Hepatitis & Cirrhosis. Dr. Gehan M ohamed Dr. Abdelaty Shawky. Learning objectives. Understand the normal Liver Functions so can predict what is the clinical picture when liver failure occur. Recognize definition of hepatitis and discuss its types(Acute, Chronic, Fulminant).
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Dr. Gehan Mohamed Dr. Abdelaty Shawky
Hepatitis is necro-inflammatory liver disease characterized by the presence of inflammatory cells in in the portal tracts then spillover to neighboring parynchmatous liver cells .
1. Viral: hepatotropic (A, B, C, D….) and non-hepatotropic (cytomegalovirus and Epstein bar virus).
3. immune mediated: autoimmune hepatitis.
4. Drug induced.
5. Metabolic disorders: Hemochromatosis (due to iron accumulation) and Wilsons disease (copper accumulation) can cause liver inflammation and necrosis.
1. Clinical picture.
2. Laboratory investigations.
3. Histopathologic diagnosis of liver biopsy.
1. Ultrasound examination to detect any biliary stones, hepatomegaly.
2. Serologic examination to detect :
a- Elevated hepatic enzymes as
- aspartate aminotransferase(AST)
- alanine aminotransferase(ALT).
b- Viral hepatitis markers as HBV sAg, HCV Antigen and Antibody
c- Autoantibodies as in case of autoimmune hepatitis.
d- Polymerase chain reaction(PCR) to identify the virus.
I. Portal tracts show:
a. Piece meal necrosis: necrosis of the hepatocytes at the limiting plate.
b. Portal tract inflammation:
III. Fibrosis & Cirrhosis.
Grading of chronic hepatitis by assessing the degree of activity:this is done by examining 4 parameters; portal inflammation, piece meal necrosis, focal (spotty) necrosis and confluent necrosis. The degree of activity is graded as mild, moderate and marked according to the score of these parameters.
Histopathology show ground glass hepatocytes, which are seen in chronic hepatitis B infections represent accumulations of viral antigen in the endoplasmic reticulum. H&E
Histopathology show lymphoid aggregates and fatty change of the hepatocytes, which are characteristically seen in chronic hepatitis C infections
Chronic Diffuse, irreversible disorder of the liver characterized by;
A. Congenital cirrhosis:
1. Post-hepatitic (viral).
3. Biliary cirrhosis.
4. Cirrhosis caused by circulatory disorders e.g. chronic right sided heart failure.
1. Liver cell Failure
2. Portal hypertension
3. Hepatocellular carcinoma.
1. Jaundice: yellow colour of skin ,mucosa due to hyperbilirubinemia as liver became unable to conjugate bilirubin so it not secreted in urine and so it is reabsorbed by blood and precipitate in tissues.
2. Coagulopathy:→ bleeding tendency
3. Hypoproteinemia specially albumin → decrease osmotic pressure of blood → generalized edema
4. Hepatic Encephalopathy: caused by the inability of the liver to detoxify amonia which produced by effect of intestinal bacteria on food so this amonia can affect brain causing coma.
5. Hyperestrogenemia due to decrease estrogen degradation by the diseased liver leading to gynaecomastia and testicular atrophy in males
1. Varices: esophageal varices, piles.
2. Splenomegaly due to splenic congestion.
3. Ascites which is accumulation of transudate in the peritoneal cavity.