醫學三：80題 ( 包括內科,家庭醫學科等科目及其相關臨床實例與醫學倫理 )題庫下載題庫

(A)

The size considered ideal for histological analysis is under debate in the literature. Some studies suggest that a biopsy of 10-15 mm in length, with 4-6 PT is sufficient for staging of chronic hepatitis whereas, other authors suggest a minimum size of 20 to 25 mm.

至少要一公分

ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793951/

(B)

“Chronic hepatitis” is characterized by chronic inflammation that is predominantly in the portal tracts, with evidence of interface activity (what used to be referred to as “piecemeal necrosis”). In this process, chronic inflammatory cells bre...

(A)

The size considered ideal for histological analysis is under debate in the literature. Some studies suggest that a biopsy of 10-15 mm in length, with 4-6 PT is sufficient for staging of chronic hepatitis whereas, other authors suggest a minimum size of 20 to 25 mm.

至少要一公分

ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793951/

(B)

“Chronic hepatitis” is characterized by chronic inflammation that is predominantly in the portal tracts, with evidence of interface activity (what used to be referred to as “piecemeal necrosis”). In this process, chronic inflammatory cells breach the collagenous limiting plate, and percolate through and surround adjacent hepatocytes. A clue that this process has occurred is the presence of hepatocytes within the fibrous matrix of the portal tract. Thus, “trapped” hepatocytes are evidence of prior interface activity and the biopsy is designated as periportal fibrosis. Fibrosis of any amount may or may not be present in chronic hepatitis; thus, fibrosis is not a “required” feature for diagnosis

ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188273/

(C)

nonalcoholic steatohepatitis (NASH)可分成三級

第一級 (grade 1) 屬輕度 (mild)：脂肪變性主要為大泡性 (macrovesicular)，大部分影響肝小葉，小於33%但有時也可能高達66%，在肝小葉 zone 3偶而會發現膨脹性退化。小葉出現分散且輕度急性發炎反應 (嗜中性白血球浸潤)，偶有慢性發炎反應 (單核細胞浸潤)。

第二級 (grade 2) 屬中度 (moderate)：脂肪變性常為混合型 (大泡性與小泡性)，在肝小葉 zone 3常見膨脹性退化。小葉出現輕度慢性發炎反應，細胞周緣纖維化，肝細胞膨脹。門脈出現輕至中度發炎反應。

第三級 (grade 3) 屬重度 (severe)：脂肪變性常為混合性，典型 > 66%，在肝小葉 zone 3常見顯著膨脹性退化。小葉出現分散性急、慢性發炎反應，類竇旁 (perisinusoid) 纖維化，肝細胞膨脹。門脈出現輕至中度發炎反應2。

臨床上 NAS (NAFLD activity score) 是個有效評估 NAFLD 活動度指數的工具，評估肝組織切片特徵 (表二)，三項加總分數為0-8分，分數 < 3分表示為單純脂肪肝，≧ 5分表 NASH 持續活動中。NAFLD Fibrosis Score 評估包含六個面向，是非侵入性方式以評估 NAFLD 發展成 NASH 的方法。

ref: http://jtp.taiwan-pharma.org.tw/135/027-032.html

Nonalcoholic steatohepatitis (NASH) has a wide spectrum of histopathological features in terms of the necroinflammatory grading and the staging of fibrosis. Among these features, steatosis, necroinflammatory changes in the acinus (lobular hepatitis), and fibrosis show a definite zonal heterogeneity in liver acini; namely, a zone-3 predominance.

Macrovesicular liver-cell steatosis is usually seen in zone 3. Ballooning degeneration and Mallory’s hyaline are predominantly observed in liver cells in acinar zone 3, and the activation of Kupffer’s cells and hepatic stellate cells (HSCs) is also present in zone 3. The basic and initial fibrosis that characterizes NASH also occurs in zone 3.

ref: https://link.springer.com/chapter/10.1007/4-431-27172-4_3