Pathology of the liver 2

Question 1

Describe Viral hepatitis

Answer 1

• infection of the liver
• May cause acute injury or chronic liver injury
• Causes can be common or rare

Question 2

What are the common types of hepatitis virus

Answer 2

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis E

Question 3

What are rare causes of hepatitis

Answer 3

Ebstein-Barr virus, Yellow fever virus, Herpes simplex cirus and cytomegalovirus

Question 4

Describe hepatitis A

Answer 4

• Transmission: Faecal-oral spread - contaminated food or water
• Short incubation time
• Can be sporadic or endemic (isolated or common)
• Acute - mild ilness with full recovery usuaully
• Directly cytopathis - direct change to host cell
• no carrier state

Question 5

What are the serological markers in HAV

Answer 5

• IgM = active infection
• IgG = recovery antibody - tells us that there has been recovery from HAV

Question 6

What are the histological features of HAV

Answer 6

• Periportal inflammation, necrosis and apoptosis

Question 7

Describe hepatits B virus

Answer 7

• Transmission: blood, blood products, sexually and in utero
• long intubation time
• Liver damage is by antiviral immune response
• Carriers exist
• only 20% become chronic but depends on age - the younger the patient the more likely to become chronic

Question 8

Describe hepatitis C virus

Answer 8

• Transmission: blood, blood products and sexually
• Short intubation time
• often asymptomatic
• Tends to become chronic

Question 9

describe the histological features of HCV

Answer 9

• Dense portal chronic inflammation - lymphocytosis
• Interface hepatitis - piecemeal necrosis
• Lobular inflammation
• Council man bodies - intracytoplasmic eosinophillic collection of globulate inside the cell of dying hepatocytes
• Fibrosis and cirrhosis

Question 10

What is piecemeal necrosis

Answer 10

Piecemeal necrosis is defined as the appearance of destroyed hepatocytes and lymphocytic infiltration at the interface between the limiting plate of periportal hepatocyte, parenchymal cells and portal tracts

Question 11

What does lobular inflammation look like

Answer 11

Question 12

Describe the outcome of hepatitis B virus

Answer 12

• Fulminant acute infection - death
• Chronic hepatitis
• Cirrhosis
• Hepatocellular carcinoma
• Asymptomatic - Carrier

Question 13

What is the outcome of hepatitis C

Answer 13

• Chronic hepatits
• Cirrhosis

Question 14

What are other causes of chronic hepatits

Answer 14

• Hepatitis B, C
• pirmary biliary cirrhosis
• Autoimmune hepatits
• Drug induced hepatitis
• Primary Sclerosing cholangitis

Question 15

Describe primary biliary cirrhosis

Answer 15

• Rare autoimmune disease - unknown cause
• Associated with autoantibodies to mitochondria
• Females - 90%
• Biopsy - to stage doisease
• Presence of granulomas and bile duct loss
• Outcome: unpredictable

Question 16

Descirbe the histological features of primary biliary cirrhosis

Answer 16

• Dese lymphocytic infiltrate in porta tracts
• Inflammation of bile duct
• Granuloma around duct

Question 17

What does inflammed bile duct look like

Answer 17

Question 18

What does the duct granuloma look like

Answer 18

Question 19

What is the complication of primary BC

Answer 19

• Cholestasis
• Liver injury
• inflammation
• fribrosis and cirrhosis

Question 20

What is autoimmune hepatitis

Answer 20

Chronic self perpetuating inflammatory liver disease of unknown cause mainly occurring in females of all ages and ethnic groups

• Associated with other AI diseases
• Pattern is similar to chronic hepatitis
• Numerous plasma cells
• Autoantibodies to - SM, nuclear, LKM and raised IgG
• Trigger : drugs

Question 21

Describe chronic drug induced hepatitis

Answer 21

• Similar features to all other types of chornic hepatitis
• May lead to autoimmune hepatits
• loads to causes