% acute hep B
5-10% chronic hep B

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12
Q

outcome of acute hep B

A

99% recovery

1% fulminant hep

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13
Q

outcome of chronic hep B

A

20-30% cirrhosis
2-3% HCC
recovery in the rest

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14
Q

protective antibody against hep B

A

anti-HBs (antibody against surface antigen)

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15
Q

what determines outcome of hep B infection?

A

host immune response to virus
strong CD4 and CD8 interferon producing T cells associated with resolution of acute infection
HBV does not cause direct hepatic injury, injury is caused by CD8 cytotoxic T cells attacking infected cells

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16
Q

histo of hep B

A

ground glass hepatocytes

cells with ER swollen with HSsAg

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17
Q

epidemiology of hep C

A

3.9 mil have Ab to hep C
75% have chronic infection (viral DNA in serum)
most common blood bourne infection in US
accounts for almost 1/2 of pts in US with chronic liver disease

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18
Q

transmission of hep C

A 
IV drugs - 60%
transfusion - 10% prior to 1991
hemodialysis and health care- 5%
sexual - 15%
vertical transmission - 6%
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19
Q

description of hep D

A

unique RNA virus that is replication defective
only causes infection when it is encapsulated by HBsAg
dependent on hep B for multiplication

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20
Q

2 types of hep D infection

A 
acute coinfection (simultaneous exposure with hep B)
superinfection (exposure of chronic hep B carrier)
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21
Q

hep E overview

A

enterically transmitted, water bourne
mostly self limiting
high mortality in pregnant women (20%)

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22
Q

4 primary courses of hepatitis

A
  1. acute asymptomatic infection with recovery- serologic evidence only
  2. acute symptomatic hepatitis with recovery
  3. chronic hepatitis- with or without progression to cirrhosis
  4. fulminant hepatitis- massive to submassive hepatic necrosis
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23
Q

acute hepatitis on histo

A 
dominant features are in lobular/acinus
disordered, "dirty" appearance
acidophilic (apoptotic) cells
liver plate disarray
confluent bridging or submassive necrosis
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24
Q

appearance of sinusoidal lymphocytes

Study These Flashcards
A

blue dots in typically empty sinusoidal white spaces

25
clinical definition of chronic hepatitis
persistent inflammatory reaction of the liver with more than 6 months of clinical signs and symptoms
26
chronic hepatitis on histo
``` marked and patchy expansion of the portal tracts by predominantly lymphocytes interface hepatitis varying degrees of bile duct damage steatosis lobular inflammation ```
27
who gets progressive chronic hep C?
``` >40 at infection immunodeficient viral heterogeneity genotype 1 males long duration of infection ethanol ```
28
grading hep C
activity - portal inflammation - interface hepatitis - confluent necrosis - apoptosis
29
staging hep C
fibrosis
30
what is harvoni?
treats genotype 1 of hep C one pill, once a day 96-99% of patients who had no prior therapy cured with 12 weeks of therapy $95,000 for full treatment
31
appearance of fibrosis on histo
blue strands blue is bad can grow to bridge between different areas
32
clinical signs of cirrhosis
``` jaundice hypoalbuninemia hyperammonemia hyperestrogenemia coagulopathy encephalopathy hepatorenal syndrome portal hypertension ```
33
features of autoimmune hepatitis
young and middle aged women ANA or anti-SMA usually present chronic disease, fatal if left untreated steroid therapy leads to symptomatic improvement pts with LKM antibody positive diseases have poorer prognosis
34
diagnosis of autoimmune hepatitis
very complex multiple factors taken into account scored based on features
35
important diagnostic criteria of autoimmune hepatitis
``` female polyclonal hypergammaglobulinemia circulating autoAb (ANA, ASMA) absence of viral infection, drugs, EtOH favorable response to immunosuppression hepatic rather than a cholestatic liver enzyme profile ```
36
autoimmune hepatitis on histo during flare
marked interface hepatitis lymphoplasmacytic infiltrate hepatocyte rosettes, emperipolesis lobular activity
37
autoimmune hepatitis on histo during quiescent phase
no lobular activity no to minimal interface activity mild portal inflammation
38
what are hepatocyte rosettes
clusters of hepatocytes in a sea of lymphocytic infiltrates
39
what is emperipolesis
hepatocytes engulf T cells | blue inclusions in hepatocytes
40
causes of fatty liver disease
alcoholic steatohepatitis NAFLD NASH (non-alcoholic steatohepatitis)
41
what causes steatosis in alcohol induced liver disease
production of excess reducing equivalents (NADH + H+) due to metabolism of alcohol
42
appearance of hepatic steatosis
small and large fat droplets initially centrilobular; progressed to entire lobule reversible with abstinence
43
histo features of alcoholic hepatitis
hepatocyte swelling and necrosis (ballooning) Mallory hyaline (ubiquinated cytokeratin intermediate filaments) neutrophilic reaction fibrosis
44
unique feature of fibrosis in alcoholic hepatitis
chicken wire fibrosis | fibrosis around individual cells (usually in zone 3)
45
2 types of steatosis
macrovesicular (large and small droplet) | microvesicular (VERY small droplets filling hepatocytes)
46
etiologies of microvesicular steatosis
reye syndrome fatty liver of pregnancy valproic acid toxicity
47
definition of large droplet
fat droplet occupying greater than one half of the hepatocyte
48
definition of small droplet
fat droplet occupying less than one half of the hepatocyte | not as bad as large droplet
49
reye syndrome
acute post viral illness in children who are given aspirin for fever microvesicular steatosis encephalopathy due to widespread mitochondrial injury
50
fulminant hepatitis
hepatic insufficiency progresses from onset of symptoms to hepatic encephalopathy in 2-3 weeks
51
causes of fulminant hepatitis
drug/chemical -52% viral (HAV or HBV) - 12% amanita phalloides (mushroom) obstruction hepatic veins, Wilson disease, fatty liver of preg, Reye
52
histo features of APAP overdose
``` centrolobular necrosis centrolobular hepatocytes (zone 3) contain more microsomal biotransformation enzymes than the peripheral (zone 1) hepatocytes ```
53
HCC etiologies
viral infection alcohol food contaminants (aflatoxins) hemochromatosis
54
what are aflatoxins
from fungus aspergillus flavus carcinogenic toxins in moldy grains and peanuts cause mutations in tumor suppressor genes (p53)
55
when does carcinogenesis occur in the liver
in mitotically active liver | chronic viral hepatitis with recurrent injury and regeneration
56
features of HCC
can be unifocal, multifocal, diffusely infiltrative green tinge invade vascular channels range from well differentiated to anaplastic can be trabecular, acinar, solid, scirrhous 2/3 have AFP >1000 majority arise in background of cirrhosis
57
what are expanded trabeculae
more than 1-2 cells thick between sinusoids
58
features of fibrolamellar HCC
young woman (20-40 years) no risk factors no cirrhosis better prognosis?
59
histo fibrolamellar HCC
thick hyalinized fibrous bands

GIR Test 2 (20 decks)

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