Acute Hepatitis Including Acute Liver Failure

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Acute Hepatitis - Aetiological Considerations Liver biopsy rarely identifies a previously unsuspected aetiology • Biopsies mostly obtained from people in whom main recognised causes have been excluded (“seronegative hepatitis”) • Biopsy sometimes provides pointers to a previously unsuspected aetiology Aetiology Suggestive Histological features Drugs • Disproportionately severe / well-circumscribed necrosis (relatively little inflammation – lobular and/or portal) • Unusual patterns of necrosis - e.g periportal (zone 1) necrosis • Unusually prominent cholestasis • Eosinophils, granulomas Autoimmune hepatitis (Abe 2007, Fujiwara 2008, Stravitz 2011, Yasui 2011) • Plasma cell rich portal infiltrate (also seen in hepatitis A) • Prominent periportal inflammation (interface hepatitis) • Lymphoid aggregates • Prominent centrilobular inflammation (“central perivenulitis”)
Acute Hepatitis - Aetiological Considerations Liver biopsy may identify a cause of acute liver injury not due to acute hepatitis • Decompensated chronic liver disease (e.g. Wilson’s disease) • Another cause of acute liver damage (e.g. ischaemic hepatitis, severe alcoholic hepatitis, paracetamol toxicity) • Hepatic infiltration (usually lymphoma, less commonly carcinoma) – Liver usually enlarged
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Acute Hepatitis Including Acute Liv
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Acute Liver Failure (ALF) FHF and L
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Acute Liver Failure Admissions Birm
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Acute Liver Injury Establishing the
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Acute Liver Injury Establishing the
Page 11 and 12: Case 1
Page 13 and 14: Liver Biopsy in Acute Hepatitis His
Page 17 and 18: Case 1 - ductular reaction CK7 immu
Page 21 and 22: Case 1 (PAS-diastase)
Page 23 and 24: Acute Hepatitis Hepatocyte Prolifer
Page 25 and 26: Case 1 (HVG)
Page 27 and 28: Case 1 Diagnosis • Acute hepatiti
Page 29 and 30: Autoimmune Hepatitis - Acute Presen
Page 31 and 32: Case 1- outcome • Treatment with
Page 33: Case 2 LIVER BIOPSY
Page 39 and 40: Case 2 - outcome • Mild encephalo
Page 41 and 42: Case 2. Macroscopic Appearances Shr
Page 46 and 47: Could this be cirrhotic?
Page 51 and 52: Other Changes Seen in Areas of Pare
Page 53 and 54: Hepatectomy Specimen - Case 2 Histo
Page 55 and 56: Role of Liver Biopsy in Acute Hepat
Page 57 and 58: Acute versus Chronic Damage Severe
Page 59 and 60: Liver Cell Death in Acute Hepatitis
Page 61: Acute Hepatitis - Common Causes 1.
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Acute Hepatitis Including Acute Liver Failure

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