HBV 

Hepatocytes whose cytoplasm is laden with HBsAG and has finely granular, eosinophilic appearance

_____ = non-env. ss RNA Pecorno virus

Ig's ?

Hep A 

self limiting but most potential for epidemic

fecal oral

IGM = Accute infection

IGG = past exposure, Immunity

_____ = env. DNA virus with long asympt. incubation

 _____ = Tell?

Where can infection be spread?

Chronic?

Hep B

DANE PARTICLE

sexual/parenteral rout -- mucus, semen, blood, saliva, vag, tears

NOT PRESENT IN STOOL

3) CHRONIC in 3-5%, fatal in 1-3%

95% of those infe cted in early life become carriers

Serologic MArkers for Hep B:

1) +Anti HBS IgG

2) +ANTI-HBE Ag

3)Which is present durring window?

4)  which is FIRST to arrise

5) Which means immunized?

6) Chrinic Infect shows what?

1) Means immunity, but not nec infection, because the vaccine only has HbS

2)  Resolvd infection  (E is not present in Vaccine)

3) HBc IgM

 4)HBsAg

5) Anti- HbS

6) HBsAG, HBeAG, HBcIgG (If E AG still around, still infective)  FOR MORE THAN 6 MONTHS

Hep C

Post transfusion

IV DRUG, Parents, Homosexuals

MAJOR cause of chronic liver DZ -- 50% acute cases

HEP c:

Serologic Markers:

Tests?

Anti HCV (IGM AND IGG) = infectio / recovery

does NOT confer immunity

***CIRCULATING RNA PERSIST DISPITE ABs***

 TESTS:

pos RIBA and HCV RNA indicate INFECTION

Pos RIBA and NEG HCV RNA = RECOVERY

What does hep D require from B?

HEP D:

Serology

IgM anti HDV

       -indicator of recent exposore and acute infect

IgG anti HDV

     - Marker of previous infection

       -imparts immunity

nonenv ss RNA virus

Water born

Endemic to africa and asia

slef limiting

______________

*** Where is it DANGEROUS***

Hep E

PREGNANT FEMALES -- 20% mortality rate

ATP7B

liver cell NECROSIS with foci of NEUTROPHILS

Mallory bodys (Alch hyalin)

Eosinophilic intracytoplasmic inclusions

Fibrosis of sinusoids and perivenular

Fat may or may not be present

Describe alch Cirrhosis:

***Name?**

Initially micronodular

Perisinusoidal collagen 

     --> Portal fibrosis, bile duct prolif

****Lannec's Cirrhosis = Parenchymeal nodules from surface

>100g/day 15-20 years

ALCH INJESTION

Hobnailed Parenchymal nodules ffrom surface

ZONE 1 -- Centrilobular

**the one on outside of the lobile

Lobular dissaray:

Cell swelling causes compression of vasc sinusoids and loss ofnormal radial array of hepatocytes

Ballooning and feathery degeneration

Councilman bodies = Apoptotic bodies

Can occur with any hep, Uncommon with A

dev in 1% of Hep patients wwithin 24 hours ---  60-90%death

Common with older

Fulminant Hep = MASSICE necrosis, with 25-90% mortality

Most Massive Necrosis = death, 

submassive necrosis --> Cirrhosis

Difference between massive and submassive?

Massive: 

Panlobular Necrosis

Bile Duct prolof

Lymph infiltrate

Submassive:

 NOT panlobular necrosis

outer 1/3 of liver lobule preserved

This dz occurs mainly in young women

Arthritis, rash

Sjoren's syndrome, thyroiditis, ulcerative colitis

High serum ABs in 80%

ANA (Antinuc AB)

AMA (AntiMitoch AB)

ASMA (Anti Smooth Musc AB)

Chronic Autoimmune Hep

Hypergammaglobulinemia

INCRESED Plasma Cells

Piecemeal necrosis

REsp well to immunosuppression

TF

Viral Hep is more common in Men

Piecemeal necrosis is a hallmark of ______

What other type of  necrosis is assoc?

Chronic Hep

Piecemeal = near portal triad

Centro-Lobar = near portal vein

Bridging

Hereditary hemochromatosis = excessive intestinal Fe absorp

Net accumulation of:

treatment?

.5 - 1 gm/year

phlobotomy or Fe Cleaters

1)  Microskelital steatosis = ______

2) Lung Dz = __________ 

3)  Cytoplasmic Globular inclusions -- PAS positive diastase resistant

1)  Reye's syndrome -- Aspirin and Viral infection

2)  Alpha-1 Antitrypsin

3)  Alpha-1 Antitrypsin

What CHROM

1) HHE

2)  Wilsons Dz

3)  Alpha 1 Antitrypsis

1)  6

2)  13

3)  14

HHC -- Chrom 6

Hereditary

PiMM -- Normal (90%)

PiZZ -- Abnormal (10%)

Pi-Nill -- No serum A1At

**** Diastase resistant Globules***

Cavernous Hemangioma

Female Predominance

Most Asymptomatic

               pain if symptomatic

GIANT if >10 cm

Central fibrosis

Most common benign tumor

Large blood filled space lineed by endotherelial cells and some fibrous tissue   ---

***NO hepatocytes present in lesion

Liver cell ADENOMA

Proliferating hepatocytesw with no BILE DUCTS of FIBROUS TISSUE

Diff between:

Liver Cell Adenoma

and 

Focal Nodular Hyperplasia

1) No Scar

No Bile Ducts

Dilated Sinusoids

May rupture

Assoc with OCP (Oral contraceptive pills)

2) Cnentral Scarring

Bile Duct inflamm

inconspicuous Sinusoids

? OCP assoc

wHAT is most directly assoc with the global distribution of Hepatocellular carcinoma>

1 main, 3 others

HEP B

Also with Alch, HCV, Hemachromatosis

[image]

CD ___ stains endotherlial sells surrounding normal or malig hapatocytes -- allows to see thickness of cords

2)  

What Serum comp is elevated in 75 % of HCC Cases?

34

Very obvious

-----------------------

2) Serum AFP

Serum AFP means what?

fals pos?

HCC Hepatocellular Carcinoma

Treatment -- Resection -- NOT transplant

False pos = cirrhosis, necrosis, chronic hep, preg, yolk sac tumor, preg, fetal distress

This type of HCC has a better prognosis, is assoc with YOUNGER POP, and arrises predom in NONCIRRHOTITC livers

This is a rare malignancy of the bile ducts,

presents with painless jaundice

NOT assoc with cirrhosis

____ = risk facots

Cholangiocarcinoma

Thorotrast, liver flukes, PSC

______= most common hepatic tumor of neonates and young children  1-5%

AFP elevated 80-90%

Present with abd mass

Rapidly progressive, resist to chemo

*** 2 types -- name***

Hepatoblastoma

Epithelial type

                -Hyperchromatic fetal hepatocytes

Mixed type

             - Epithelial tissue with mesenchyme

____ = Aggressive malignancy of endothelial cells

Risk Factors?

Angiosarcoma

Vinyl chloride, arsenic, thorotrast

chronic lymphedema

aplha - 1 antitrypsin,

alphafetoprotein,

bile

are often found in ______