Tutorial title - Hepatobiliary System - Patterns of Liver injury & repair
18 important questions on Tutorial title - Hepatobiliary System - Patterns of Liver injury & repair
What is the principle cell in scar formation and what happens when chronic injury is interrupted?
- The principle cell in scar formation is the stellate cell.
- Activated into highly fibrogenic myofibroblasts.
- Scar deposition begins in space of disease.
- When chronic injury is interrupted, stellate cell activation ceases, leading to scar condensation and thinning.
- MMPs break apart the scars, resulting in scar reversal.
What are the components of LFTs in hepatitis investigations and their significance?
- Bilirubin levels: Elevated levels indicate liver dysfunction.
- AST, ALT levels high: Suggest hepatocellular injury.
- ALP, GGT elevated: Indicate obstruction.
Describe the characteristics of cirrhosis as mentioned.
- Cirrhosis involves progressive injury and fibrosis.
- It develops nodules of regenerating hepatocytes surrounded by scars.
- Nodules can be micronodular (less than 3mm) or macronodular (greater than 3mm).
Keywords: cirrhosis, fibrosis, nodules, micronodular, macronodular.
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What are the mechanisms of toxic hepatitis?
- Dose-dependent mechanism: Involves pharmacological hepatotoxicity, direct hepatocyte damage, or blocking metabolic processes. Example: Carbon tetrachloride (CCl₄) or paracetamol (acetaminophen).
- Idiosyncratic mechanism: Unpredictable, not dose-dependent, due to enzyme deficiency. Example: Stevens-Johnson Syndrome, lack of enzymes to metabolize drugs, making them toxic regardless of dose.
What is the role of serum biochemistry in hepatitis investigations?
- Urea: Assesses glomerular filtration rate.
- Creatinine: Evaluates kidney function.
- Electrolytes: Checks for imbalances.
What is ductular reaction and its association with liver disease?
What are the markers of reversible cell injury in the liver?
- All swelling due to increased water accumulation (hydropic change).
- Increased permeability from failure of the Na+/K+ ATPase pump.
- Intracellular accumulation of substances like copper (Wilson's disease), iron (hemochromatosis), and fat (steatosis).
How is toxic hepatitis diagnosed?
- Ruling out other causes of jaundice.
- Looking at risk factors.
- Conducting a history and physical exam.
Describe the blood serology and radiology methods used in hepatitis investigations.
- Blood serology: Tests for antibodies and nucleic acid for hepatitis viruses.
- Radiology: Utilizes ultrasounds, CT, and MRI for imaging.
List the primary diseases of the liver mentioned.
- Viral hepatitis
- NAFLD
- Alcoholic liver disease
- Hepatocellular carcinoma
How is necrosis characterized in liver injury?
- Predominance in ischemic/hypoxic injury.
- Cell swelling, membrane blebs, and cell rupture.
What are the clinical features of hepatitis?
- Features of acute phase response (non-specific).
- Jaundice.
- Hepatomegaly or splenomegaly.
- Right upper quadrant pain.
- Pedal edema.
- Dark urine color change.
- Changes in stool.
- Easy bruising and spontaneous hemorrhage.
- Anasarca.
- Features of hypoglycemia.
- Features of hepatic encephalopathy.
- Confusion that may progress to coma.
- Weight loss.
- Bilirubinuria.
What are the complications associated with hepatitis?
- Water & electrolyte imbalances: Causes dehydration, acidosis, hypokalemia.
- Chronic carrier state: Leads to viral hepatitis infections.
- Cholestatic hepatitis
- Fulminant hepatitis
- Liver cirrhosis
- Malignant transformation: Leads to hepatocellular carcinoma.
What are the secondary diseases of the liver listed?
- HF
- Extrahepatic infections
- Metastatic tumors
What distinguishes apoptosis in liver diseases?
- Seen in many forms of liver disease.
- Characterized by hepatocyte shrinkage, nuclear chromatin condensation (pyknosis), and nuclear fragmentation (karyorrhexis).
- Cellular fragmentation into acidophilic apoptotic bodies (councilman bodies).
Explain the function and significance of α-1 Antitrypsin in liver health.
- Prevents protease destruction: Protects against inflammation.
- Deficiency: Causes emphysema and liver destruction.
How is hepatitis classified based on time frame and etiology?
- Acute: < 26 weeks.
- Chronic: > 26 weeks, almost always fibrosing.
- Infective: Hepatitis viruses A, B, C, D, F, & G.
- Non-infective: Toxic hepatitis (alcohol), autoimmune hepatitis, iatrogenic (paracetamol, Wilson's).
What are the mechanisms of damage in viral hepatitis?
- Cytopathic mechanism: Structural alteration of the host cell by the virus without the immune system.
- Immunogenic mechanism: Immune-mediated injury where the immune response attacks infected hepatocytes presenting viral Ag on MHC Class I to CD8+ then to CD4+ (inflammation).
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