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1. Chapter 18
LIVER

2. Normal Liver

3. HEPATITIS
PATHOPHYSIOLOGY

5. N
O
FIBROUS
TISSUE

6. Normal Liver -Microscopy

8. Pathology of
Hepatitis

9. Types of Hepatitis
Hepatitis A –Infectious, oral/fecal
Hepatitis B –Serum, blood borne
Hepatitis C –Post transfusion, blood
Hepatitis D –with Hep B, drug use
Hepatitis E -Epidemic, fecal
contaminated water
Laennec’s –alcohol induced hepatitis

10. Pathophysiology of Hepatitis
Caused by acute viral infection,
toxicity, or drug induced
Liver is enlarged and congested
Distortion of lobular pattern
Results in increased portal circulation
pressure
Circulation then decreased to liver
Edema of biliary channels
Results in obstructive jaundice

11. Hepatitis A
Caused by enterovirus family
Fecal oral contamination
Children Group homes
Shellfish Water/food
Incubation 15 –50 days(2-3 weeks)
Mild flu-like signs and symptoms
Immune globulin within two weeks of
exposure

12. Hepatitis B
Skin/mucus membrane contamination
with blood or serous fluid
Lower concentrations of virus in saliva,
semen and vaginal fluid
Incubation: 48 -180 days
Usually young adults between 20 –39
Complications: chronic hepatitis,
cirrhosis, liver cancer.

13. Hepatitis C
Skin/mucus membrane exposure with blood
or serum
IV drug use tatoospiercings
toothbrushes razorsblood tx prior to 1992
needle sticks
Incubation: 21 –140 days (avg=7weeks)
90% develop chronic hepatitis
#1 cause of cirrhosis and liver cancer
Usually severe signs and symptoms

14. Hepatitis D
Seen with
Hepatitis B
Same
contamination
route as Hep B
Incubation: 14 –
56 days
Usually
asymptomatic

15. Hepatitis E
Waterborne virus
Contaminated water
in third world
countries = fecal oral
route
Incubation: 15 –64
days

16. NON-Viral hepatitides
Staph aureus(toxic shock)
Gram-Negatives(cholangitis)
Parasitic:
Malaria
Schistosomes
Liver flukes (Fasciola hepatica)
Ameba(abscesses)
AUTOIMMUNE
ALCOHOLIC HEPATITIS

17. Signs and Symptoms
Abdominal pain
Joint and muscle pain
Change in bowel function
Nausea, vomiting, anorexia
Lethargy, malaise
Fever (Hepatitis A)
Irritability

18. More Signs and Symptoms
Jaundice
clay colored stools
dark urine
Pruritis/urticaria
Skin abrasions
Rash

19. B

20. C
LESS common than B (one fourth)
LESSdangerous than B in the acute phase
MORElikely to go chronic than B
MOREclosely linked with hepatoma than B

21. Diagnostic Data
Elevated liver enzymes
ALT
AST
Alkaline phosphatase
Serum Bilirubin
Urine Bilirubin
Specific serum antibodies
ie: anti-HAV
ELISA

22. More Diagnostics
Liver biopsy –
chronic versus
acute
Extent of liver
damage
Helps to
determine a
prognosis

23. ACUTE HEPATITIS-Key morphologic
features
Enlarged liver
Parenchymal changes:
 balloning degeneration
 cholestasis
 steatosis
Hepatocyte necrosis
 apoptosis,bridging
necrosis,lobular disarray

24. Key morphologic features
REGENERATIVE CHANGES
SINUSOIDAL CHANGES
PORTAL TRACT CHANGES

25. CHRONIC HEPATITIS
PORTAL TRACT
INTERFACE HEPATITIS
BRIDGING INFLAM & NECROSIS
FIBROSIS
PORTAL,PERIPORTAL,BRIDGING
HBV: GROUND GLASS HEPATOCYTES.

27. BALOONING DEGENERATION

28. Chiefly Portal Inflammation

29. APOPTOSIS

30. “FEATHERY” DEGENERATION

31. FULMINANT HEPATITIS

32. “FULMINANT” Acute Viral Hepatitis

33. ACUTE HEPATITIS-Key morphologic
features
Enlarged liver
Parenchymal changes:
 balloning degeneration
 cholestasis
 steatosis
Hepatocyte necrosis
 apoptosis,bridging
necrosis,lobular disarray

34. Key morphologic features
REGENERATIVE CHANGES
SINUSOIDAL CHANGES
PORTAL TRACT CHANGES

35. CHRONIC HEPATITIS
PORTAL TRACT
INTERFACE HEPATITIS
BRIDGING INFLAM & NECROSIS
FIBROSIS
PORTAL,PERIPORTAL,BRIDGING
HBV: GROUND GLASS HEPATOCYTES.

36. Treatment
Rest
Diversional activities
Diet –High in carbs and calories; moderate
fat and protein
Meds –antiemetics ( No Compazine)
Inferon for Hepatitis B and C
antivirals for Hepatitis B

37. Treatment
Comfort –decrease odors
Liver transplant
Home care
Infection control
Long term rehabilitation
No hepatotoxic agents
Alcohol, acetaminophen,
Rest
Diet

38. Prevention Teaching
What would you teach?