Liver & Gall bladder

Diseases Of The Liver, Gall bladder & Pancreas Lab 16

Jaundice …….

Ductular reaction inchronic cholestasis.

CHOLESTASIS

Hepatitis

The inflammation of hepatitis starts in the portal triad areas, with increasing severity it extends to the sinusoids.
Portal Inflammation

Piecemeal necrosis

A mononuclear inflammatory cell infiltrate extends from portal areas and disrupts the limiting plate of hepatocytes which are undergoing necrosis, the so-called "piecemeal" necrosis


A large pink cell undergoing "ballooning degeneration" is seen below the right arrow. At a later stage, a dying hepatocyte is seen shrinking down to form an eosinophilic "councilman body" below the arrow on the left.

Ballooning of the cytoplasm in degenerating hepatocytes is demonstrated.

FULMINANT HEPATITIS
“Fulminant” hepatitis is associated with massive hepatic necrosis and usually results in death.

“FULMINANT” Acute Viral Hepatitis : Note complete COLLAPSE of lobules, and only remnants of biliary epithelium.

HCV with extensive fibrosis and progression to macronodular cirrhosis, as evidenced by the large regenerative nodule at the center right.

Liver Cirrhosis 

Definition: Diffuse scarring of the liver with Nodular regeneration of hepatocytes, resulting in Severe disruption (complete loss) of hepatic architecture.

Etiology of Cirrhosis

Alcoholic liver disease60-70%Viral hepatitis10%Biliary disease5-10%Primary hemochromatosis5%Cryptogenic cirrhosis10-15%Wilson’s, 1AT defrare

Macronodular Cirrhosis

Micronodular cirrhosis
Liver Cirrhosis: Nodule Size
1- Micronodular cirrhosis -nodule < 3mm.
2- Macronodular Cirrhosis -nodules > 3mm.
3- Mixed

NUTMEG LIVER

Nutmeg liver seen with chronic passive congestion of the liver. Note the dark red congested regions that represent accumulation of RBC's in centrilobular regions.
Microscopically, the nutmeg pattern results from congestion around the central veins, as seen here. This is usually due to a "right sided" heart failure.

Complications Of Cirrhosis

Include: Portal hypertension Ascites Hepatocellular dysfunction Portal vein thrombosis Hepatocellular carcinoma Hyperestrinism

Ascites

Gynaecomastia in cirrhosis
Porta-systemic anastomosis: Prominent abdominal veins

HEMOCHROMATOSIS……

Kayser-Fleischer rings, which are present in patients with Wilson disease, are green to brown copper deposits present in the periphery of the Descemet membrane of the cornea.
This special stain (rhodanine stain) highlights the accumulation of copper in the hepatocytes of patients with Wilson disease.


PAS positive inclusions with alpha-1-antitrypsin deficiency
Alpha-1-antitrypsin PROTECTS tissues, especially lung, liver, from HARMFUL NATURAL PROTEASE. Lack of this enzyme, due to a genetic defect, would then be expected to cause destructive changes in these areas.


B- Secondary biliary cirrhosis * is characterized by extrahepatic biliary obstruction, which leads to dilation and increased pressure within intrahepatic bile ducts resulting in ductal injury, ductal and periductal inflammation, and resolution by fibrous tissue formation. * is often complicated by ascending cholangitis and bacterial inflammation of the intrahepatic bile ducts. * is marked histologically by evidence of bile stasis and by bile lakes, accumulation of bile within hepatic parenchyma.
Bile “plugs”, Bile “lakes Liver, biliary cirrhosis - Gross, cut surface

Concentric periductular fibrosis around bile ducts, leading eventually to destruction and stricture of affected bile ducts

Primary Sclerosing Cholangitis

hepatic vein thrombosis Budd-Chiari syndrome


are the most common benign tumors of the liver (7%) . They are small and asymptomatic, larger tumors have been reported to cause abdominal symptoms and even hemorrhage into the abdominal cavity.

Grossly: solitary and less than 5 cm. - Microscopically: cavernous hemangioma.

Hemangioma



Hepatic Adenoma

Hepatocellular Carcinoma

cholangiocarcinoma

Angiosarcoma * is a rare * highly malignant * M > F , age 50-60 * is associated…. * hepatomegally, ascites, jaundice , loss of weight

Secondary (Metastatic) Tumors The most common malignancy in the liver. Can come from many primary sites. multiple nodules with central umblication

Gall Bladder

Phrygian Cap


Choledochal cyst in a 5-year-old female. The structure to the left is the attached gallbladder.

Hydrops of gallbladder resulting from a stone impacted in the cystic duct.

Cholesterolosis of gallbladder mucosa

Gall Stones

Types: Cholestrol Pure Mixed Pigmented

Acute cholecystitis

Acute cholecystitis showing extensive ulceration, hemorrhage, and edema but only scanty inflammation.

chronic cholecystitis

Rokitansky-Aschoff sinuses

Adenocarcinoma of the gallbladder

In severe acute pancreatitis, black areas of hemorrhage are present within the pancreas as well as chalky, yellow-white areas of fat necrosis.
severe acute pancreatitis shows an area of acute inflammation with necrosis. Within the necrotic area is a blood vessel showing fibrinoid necrosis of the vessel wall.

Chronic pancreatitis is characterized by fibrosis, chronic inflammation, and acinar drop-out. The lobular arrangement of the remaining ductules is retained.


Pancreatic pseudocyst
Most common pancreatic cyst Sequelae of chronic pancreatitis Most occur in body/tail Usually solitary and unilocular Can mimic malignancy

Small pseudocyst, showing organizing inflamation on right

Football sized pseudocyst

well-differentiated adenocarcinoma of the pancreas with an infiltrating pattern of growth and desmoplastic reaction