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Faculty of allied medical sciences

Faculty of allied medical sciences. Histopathology and cytology (MLHC-201). Liver Pathology. Supervision: Prof.Dr.Noha Ragab. Outcomes. By the end of this lecture, the student will be able to know: 1-The meaning and causes of jaundice 2-Bilary tract obstruction 3-Cirrhosis

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Faculty of allied medical sciences

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  1. Faculty of allied medical sciences Histopathology and cytology (MLHC-201)

  2. Liver Pathology Supervision: Prof.Dr.NohaRagab

  3. Outcomes By the end of this lecture, the student will be able to know: 1-The meaning and causes of jaundice 2-Bilary tract obstruction 3-Cirrhosis 4-Viral hepatitis and its types

  4. The liver is the largest parenchymal organ, lying just below the diaphragm. The right lobe is larger than the left lobe. The falciform ligament is the rough dividing line between the two lobes.

  5. This is the external surface of a normal liver. The color is brown and the surface is smooth. A normal liver weighs about 1200 to 1600 grams.

  6. Jaundice

  7. Jaundice • Clinically jaundice occurs with bilirubin levels >2-3 mg/dl Clinical presentation: • Yellow skin (jaundice) and sclera (icterus)

  8. Yellow skin (jaundice)

  9. Yellow sclera (icterus)

  10. Causes of jaundice: • Overproduction of bilirubin • Defective hepatic bilirubin uptake • Defective conjugation • Defective execretion

  11. Increased RBC’s turnover: • RBCs are a major source of bilirubin Eitiology: • Hemolytic anemia • Ineffective erythropoiesis (Thalassaemia, megaloblastic aneamia, etc.) • Chronic hemolytic anemia patients often develop pigmented bilirubinated gallstones Laboratory: • increased unconjugated bilirubin

  12. Physiological jaundice of the new born • Definition: transient unconjugated hyperbilirubinaemia due to the immaturity of the liver • Risk factors: • Prematurity • Hemolytic disease of new born (erythroblastosis fetalis) • Complication: kernicterus

  13. Biliary tract obstruction

  14. Biliary tract obstruction • Eitiology: • Gallstones • Tumors (pancreatic, gallbladder and bile duct) • Strictures • Parasites (liver flukes or fasciola)

  15. Clinical presentation: • Jaundice • Pruritus due to increased plasma levels of bile acids • Abdominal pain, fever and chills • Dark urine (bilirubinuria) • Pale clay colored stools

  16. Laboratory investigation: • Elevated conjugated bilirubin • Elevated alkaline phosphatase

  17. CIRRHOSIS

  18. CIRRHOSIS • Definition: End stage liver disease characterized by distruption of the liver architecture by bands of fibrosis that divide the liver into nodules of regenerating liver parenchyma

  19. Etiology (Causes of Cirrhosis): • Alcohol • Viral hepatitis • Biliary tract disease • Hemochromatosis • Idiopathic

  20. Grossly: • Micronodular nodules • Macronodular nodules • Mixed micronodular and macronodular • At the end stage , the disease results in mixed pattern, and the etiology may not be distinguished based on the appearance

  21. “Macronodular" cirrhosis

  22. Micronodular cirrhosis

  23. CIRRHOSIS

  24. Complications: A- Portal hypertension: • Ascitis • Splenomegaly • Esophageal varices • Haemorrhoids • Caput Medusa

  25. Splenomegaly

  26. Esophageal Varices are seen here in the lower esophagus as linear blue dilated veins. There is hemorrhage around one of them. Such varices are easily eroded, leading to massive gastrointestinal hemorrhage.

  27. “Caput medusae" which consists of dilated veins seen on the abdomen of a patient with cirrhosis of the liver

  28. B- Decreased detoxification: • Hepatic encephalopathy • Spider angiomata • Palmar erythema • Gynecomastia C- Decreased synthesis • Hypoalbuminemia • Decreased clotting factors D- Hepato-renal syndrome

  29. VIRAL HEPATITIS

  30. Clinical presentation: • Asymptomatic • Malaise and weakness • Nausea and anorexia • Jaundice • Urine may be dark

  31. Laboratory investigations: • Markedly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

  32. Acute viral hepatitis • Definition: Signs and symptoms less than six months • Eitiology: Any hepatitis viruses

  33. Microscopically: • Lobar disarray • Hepatocytes swelling (balloon cells) • Apoptotic hepatocytes (councilman’s bodies) • Lymphocytes in portal tract and in the lobules • Hepatocytes regeneration • cholestasis

  34. Chronic viral hepatitis • Definition: Signs and symptoms more than six months • Eitiology: Caused by hepatitis virus B, C and D

  35. Microscopically: • Chronic persistant hepatitis inflammation confined to the portal tracts • Chronic active hepatitis inflammation spills into the parenchyma causing interface hepatitis (piecemeal necrosis) • Hepatitis B often has a ground glass hepatocytes

  36. councilman body ballooning degeneration • 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.

  37. Questions: Complete: 1-Causes of jaundice are……………………. 2-Causes of cirrhosis are…………………… 3-…………. Transient unconjugatedhyperbilirubinaemia due to the immaturity of the liver 4-Chronic active hepatitis inflammation spills into the parenchyma causing ……………. 5-Biliary tract obstruction is caused by…………

  38. THANK YOUANDGOOD LUCK

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