Chronic Hepatitis Quiz

Liver Anatomy

• The liver is 1400-1600 gm in adults.
• It has a dual blood supply: portal vein (60-70%) and hepatic artery (30-40%).
• Portal tracts contain portal veins, hepatic arteries, and bile ducts.
• The liver is divided into lobules (1-2 mm).
• Lobules are oriented around the terminal hepatic veins.
• Portal tracts are at the periphery of lobules.
• Hepatocytes are organized into sheets or plates.
• Vascular sinusoids are between the plates.
• Space of Disse is beneath endothelial cells.
• Kupffer cells are in the space of Disse.
• Myofibroblastic hepatic stellate cells also reside in the space of Disse.

Liver Histology

• Liver lobules are 1-2 mm in diameter.
• Hepatic architectural structures are based on a lobular model.
• The portal vein branches, hepatic arteries and bile ducts travel in parallel.
• Hepatocytes near the terminal hepatic vein are centrilobular, and those near the portal tract are periportal.
• Hepatocytes are organized into anastomosing sheets or plates, extending from portal tracts to terminal hepatic veins.
• Vascular sinusoids separate the plates.
• The space of Disse contains stellate cells (mononuclear phagocyte system) and is beneath endothelial cells.

Liver Acinus

• A functional unit of the liver from a metabolic perspective.
• Centered on the line connecting two portal triads.
• Extends outward to the two adjacent central veins.

Liver Cords and Sinusoids

• Hepatocytes are organized into cords that are separated by sinusoids.
• Blood-filled sinusoids contain blood, Kupffer cells, and the space of Disse.
• Hepatocytes line the sinusoids.
• Stellate cells reside in the space of Disse.
• Endothelial cells line the sinusoid lumen.

Normal Liver Structure

• Histologically divided into lobules.
• Functionally divided into 3 zones, based on oxygen supply.
• Zone 1 encircles portal triads - oxygenated blood from hepatic arteries enters.
• Zone 3 surrounds the central vein - poor oxygenation.
• Zone 2 is between Zone 1 and Zone 3.

Portal Triad

• Interlobular connective tissue. Branch of the portal vein, hepatic artery, and bile duct.

Liver H&E Staining

• Basic histological staining procedure for visualization of specific features.

Liver Histology Micrographs

• Microscopic images of stained liver tissue.
• Portal vein, hepatic artery, and bile duct identification.
• Connective tissue interface.

Gross Images

• Visual representations of liver with cirrhosis, showing nodules of fat.

Microscopic Description

• Diffuse disruption in the liver architecture.
• Bridging fibrous septa.
• Roundish parenchymal nodules of regenerating hepatocytes.

Interface Hepatitis

• Inflammation between inflamed portal tracts and periportal parenchyma.
• Inflammatory cells.
• Portal tracts and periportal parenchyma.

Giant Cell Transformation

• Hepatocytes with 6 or more nuclei.

Mallory Hyaline

• Irregular, rope-like inclusions of cytokeratin.
• Often seen in ballooning cells (alcoholism).

Microvesicular Steatosis

• Multiple tiny intracytoplasmic fat droplets that do not displace the nucleus.

Macrovesicular Steatosis

• Single large intracytoplasmic fat droplet which displaces the nucleus.

Cirrhosis

• Diffuse nodulation of liver due to fibrous bands.
• Fibrous bands divide liver into regenerative nodules.
• Common causes include chronic viral hepatitis, fatty liver disease, autoimmune hepatitis, primary biliary cholangitis, and drug-induced liver injury.
• Chronic cirrhosis can regress.

Child-Pugh Classification

• Scoring system for assessing severity of cirrhosis.
• Factors such as bilirubin, albumin, prothrombin time, and encephalopathy are measured and scored to determine a class, from A (less severe) to C (more severe).
• Used to determine the appropriate treatment, such as transplantation.

Hepatocyte and Parenchymal Responses

• Necrosis of hepatocytes, due to cluster of macrophages—indicating tissue damage.
• Acidophil bodies are seen after cell death; they represent debris from hepatocytes.
• Councilman bodies (acidophilic bodies) represent single cell death.

Ballooning (Feathery) Degeneration

• Hepatocyte swelling with increased pale cytoplasm.

Bridging Necrosis

• Necrotic cells span adjacent lobules.

Centrilobular Necrosis

• Necrotic hepatocytes around central vein.
• Usually result from ischemia, drugs, or toxins.

Portal Hypertension

• Increased resistance to portal blood flow.
• Prehepatic, intrahepatic, or post-hepatic conditions are obstructive thrombosis, severe right-sided heart failure, constrictive pericarditis, or hepatic vein outflow obstruction.
• Four consequences include ascites, portosystemic venous shunts, congestive splenomegaly, and hepatic encephalopathy.

Ascites

• Accumulation of excess fluid in the peritoneal cavity.

Hepatic Encephalopathy

• Spectrum of disturbances in consciousness.
• Fluctuations in neurological signs (rigidity and hyperreflexia).
• Asterixis (nonrhythmic, rapid extension-flexion movements).
• Disorder of neurotransmission in the central nervous system.
• Elevated ammonia correlates with impaired neuronal function.

Hepatitis A, B, C, D, E Viruses

• Different viruses that cause liver inflammation (hepatitis).
• Routes of transmission, symptoms, prevention, and typical outcomes (acute or chronic).

a₁-Antitrypsin Deficiency

• Autosomal recessive disorder of protein folding.
• Low levels of circulating a₁-antitrypsin.
• Inhibition of proteases (neutrophil elastase, cathepsin G, and proteinase 3).
• Pulmonary emphysema and liver disease.
• Cytoplasmic, globular inclusions in hepatocytes.

Wilson's Disease

• Autosomal recessive disorder of copper metabolism.
• Defective ATP7B gene leads to impaired copper excretion.
• Copper accumulates in the liver, brain, and eyes.
• Kayser-Fleischer rings are a hallmark diagnostic finding from copper accumulation in the eyes.

Alcoholic Liver Disease

• Excessive alcohol consumption is the leading cause.
• Three distinctive forms of alcoholic liver injury:
  • Hepatocellular steatosis.
  • Alcoholic hepatitis.
  • Steatofibrosis.
• These forms are overlapping, and can transition into each other as the disorder progresses.

Alcoholic Steatofibrosis

• Chronic alcoholic hepatitis is accompanied by prominent activation of sinusoidal stellate cells and portal fibroblasts resulting in fibrosis.

Interface Hepatitis ("Piecemeal Necrosis")

• Inflammation at the interface between the connective tissue and liver parenchyma.
• Severity classified according to how widely the inflammation spreads or the proportion of involved portal tracts (focal or diffuse).

Hemochromatosis

• Excessive iron absorption causing iron deposition in parenchymal organs.
• Golden-yellow hemosiderin granules in the hepatocytes.
• Micronodular cirrhosis.

Test your knowledge on the histological features and patterns associated with chronic viral hepatitis and autoimmune hepatitis. This quiz covers critical aspects such as interface hepatitis, cellular changes, and demographic prevalence. Perfect for students and professionals in the field of hepatology.