Chronic Hepatitis Quiz

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Questions and Answers

What is the primary histological feature that defines chronic viral hepatitis?

Spotty necrosis in hepatocytes

Hepatocyte apoptosis

Fibrous septa in portal tracts

Mononuclear portal infiltration (correct)

What histological pattern is associated with interface hepatitis in chronic liver conditions?

Infiltration at the portal tract stroma (correct)

Inflammation within portal tracts

Necrosis of hepatocytes

Destruction of hepatocyte parenchyma

Which cell type is identified by swollen endoplasmic reticulum due to HBsAg in chronic hepatitis B?

Lymphocytes

Ground-glass hepatocytes (correct)

Kupffer cells

Fibroblasts

In advanced cases of chronic liver damage, what key feature develops alongside increasing scarring?

Ductular reaction reflecting stem cell activation Signup and view all the answers

What characterizes autoimmune hepatitis in relation to its demographic prevalence?

Female predominance Signup and view all the answers

Which test is considered the most sensitive and accurate for diagnosing Wilson disease?

Hepatic copper content analysis Signup and view all the answers

What is a characteristic ocular finding in patients with neurologic involvement of Wilson disease?

Kayser-Fleischer rings Signup and view all the answers

In Wilson disease, what region of the brain is primarily affected by toxic injury?

Basal ganglia Signup and view all the answers

What describes the inheritance pattern of α1-Antitrypsin deficiency?

Autosomal recessive Signup and view all the answers

What is the primary cause of ascites in 85% of cases?

Cirrhosis Signup and view all the answers

What is a key biochemical marker indicating α1-Antitrypsin deficiency?

Very low levels of circulating α1-Antitrypsin Signup and view all the answers

Which clinical sign is characteristic of hepatic encephalopathy?

Asterixis Signup and view all the answers

What is the major role of the hepatitis D virus (HDV)?

It requires hepatitis B virus for its replication Signup and view all the answers

What characterizes the fluid accumulation in ascites?

It is generally serous and may include few mesothelial cells Signup and view all the answers

Which of the following is NOT a major clinical consequence of portal hypertension?

Bacterial infection Signup and view all the answers

What is the main neurological disturbance associated with hepatic encephalopathy?

Coma and death Signup and view all the answers

In acute viral hepatitis, the portal inflammation is typically characterized as:

Minimal or absent Signup and view all the answers

What is a common clinical presentation in hepatic encephalopathy?

Hyperreflexia Signup and view all the answers

What is marked by plasma cell predominance in the mononuclear inflammatory infiltrates?

Autoimmune hepatitis Signup and view all the answers

What initiates all changes in alcoholic liver disease?

Zone 3 of the acinus Signup and view all the answers

Which of the following statements regarding hepatocellular steatosis is true?

Lipid droplet accumulation can begin after moderate alcohol consumption. Signup and view all the answers

What typically signifies the presence of alcoholic hepatitis?

Single or scattered foci of hepatocyte necrosis and swelling Signup and view all the answers

Which is a major consequence of alcoholic (steato-) hepatitis?

Activation of sinusoidal stellate cells Signup and view all the answers

Which structures are typically associated with alcoholic liver disease?

Mallory-Denk bodies Signup and view all the answers

What condition is primarily caused by excessive ethanol consumption?

Alcoholic liver disease Signup and view all the answers

What happens to lipid droplets in hepatocytes over time with chronic alcohol intake?

They coalesce into larger droplets. Signup and view all the answers

What is a characteristic feature of macrovesicular steatosis?

Displacement of the nucleus by a large fat droplet Signup and view all the answers

Which of the following is NOT a common cause of cirrhosis?

Acute viral hepatitis Signup and view all the answers

What complication is primarily associated with portal hypertension?

Hepatorenal syndrome Signup and view all the answers

Which symptom is specifically related to impaired liver function?

Ascites Signup and view all the answers

What is a potential outcome of fully established cirrhosis?

Possibility of regression of fibrosis Signup and view all the answers

Which of the following laboratory findings is typically associated with liver failure?

Hepatic encephalopathy Signup and view all the answers

Which of the following conditions is a major cause of post-hepatic portal hypertension?

Constrictive pericarditis Signup and view all the answers

Which symptom is indicative of impaired estrogen metabolism in liver disease?

Spider nevus Signup and view all the answers

What characterizes the pattern of perisinusoidal scarring in fibrosis?

A chicken wire fence pattern surrounding hepatocytes Signup and view all the answers

What is a classic morphological hallmark of hemochromatosis?

Golden-yellow hemosiderin granules in periportal hepatocytes Signup and view all the answers

What primarily causes Wilson disease?

Impaired copper excretion due to ATP7B gene mutation Signup and view all the answers

Which condition is characterized by the presence of micronodular cirrhosis?

Alcoholic cirrhosis Signup and view all the answers

Which of the following statements regarding Wilson disease is true?

Copper accumulates mainly in the liver and brain. Signup and view all the answers

What is a notable feature of alcoholic cirrhosis?

It leads to significant portal hypertension. Signup and view all the answers

What is the primary disorder in hemochromatosis?

Excessive iron absorption and deposition Signup and view all the answers

Which of these organs is NOT commonly affected by copper accumulation in Wilson disease?

Skin Signup and view all the answers

Study Notes

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.

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Description

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.