Pathology of the liver 2

Question 1

Common causes of viral hepatitis

Answer 1

Hep A
Hep B
Hep C
Hep E

Question 2

Rare causes of viral hepatitis

Answer 2

Delta agent 
Ebstein-Barr virus 
Yellow fever virus 
Herpes simplex virus 
Cytomegalovirus

Question 3

Summary of Hep A

Answer 3

faecal oral spread 
short incubation period 
sporadic or endemic 
directly cytopathic 
no carrier state 
mild illness, usually full recovery

Question 4

How is Hep B spread

Answer 4

Blood, sexually, vertically 
Long incubation period 
carriers exist 
outcome is variable 
increases risk of carcinoma

Question 5

Outcomes of Hep B infection

Answer 5

Acute hepatitis with resolution
Acute hepatitis with liver failure
Chronic hepatitis
Asymptomatic carrier

Question 6

Types of chronic hep

Answer 6

Non-progressive-stays the same but doesn’t go away

Progressive - gets worse until cirrhosis develops

Question 7

How is Hep C spread

Answer 7

blood, sexually, virtically

Question 8

What doesn’t Hep C have a vaccine

Answer 8

Does not have a constant antigen and can exist in many forms

Question 9

Hep C has a long incubation period true/false

Answer 9

False

Short

Question 10

Hep C tends to become chronic true/false

Answer 10

true

Question 11

What does acute hep look like

Answer 11

ballooning degeneration -slightly clear cytoplasms
Chronic Inflammatory cells - mainly lymphocytes
Inflam cells infiltrate the portal triad
globular inflammation

Question 12

What does cirrhosis look like

Answer 12

Scarring between the portal triads splitting up the hepatocytes and isolating them from each other and vasculature

Question 13

What are the two types of cirrhosis

Answer 13

macro >3mm

micro <3 mm

Question 14

Outcomes of hep c

Answer 14

chronic hep

cirrhosis

Question 15

Other causes of chronic hepatitis (not viral)

Answer 15

Primary biliary cirrhosis
Autoimmune hepatitis
Drug induced hepatitis
Primary Sclerosing cholangitis

Question 16

What is primary biliary cirrhosis

Answer 16

Rare autoimmune disease- unknown aetiology
mainly females affected
associated with auto antibodies to mitochondria

Question 17

What does PBC look like histologically

Answer 17

Granulomas
Bile duct loss
Granuloma around bile duct while lymphocytes attack bile duct

Question 18

What is the outcome of PBC

Answer 18

unpredictable

Question 19

What is the definition of a granuloma

Answer 19

A collection of histocytes surrounded by lymphocytes

Question 20

If untreated what does PBC lead to

Answer 20

Cholestatis (reduction of bile flow) 
liver injury 
inflammation 
fibrosis 
cirrhosis

Question 21

What is autoimmune hepatitis

Answer 21

Autoimmune disease 
common in females 
Associated with other AI diseases 
Autoantibodies to smooth muscle
raised IgG
May have triggers including drugs

Question 22

What is drug induced hepatitis

Answer 22

similar features to all other types of chronic hep
may trigger autoimmune hep
chronic adverse process
too many causes to list

Question 23

Is drug induce hep always dose related

Answer 23

No

sometimes idiosyncratic

Question 24

What is primary sclerosis cholangitis

Answer 24

chronic inflammation affecting intra and extra hepatic bile ducts
Leads to duct destruction, jaundice and fibrosis

Question 25

Primary sclerosis cholangitis is more common in males true/false

Answer 25

True

Question 26

What other GI condition is primary sclerosisng cholangitis associated with

Answer 26

Ulcerative colitis

Question 27

PSC increases/decreases risk of malignancy in liver/bile ducts

Answer 27

Increases | Bile ducts

Question 28

What are the main storage diseases

Answer 28

Haemochromatosis Wilson's disease Alpha-1-antitripsin deficiency

Question 29

What is haemochromatosis

Answer 29

Excess iron in the liver

Question 30

What is the difference between primary and secondary haemochromatosis

Answer 30

Primary - genetic condition, increases absorption of iron Secondary- iron overload from diet, transfusions, iron therapy

Question 31

Describe primary haemochromatosis

Answer 31

Inherited autosomal recessive condition Gene defect Excess iron absorption from intestine Worse in homozygotes, men

Question 32

Primary haemochromatosis gives a variety of symptoms

Answer 32

False, asymptomatic for years

Question 33

Where is iron eventually deposited in primary haemochromatosis

Answer 33

Portal connective tissue | this stimulated fibrosis

Question 34

What happens if primary haemochromatosis is not treated

Answer 34

Cirrhosis Predisposed to carcinoma Causes diabetes, cardiac failure, and impotence

Question 35

How is iron confirmed to have accumulated in hepatocytes

Answer 35

Perls stain

Question 36

What is Wilsons disease

Answer 36

Inherited autosomal recessive disorder of copper metabolism | Copper accumulates in liver and brain

Question 37

What does Wilson's disease cause

Answer 37

chronic hep | neurological deterioration

Question 38

Sign of Wilsons disease

Answer 38

Kayser-Fleischer rings at corneal limbus

Question 39

What is alpha 1- antitrypsin deficiency

Answer 39

inherited autosomal recessive disorder of production of an enzyme inhibitor

Question 40

What does alpha 1- antitrypsin deficiency cause

Answer 40

emphysema | cirrhosis

Question 41

What are the primary (rare) liver tumours

Answer 41

Hepatocellular adenoma | Hepatocellular carcinoma

Question 42

What are the secondary (common) liver tumours

Answer 42

Multiple | metastases from colon, pancreas, stomach, breast, lung, others

Question 43

What is a hepatocellular adenoma

Answer 43

``` Benign Females get it May become large- can rupture or bleed Most remain assymptomatic Poor prognosis ```

Question 44

What is a hepatocellular carcinoma

Answer 44

Rare in Europe | Associated with HBV, HVC, and cirrhosis

Question 45

How does hepatocellular carcinoma present

Answer 45

Mass Pain obstruction usually advanced unless discovered incidentally