Date post: | 02-Nov-2014 |
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"It's not the will to win, but the will to prepare to win that makes the
difference."
Bear Bryant1913-1983, Football Coach
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Pathology of Common Liver Disorders
Dr. Venkatesh M. Shashidhar.Assoc.Prof & Head of Pathology
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Viral serology interpretation:HBsAg Positive, Anti HBcAg PositiveAnti HBcAg IGM NegativeAnti HBsAg Negative
1 2 3 4 5
41%
7%
0%
26%26%
A. Acute Viral HepatitisB. Immunised against Hep. BC. Chronic Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis B
IgM anti-HAV antibody
Acute Hepatitis A
HBsAg Hepatitis B or carrier – exp./inf.
HBeAg Active hepatitis B infection
Anti-HCV antibody Hepatitis C virus exposure
HCV RNA Active hepatitis C infection
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?
A. B. C. D. E.
20% 20% 20%20%20%A. Chronic Passive Hepatitis BB. Chronic Viral Hepatitis AC. Hepatitis CD. Alcoholic Hepatitis.E. Transfusion Haemochromatosis.
5
51y M, Alcoholic: Look at Arrow ? Pathogenesis.
1 2 3 4 5
0% 0% 0%
13%
88%
A. Porta-systemic shuntB. Hyper-oestrogenemiaC. Portal hypertensionD. Hypo-albuminemiaE. Decreased vit-K
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?
1 2 3 4 5
18%
29%
12%
29%
12%
1. Acute Alcoholic hepatitis.2. Drug induced Hepatitis.3. Fulminant Hepatitis.4. Nutmeg liver (venous congestion)5. Budd Chiari Syndrome.
42y M, alcoholic, recurrent fatigue 3 years. Liver biopsy. ? Diagnosis
1 2 3 4 5
0% 0%6%
0%
94%
A. Acute HepatitisB. Chronic Active hepatitis.C. Chronic Persistant hepatitis.D. Fulminant Hepatitis.E. Cirrhosis.
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?
1 2 3 4 5
65%
0% 0%
29%
6%
1. Acute Alcoholic hepatitis.2. Drug induced Hepatitis.3. Fulminant Hepatitis.4. Acute Viral hepatitis5. Budd Chiari Syndrome.
Pathogenesis - typical of which virus?
1 2 3 4 5
100%
0% 0%0%0%
1. HAV2. HBV3. HCV4. HDV5. Non Specific
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?
1 2 3 4 5
59%
6%
0%0%
35%
1. Hepatic failure – cirrhosis.2. Hepatic encephalopathy.3. Hepatorenal syndrome.4. Chronic renal failure.5. Budd Chiari Syndrome.
A 42year travelling salesperson has routine medical test for insurance. Following initial testing he was advised liver biopsy. This is a image of his Liver Biopsy. What is the most likely diagnosis?
A. B. C. D. E.
31%
0% 0%
19%
50%
A. Acute Viral HepatitisB. Alcoholic hepatitis.C. Chronic viral Hepatitis. D. Post viral cirrhosis.E. Alcoholic Cirrhosis.
69y Female, Chronic bronchitis. Died following chronic Cardiac failure. Liver specimen. Likely diagnosis?
1 2 3 4 5
0%7%
14%
79%
0%
A. Alcoholic Hepatitis B. Dubin-Johnson SyndromeC. Alcoholic cirrhosisD. Nutmeg liverE. Metastatic deposits
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Viral serology interpretation:HBsAg Negative, Anti HBcAg Ab NegativeAnti HBcAg IGM NegativeAnti HBsAg Ab PositiveA. Acute Viral Hepatitis
B. Immunised against Hep. BC. Past Hepatitis BD. Hepatitis B carrier stageE. Fulminant hepatitis B
28y M, alcoholic, homosexual icterus and fever. Liver biopsy. ? diagnosis
A. B. C. D. E.
80%
0%
10%
0%
10%
A. Acute viral hepatitisB. Hemolytic anemiaC. Chronic persistent hepatitisD. Alcoholic fatty liver.E. Alcoholic Hepatits.
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Viral serology interpretation:
1 2 3 4 5
0% 0% 0%
50%50%
HBsAg Negative, Anti HBsAg Ab PositiveAnti HBcAg Ab PositiveAnti HBcAg IGM NegativeA. Acute Viral Hepatitis B
B. Immunised against Hep. BC. Past Hepatitis BD. Hepatitis B carrier stageE. Carrier state of Hepatitis B
58y M, alcoholic, distended abdomen & icterus. Liver biopsy. ? diagnosis
1 2 3 4 5
0% 0%
50%
0%
50%
A. Chronic active hepatitis.B. Chronic Persistant hepatitis.C. Hepatocellular carcinoma.D. CirrhosisE. Chronic alcoholic hepatitis.
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Lab Investigations interpretation:
A. B. C. D. E.
57%
14%
0%
14%14%
Protein (Total) 59 g/LAlbumin 30 g/LGlobulin 29 g/LBilirubin (Total) 27 μmol/LALP 71 U/LGGT 523 U/LALT 79 U/LAST 151 U/L
A. Alcoholic Liver diseaseB. Acute Viral Hepatitis.C. Past Hepatitis BD. Hepatitis B carrier stageE. Carrier state of Hepatitis B
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51y M, Alcoholic: Look at Arrow ? Pathogenesis.
1 2 3 4 5
0%
81%
0%
13%6%
A. Porta-systemic shuntB. Hyper-oestrogenemiaC. Portal hypertensionD. Hypo-albuminemiaE. Decreased vit-K
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Lab Investigations interpretation:
A. B. C. D. E.
33% 33% 33%
0%0%
Urea 5.8 mmol/LCreatinine 80 μmol/LProtein (Total) 66 g/LAlbumin 35 g/LGlobulin 31 g/LBilirubin (Total) 192 μmol/LBilirubin (Conj.) 130 μmol/LALP 203 U/LGGT 470 U/LALT 6055 U/LAST 4860 U/L
A. Alcoholic Fatty liverB. Past Hepatitis B C. Acute Viral Hepatitis.D. Hepatitis B carrier stageE. Chronic Hepatitis
62 year Male, malaise, lethargy since 2 years. Liver mildly enlarged. No jaundice. Liver function tests normal. Image from liver biopsy. Most likely diagnosis?
A. B. C. D. E.
33%
67%
0%0%0%
A. Alcoholic fatty liver. B. Acute viral hepatitis.C. Fulminant hepatitis.D. Chronic viral hepatitis.E. Alcoholic Cirrhosis.
MG, 29 year old man presents with arthritis, darkening of skin and fatigue since 3 years. He has also recently developed congestive cardiac failure. His Hb A1c is 11.2%. Image shows his liver biopsy stained with Prussian blue stain for iron. Most likely diagnosis?
A. B. C. D. E.
0% 0% 0%0%0%
A. Cirrhosis of liver. B. Hemosiderosis.C. Hemochromatosis.D. Wilson’s disease.E. Chronic pancreatitis.
22y M, alcoholic, 3wk fatigue, icterus & fever. Liver biopsy. ? Identify the structure
1 2 3 4 5
0%
33% 33%33%
0%
A. Mallory hyalineB. Apoptotic cellC. Viral inclusionD. Hepatocyte necrosisE. Inflammatory cell
34y M, icterus and fever. Liver biopsy. ? diagnosis
1 2 3 4 5
0%
100%
0%0%0%
A. Acute HepatitisB. Chronic Persistent Hepatitis.C. Chronic active HepatitisD. Fulminant HepatitisE. Cirrhosis
56y chronic alcoholic, 2 days fever, abdomen distended, tender, tap yielded cloudy yellow fluid with 98% neutrophils, Blood culture E.coli. Patient dies 3 days later. Image shows his liver.
1 2 3 4 5
0% 0% 0%0%0%
A. A1 antitrypsin deficiencyB. HEV infectionC. Hereditary hemochromatosisD. Primary sclerosing cholangitisE. Alcoholic cirrhosis
22y M, alcoholic, 3wk fatigue, icterus & fever. Liver biopsy. ? Identify the structure
1 2 3 4 5
0% 0% 0%0%0%
A. Mallory hyalineB. Apoptotic cellC. Viral inclusionD. Hepatocyte necrosisE. Inflammatory cell
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Learn from the mistakes of others. You can't live long enough to make them all yourself…!
61% of 5th year students exceeded ‘sensible’ limitsDrugs and alcohol were taken mainly for pleasure and were perceived as a normal part of life for many students… Capability of advising patients…?
http://www.lycaeum.org/research/researchpdfs/1996_webb_1.pdf
51y M, Alcoholic, surgery for pigmented skin lesion: Liver specimen. Likely diagnosis?
1 2 3 4 5
0% 0% 0%0%0%
A. Amoebic Liver abscessesB. Multiple Liver InfarctsC. Alcoholic HepatitisD. Macronodular cirrhosisE. Metastatic deposits
59y Male, Alcoholic, presents with fatigue, anorexia. Normal liver function tests. Liver specimen. Likely diagnosis?
1 2 3 4 5
0% 0% 0%0%0%
A. Dubin-Johnson SyndromeB. Alcoholic cirrhosisC. Alcoholic HepatitisD. Fatty LiverE. Metastatic deposits
28y Male, 3 weeks after visiting east Timor, presents with malaise, fatigue, loss of appetite. Mild icterus. AST & ALT mild elevation. Total bil 3.9mg/dl (Direct 2.8). Which of the following would be positive?
1 2 3 4 5
0% 0% 0%0%0%
1. Anti HBs2. IgM anti-HDV3. Anti HCV4. IgM anti HAV5. Anti HBc
28y Male, 3 weeks after visiting east Timor, presents with malaise, fatigue, loss of appetite. Mild icterus. AST & ALT mild elevation. Total bil 3.9mg/dl (Direct 2.8). Which of the following would be positive?
1 2 3 4 5
0% 0% 0%0%0%
1. Anti HBs2. IgM anti-HDV3. Anti HCV4. IgM anti HAV5. Anti HBc
41y Female, increasing malaise, 10kg weight loss since last year. Developed coma and died. Specimen of her Liver. Most likely etiologic agent?
1 2 3 4 5
0% 0% 0%0%0%
1. Aspirin abuse2. Ferrous sulphate3. Acetaminophen4. Aflatoxins5. Raw Oysters.
A 48y man referred following high ALT in health screening. HCV immunoassay +ve. Past h/o appendectomy 10 years ago. Examination is normal. Which of the following tests would determine if he has Chronic HCV infection?
1 2 3 4 5
0% 0% 0%0%0%
1. Repeat EIA for anti HCV Ab.2. Recombinant immunoblot assay (RIBA)3. Alpha-fetoprotein levels.4. HCV RNA test.5. Direct, indirect & total bilirubin assay.
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Alcohol Metabolism: