Liver pathology

• What is the weight range of the liver?

  1400 – 1600 g
• What percentage of body weight does the liver compose?

  1. 5%
• What is the blood supply distribution to the liver?

  60-70% portal vein, 30-40% hepatic artery
• What are the structural units of the liver?

  Lobule and Acini
• What are the main etiological factors of liver disease?

  • Metabolic
  • Infections
  • Toxins
  • Circulatory and neoplastic
• When does liver decompensation occur?

  When more than 80% is destroyed
• What do biochemical tests detect in liver disease?

  Early hepatocellular injury
• What are the types of cellular injury in liver disease?

  • Cell functional and structural disturbance
  • Cell necrosis
  • Inflammation
  • Regeneration and fibrosis
• What are the types of inflammatory liver diseases covered?

  • Alcoholic liver disease
  • Cirrhosis
  • Portal hypertension
  • Hepatic failure
  • HCC
• What are the hepatotropic viruses associated with viral hepatitis?

  • HAV
  • HBV
  • HCV
  • HDV
  • HEV
  • HGV
• How is HAV transmitted?

  Fecal-oral route
• What type of disease does HAV cause?

  Benign, self-limited disease
• What is the incubation period for HAV?

  1. 6 weeks
• Does HAV cause chronic hepatitis?

  No, it does not
• What type of virus is HBV?

  DNA ds virus
• What is the incubation period for HBV?

  1. 4 months
• What are the potential outcomes of HBV infection?

  • Sub-clinical disease: 100% recover
  • Acute hepatitis: 99% recover, 1% fulminant
  • Chronic hepatitis:
  • Recovery
  • Cirrhosis (20-30%)
  • HCC (2-3%)
  • Death
  • Transplant
• What is the significance of HBsAg in HBV infection?

  Indicates active infection and carrier state
• When does Anti HBs antibody rise?

  When acute disease is resolved
• What does IgM anti-HBc indicate?

  Hepatitis infection during the window period
• What does the persistence of HBeAg indicate?

  Continued viral replication and infectivity
• What type of virus is HCV?

  Single strand RNA virus
• What is the incubation period for HCV?

  1. 8 weeks
• What are the complications associated with HCV infection?

  • Chronic liver disease
  • Cirrhosis (20-30%)
  • HCC predisposition
  • Autoimmune reactions (e.g., vasculitis)
• What is the most common cause of liver-related deaths in the USA?

  Cirrhosis
• How does HDV depend on HBV?

  It requires HBV for its life-cycle
• What are some causes of cirrhosis?

  Alcohol, viral hepatitis, NASH, biliary disease
• What is the most reliable indicator of recent HDV exposure?

  IgM anti HDV antibody
• What characterizes end-stage chronic liver disease?

  • Bridging fibrous septae
  • Parenchymal nodules or regenerating hepatocytes
  • Disruption of liver architecture
• What is the transmission route for HEV?

  Enterically transmitted
• What happens to hepatocytes in cirrhosis?

  They die, leading to ECM deposition
• What is the mortality rate of HEV among pregnant women?

  20%
• What type of collagen replaces type IV in cirrhosis?

  Type I and III collagen
• What are the morphological features of hepatitis?

  • Scant mononuclear infiltrate
  • Necrosis or apoptosis
  • Balloon degeneration
  • Confluent necrosis around central veins
  • Ground-glass hepatocytes in chronic HBV
• What is the effect of collagen deposition in the space of Disse?

  Capillarization of sinusoids occurs
• What is the weight range of a liver affected by fulminant hepatitis?

  500 – 700 g
• What are the causes of bacterial infections in the liver?

  • Sepsis
  • Direct spread from bacteria
  • Pyogenic abscess
• What cells proliferate and convert into fibrogenic cells in cirrhosis?

  Stellate cells
• What are the characteristics of amebic abscess?

  • Trophozoites spread from colitis
  • Large abscess with anchovy sauce fluid
  • May rupture into the chest cavity
• What are the mechanisms through which liver damage occurs in cirrhosis?

  • Chronic inflammatory cells (TNF, IL-1Beta)
  • Cytokines/chemokines from various liver cells
  • Disruption of ECM
  • Direct stimulation by toxins