Chapter 11 Hepatic Diseases
Chapter 11 Hepatic Diseases 1
Normal adult liver weights: 1400 to 1600 gm Dual blood supply: portal vein; hepatic artery bule Acinus normal adult liver Central vein(CV) (terminal hepatic vein Z ones 32 Portal tracts at three ofits apices: PV(branches of the portal vein) HA(Hepatic Artery BD (Bile duct HA- BD hepatic lobule(肝小叶): hepatic micro-architecture
Normal adult liver weights:1400 to 1600 gm Dual blood supply: portal vein; hepatic artery hepatic lobule (肝小叶): hepatic micro-architecture. Central vein (CV) (terminal hepatic vein) Portal tracts at three of its apices: PV (branches of the Portal Vein) HA (Hepatic Artery ) BD (Bile Duct ) 2 normal adult liver
3 cords of hepatocyte hepatic cords Micro-architecture of sinusoid Acinus is lined by fenestrated and discontinuous Endothelial HSCS cell collagen hbors acE 32 T Vascular sinusoids Hepatocytes Bile canaliculus NORMAL LIVER (HSCs: hepatic stellate cells)
cords of hepatocyte : hepatic cords Vascular sinusoids Micro-architecture of sinusoid HSCs (HSCs: hepatic stellate cells) is lined by fenestrated and discontinuous 3
iral hepatitis(病毒性肝炎) This disease-- infective one of the liver caused by a group of hepatitis virus. These viruses ---have a particular affinity for the liver, and cause similar morphologic features of disease Main morphologic changes--- hepatocyte injury and necrosis with inflammation
Viral hepatitis (病毒性肝炎) This disease--- infective one of the liver caused by a group of hepatitis virus. These viruses ---have a particular affinity for the liver, and cause similar morphologic features of disease. Main morphologic changes --- hepatocyte injury and necrosis with inflammation. 4
Etiologic agents: Hepatitis viruses -A. B. C. D. E. The hepatitis viruses(p251, 11-1) HAy HBv HCV ADDy HEy Year of idenification 1973 1965 1989 1977 1980 nn 42. nm 30-60nm 35-nm 32-34nm Agent Icosahedral Enveloped Enveloped Enveloped SsRNA; Unenvelope capsid, SsRNA dsDNA SSRNA replication defective d ssRNA Classification picornavirus hepadnavirus flavivirus unknown caliciviridae #r Transmission fecal-oral close contact fi close contact contact waterborne Incubation period(weeks) 2-6 4-26 2-26 Fuminant 0.1-0.4% rare 4% in coinfection 0.3-3% hepatitis 20% in pregnant women Carrier state None 0.1-1% 0.2-1% 1-10% None Chronic 5-10% >70% 5 coinfection None hepatiti 80% superinfection H Carcinoma No Y No
Etiologic agents: Hepatitis viruses — A．B．C．D．E. The hepatitis viruses (p251, 11-1) HAV HBV HCV HDV HEV Year of idenification 1973 1965 1989 1977 1980 Agent 27-nm 42-nm 30-60nm 35-nm 32-34nm Iscosahedral capsid, ssRNA Enveloped dsDNA Enveloped ssRNA Enveloped ssRNA; replication defective Unenvelope d ssRNA Transmission fecal-oral close contact 血 close contact contact waterborne Classification picornavirus hepadnavirus flavivirus黄 unknown caliciviridae 杯 Incubation period (weeks) 2-6 4-26 2-26 4-7 2-8 Fuminant hepatitis 0.1-0.4% 70% <5 coinfection None 80% superinfection H. Carcinoma No Yes Yes No No 5
HBV(Hepatitis B Virus) Etiologic agent of most viral hepatitis----in China 病毒性肝炎 glycoprotein HBsAg HBOA DNA多聚酶 双链DNA Tubiform body HBV (ane particle) HBsAg globular Structural pattern of HBV(1965year) On electron microscope, HBSAg globular Partially double-Stranded circular DNA molecular and tubiform body, and Dane particle(t HBcAg: Hepatitis B core antigen, retained in infe- can be detected in HBV-infected host's HBeAg: Hepatitis Be antigen, into blood serum HBsAg: Hepatitis B surface antigen, into blood HBV-X protein Encoded by hbv genome
Etiologic agent of most viral hepatitis----in China HBV (Hepatitis B Virus) On electron microscope, HBsAg globular and tubiform body, and Dane particle(←) can be detected in HBV-infected host’s serum. Structural pattern of HBV (1965year) Partially double-stranded circular DNA molecular HBcAg: Hepatitis B core antigen, retained in infeHBeAg: Hepatitis B “e” antigen, into blood. HBsAg: Hepatitis B surface antigen, into blood HBV Encoded by HBV genome -X protein HBV (Dane particle) glycoprotein globular Tubiform body 6
Pathogenesis of HBV-hepatitis Immuno-injury v The host immune response to the virus is the main determinant of the outcome of infection v The hepatocyte damage result from the virus-infected cells by CD8+ cytotoxic T cells Cellular immune-mediated injury: when host immune response is in normal Acute hepatitis O Hyper-reactive Fulminant hepatitis ● Deficiency Chronic hepatitis ● TOlerance Health” carrier state Soluble immune-mediated injury is involved in-amm", not main mechanism
Cellular immune-mediated injury: when host immune response is--- ⚫ in Normal Acute hepatitis ⚫ Hyper-reactive Fulminant hepatitis ⚫ Deficiency Chronic hepatitis ⚫ Tolerance “Health” carrier state Pathogenesis of HBV-hepatitis : Immuno – injury Soluble immune-mediated injury is involved in-----, not main mechanism ✓The host immune response to the virus is the main determinant of the outcome of infection. ✓The hepatocyte damage result from the virus-infected cells by CD8+ cytotoxic T cells. 7
Jia Subclinical disease (180000) Recovery 99% (240,000) 60%-65% Acute hepatitis Ful 20%-25% hepa ts→| Death (<600 Healthy"carn ACUTE INFECTION25%6-10%(15,000-30,000) (300.000yrin 67%90% Persistent infection Recovery (12000) ↓10%39 Chronic hepatitis 20%6-50%Cirrhosis (12004000 (500-2000) Death 10% carcin (50-200) potentialoutcomes of HBV infection in adults in the United States
Jia-1 potential outcomes of HBV infection in adults in the United States
Acute viral hepatitis Any one of the hepatotropic viruses can cause acute viral hepatitis Morphology Gross appearance: Enlarged reddened liver or greenish if cholestasis Microscopic appearance: ○ Parenchymal changes 1. Hepatocyte injury: (1 Diffuse hepatocyte swelling ballooning degeneration
Acute viral hepatitis Morphology Gross appearance: Enlarged reddened liver or greenish if cholestasis Microscopic appearance: ● Parenchymal changes 1. Hepatocyte injury: ① Diffuse hepatocyte swelling / ballooning degeneration. Any one of the hepatotropic viruses can cause acute viral hepatitis 8
Acute viral hepatitis Microscopic appearance: 2 if cholestasis occurs: canalicular bile plugs HCV: mild-fatty change of the hepatocytes
Acute viral hepatitis Microscopic appearance: ② if cholestasis occurs : canalicular bile plugs *HCV: mild-fatty change of the hepatocytes 9