Liver Pathology 2

Question 1

describe viral hepatitis

Answer 1

may cause acute liver injury or chronic liver injury

Question 2

types of viral hepatitis

Answer 2

hep A, B, C, E

delta agent

Question 3

name of hepatitis A

Answer 3

ebstein-barr virus

Question 4

name of hepatitis B

Answer 4

yellow fever virus

Question 5

name of hepatitis C

Answer 5

herpes simplex virus

Question 6

name of hepatitis E

Answer 6

cytomegalovirus

Question 7

how is hepatitis A spread

Answer 7

faecal-oral

Question 8

describe hepatitis A

Answer 8

short incubation period
sporadic or endemic
directly cytopathic
no carrier illness

Question 9

what is meant by cytopathic

Answer 9

refers to structural changes in host cells that are caused by viral invasion
the infecting virus causes lysis of the host cell or when the cell dies without lysis due to an inability to reproduce

Question 10

recovery from hepatitis A

Answer 10

mild illness

usually full recovery

Question 11

how is hepatitis B spread

Answer 11

blood
blood products
sexually
vertically (in utero)

Question 12

describe hepatitis B

Answer 12

long incubation period
liver damage via antiviral immune response
carriers exist

Question 13

recovery from hepatitis B

Answer 13

variable

Question 14

how is hepatitis c spread

Answer 14

blood
blood products
possibly sexually

Question 15

describe hepatitis C

Answer 15

short incubation period
disease waxes and wanes
tends to be chronic

Question 16

symptoms of hepatitis C

Answer 16

often asymptomatic

Question 17

microscopy of chronic viral hepatitis

Answer 17

dense portal chronic inflammation 
interface hepatitis (piecemeal necrosis)
lobular inflammation - councilman body and steatosis 
fibrosis 
cirrhosis

Question 18

describe interface hepatitis

Answer 18

necrosis of the limiting plates, by inflammatory cells

Question 19

outcomes of hepatitis B

Answer 19

fulminant acute infection - death
chronic hepatitis 
cirrhosis 
hepatocellular carcinoma 
asymptomatic (patient becomes a carrier)

Question 20

outcomes of hepatitis C

Answer 20

chronic hepatitis

cirrhosis

Question 21

aetiology of chronic hepatitis - autoimmune disease

Answer 21

primary biliary cirrhosis
autoimmune hepatitis
primary sclerosis cholangitis

Question 22

aetiology of chronic hepatitis - other causes

Answer 22

hep B
hep C
drug induced hepatitis

Question 23

describe primary biliary cirrhosis

Answer 23

rare autoimmune disease

unknown aetiology - associated with autoantibodies to mitochondria

Question 24

epidemiology of primary biliary cirrhosis

Answer 24

female

Question 25

pathology of primary biliary cirrhosis

Answer 25

granulomas | bile duct loss

Question 26

out come of primary biliary cirrhosis

Answer 26

unpredictable

Question 27

when would a biopsy be indicated for primary biliary cirrhosis

Answer 27

staging the disease

Question 28

microscopy of primary biliary cirrhosis

Answer 28

chronic portal inflammation bile ducts inflamed granuloma around duct

Question 29

outcomes of primary biliary cirrhosis

Answer 29

if untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis and cirrhosis

Question 30

epidemiology of autoimmune hepatitis

Answer 30

females

Question 31

pathology of autoimmune hepatitis

Answer 31

chronic hepatitis pattern numerous plasma cells autoantibodies to smooth muscle, nuclear or LKM, raised IgG

Question 32

epidemiology of autoimmune hepatitis

Answer 32

associated with other autoimmune diseases | may have triggers - including some drugs

Question 33

describe chronic drug-induced hepatitis

Answer 33

similar features to all other types of chronic hepatitis - chronic active process may trigger autoimmune hepatitis

Question 34

describe the effects of drugs on the liver

Answer 34

innumerable drugs can damage liver - may be dose related or idiosyncratic can mimic any liver disease

Question 35

outcomes of drugs on the liver

Answer 35

``` hepatitis granulomas fibrosis necrosis failure cholestasis cirrhosis ```

Question 36

pathology of primary sclerosis cholangitis

Answer 36

chronic inflammatory process affecting intra and extra hepatic bile ducts

Question 37

outcomes of primary sclerosis cholangitis

Answer 37

periductal fibrosis duct destruction jaundice fibrosis increased risk of malignancy in bile ducts and colon

Question 38

epidemiology of primary sclerosis cholangitis

Answer 38

males

Question 39

aetiology of primary sclerosis cholangitis

Answer 39

associated with ulcerative colitis

Question 40

microscopy of primary sclerosis cholangitis

Answer 40

peridcutal onion-skinning fibrosis

Question 41

storage diseases of the liver

Answer 41

haemochromatosis Wilsons disease alpha-1-antitrypsin deficiency

Question 42

what is haemochromatosis

Answer 42

excess iron within the liver | can be primary or secondary

Question 43

primary haemochromatosis

Answer 43

genetic condition - inherited autosomal recessive condition (worse in homozygotes, men) increased absorption of iron

Question 44

secondary haemochromatosis

Answer 44

iron overload from diet transfusion iron therapy

Question 45

pathology of primary haemochromatosis

Answer 45

excess absorption of iron from intestine abnormal iron metabolism iron deposited in liver - asymptomatic for years -deposited in portal connective tissue and stimulates fibrosis

Question 46

outcomes of primary haemochromatosis

Answer 46

``` untreated - fibrosis and cirrhosis predisposes to hepatocellular carcinoma diabetes cardiac failure impotence ```

Question 47

microscopy of haemochromatosis

Answer 47

iron accumulates in hepatocytes - confirmed by Perls stain

Question 48

what is Wilson's disease

Answer 48

inherited autosmal recessive disorder of copper metabolism

Question 49

pathology of Wilson's disease

Answer 49

copper accumulates in liver and brain (basal ganglia) Kasyer-Fleischer rings at corneal limbus low serum caeruloplasmin

Question 50

outcomes of Wilson's disease

Answer 50

chronic hepatitis | neurological deterioration

Question 51

describe alpha-1-antitrypsin deficiency

Answer 51

inherited autosomal recessive disorder of production of an enzyme inhibitor

Question 52

outcomes of alpha-1-antitrypsin deficiency

Answer 52

emphysema | cirrhosis

Question 53

pathology of alpha-1-antitrypsin deficiency

Answer 53

cytoplasmic globes of unsecreted globules of protein in liver cells

Question 54

primary tumours of the liver

Answer 54

rare; hepatocellular adenoma hepatocellular carcinoma (hepatoma)

Question 55

secondary tumours of the liver

Answer 55

common; mutliple metastases from colon, pancreas, stomach, breast, lung...

Question 56

describe hepatoceullar adenoma

Answer 56

bengin seen mostly in females may become large - rupture or bleed may remain asymptomatic

Question 57

describe hepatocellular carcinoma

Answer 57

advanced unless discovered accidentally - poor prognosis | associated with HBV, HCV and cirrhosis

Question 58

symptoms and signs of hepatocellular carcinoma

Answer 58

mass apin obstruction

Question 59

microscopy of hepatocelllar carcinoma

Answer 59

multifocal (rare) hepatocytic cholangio-