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Flashcards in Liver Lecture 2 Deck (21):
1

A transmission

fecal-oral
incubation 3-6 weeks
no chronic state
mild or asymptomatic
50% of people over 50 show previous exposure

2

B transmission

perinatal, sexual
-incubation period 4-26 weeks
1. Acute or chronic
-fulminant .1-.5%
-chronic hepatitis

Histology: ground glass

3

C transmission

Source:
IV drug use 60%
Sexual 15%
Transfusion 10% (before screening)
Occupational (4%)
incubation period 2-26 weeks
85% of patients with acute infection
Fulminant -rare
chronic 80-85%- 20-30% progress to cirrhosis
-increased risk of hepatocellular cancer
RNA

4

D transmission

-incubation period 4-26 weeks (same as in B)
Fulminant 3-4%*
Chronic

5

E transmission

Fecal-oral -contaminated water
incubation 6 weeks
fulminant .2-.3%
***20% in pregnancy
no carrier state
-unlikely risk of hepatocellular carcinoma
Endemic in tropical and subtropical countries

6

Histological difference between acute and chronic hepatitis

acute:
1. ballooning degeneration
2. macrophage aggregates
3. apoptosis
4. sometimes necrosis
5. portal inflammation

7

sAG
eAG
cAB
sAB

surface AG: active infection
-if greater than 6 months chronic
eAG-infectivity
cAB-way to tell chronic or acute, won't have if you were vaccinated without disease
sAB-victory

8

Stage 3 fibrosis is..

bridging fibrosis

9

What causes fulminant hepatitis?

1. viral hepatitis
-usually B or A
-rarely C, HSV, or dengue virus
2. drugs and chemical toxicity
3. autoimmune hepatitis
4. wilson's disease
5. budd chiari
6. rare (ischemia, malignancy
7. unknown (15%)

10

fulminant

B

11

Chronic

C

12

Acetaminophen-related liver injury

-leading cause of acute liver failure
-dose related toxin exceed 10gm/day
-very high aminotransferase levels
low t. bilirubin?

Build up of NAPQI

GIve NAC

13

What do you see in autoimmune hepatitis histology ?

Plasma cell
Interface Hepatitis

14

Hepatic Steatosis

-Reversible
short term ingestion of 80gm of alcohol
-6 beers or 8 oz of 80 proof
-10-15% of alcoholics develop fibrosis

macrovasicualr

15

Alcoholic hepatitis

fatty liver
inflammation
hepatocellular injury (hepatocyte swelling, apoptotic bodies), mallory hyaline often associated with neutrophils (proteinaceous debri)
-balloon and chicken wire fibrosis

16

How does alcohol cause Alcoholic Hepatitis

1. acetaldehyde
-metabolite of Etoh
-disrupts the cytoskeleton membrane function
2. induction of cytochrome p450 and generation of reactive species
-damages membranes and hepatocyte function
3. decrease glutathione levels
4. malnutrition and vitamin deficiencies
5. bacterial endotoxins from gut inducing inflammatory responses

17

alcoholic cirrhosis

fibrosis
hyperplastic nodule

18

Non alcoholic fatty liver disease

Histology: identical to ETOH
Obesity and metabolic syndrome: dyslipidemia, hyperinsulinemia, and insulin resistance
*most common cause of chronic liver disease and cryptogenic cirrhosis
70% of obese individuals

hepatic steatosis
-minor nonspecific inflammation

non alcoholic steatohepatitis NASH
-hepatocyte injury
-can progress to fibrosis s
-can be asymptomatic or RUQ discomfort
-associated with cardiovascular disease and metabolic syndrome
-elevated transaminases
(simple steatosis does not progress to cirrhosis)

19

Hemochromatosis

Disease of iron overload
Hereditary: recessive (HFE gene chromosome 6)
-excessive absorption of dietary iron
Secondary: transfusions or hemolysis
-iron deposition in parenchymal tissue
Treatment: phlebotomy or chelation
******SIGNIFICANT risk of hepatocellular carcinoma 200x risk

Diagnosis:
elevated serum iron
elevated ferritin
test for HFE gene
liver biopsy for quantitative iron studies and histological examination

20

wilsons disease

copper accumulation
-liver and brain
-recessive
-impaired copper excretion
-symptoms start 6-20 years
-neuropsychiatric
-kayser fleischer ring
-liver failure
-hemolytic anemia
Treatment: copper chelation

chameleon on biopsy?

Diagnosis:
-low ceruloplasmin
-increased urinary copper
-liver biopsy for quantitative copper analysis
-kayser-fleischer rings

21

Alpha 1 antitrypsin deficiency

-defective production of a1at in liver
-errors in coding sequence prevent export
-accumulation results in cell death, inflammation, fibrosis and cirrhosis
-pulmonary emphysema
-autosomal recessive chromosome 14
-PiZZ has only 10% of normal circulating levels

Can use PAS stain in histology