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CHAPTER 18. LIVER & BILIARY TRACT. LIVER. Normal Pathology. GENERAL PATTERNS INFECTIOUS AUTOIMMUNE DRUG INDUCED/TOXIC METABOLIC. INTRAHEPATIC BILE DUCTS CIRCULATORY PREGNANCY ASSOCIATED TRANSPLANTATION RELATED TUMORS. PATHOLOGY. GENERAL FEATURES. PATTERNS HEPATIC FAILURE

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Presentation Transcript
Chapter 18

CHAPTER 18

LIVER

&

BILIARY TRACT


Liver
LIVER

  • Normal

  • Pathology


Pathology

GENERAL PATTERNS

INFECTIOUS

AUTOIMMUNE

DRUG INDUCED/TOXIC

METABOLIC

INTRAHEPATIC BILE DUCTS

CIRCULATORY

PREGNANCY ASSOCIATED

TRANSPLANTATION RELATED

TUMORS

PATHOLOGY


General features
GENERAL FEATURES

  • PATTERNS

  • HEPATIC FAILURE

  • CIRRHOSIS

  • PORTAL HYPERTENSION

  • JAUNDICE/CHOLESTASIS




Cirrhosis
Cirrhosis

  • Common Histologic Features

    • Fibrosis

    • Nodules

  • Clinical Features


Portal hypertension
Portal Hypertension

  • Ascites

  • Portosystemic Shunts

  • Splenomegaly


Jaundice cholestasis
Jaundice/Cholestasis

  • Bilirubin/Bile Formation

  • Pathophysiology

  • Neonatal Jaundice

  • Hereditary Hyperbilirubinemia

  • Cholestasis

  • Familial Intrahepatic Cholestasis


Infectious viral
INFECTIOUS- VIRAL

  • Viral Hepatitis:

    • A,

    • B,

    • C,

    • D,

    • E

  • Other Viruses


Infectious viral1
INFECTIOUS- VIRAL

  • Clinicopathologic Syndromes

    • Acute Asymptomatic with Recovery

    • Acute Symptomatic

    • Chronic Hepatitis


Infectious viral2
INFECTIOUS- VIRAL

  • Morphology

    • Acute

    • Chronic

    • Fulminant


Infectious nonviral
INFECTIOUS- NONVIRAL

  • Bacterial

  • Parasitic

  • Helminthic



Hepatitis drug toxic
HEPATITIS- DRUG/TOXIC

  • Alcohol

  • Alcohol

  • Alcohol

  • All Others


Hepatitis drug toxic alcohol
HEPATITIS- DRUG/TOXICALCOHOL

  • Steatosis

  • Alcoholic Hepatitis

  • Cirrhosis


Metabolic liver disease
METABOLICLIVER DISEASE

  • NON-Alcoholic Fatty

  • Hemochromatosis

  • Wilson Disease

  • α1-Antitrypsin Deficiency

  • Neonatal Cholestasis


Non alcoholic fatty liver
NON-AlcoholicFatty Liver




1 antitrypsin deficiency
α 1-Antitrypsin Deficiency


Intrahepatic bile duct disease
INTRAHEPATICBILE DUCT DISEASE

  • Secondary Biliary Cirrhosis

  • Primary Biliary Cirrhosis

  • Primary Sclerosing Cholangitis

  • Biliary Tree Anomalies and Cysts



Primary biliary cirrhosis
Primary BiliaryCirrhosis


Primary sclerosing cholangitis
Primary SclerosingCholangitis


Biliary tree anomalies and cysts
Biliary Tree Anomalies and Cysts

  • Von Meyenburg Complexes

  • Polycystic Liver

  • Congenital Hepatic Fibrosis

  • Caroli Disease


Circulatory disorders
CIRCULATORYDISORDERS

  • Impaired Flow INTO

    • Hepatic Artery

    • Portal System

  • Impaired Flow THROUGH

  • Hepatic Venous Obstruction


Impaired flow into
Impaired Flow INTO

  • Arterial System

  • Portal System


Impaired flow through
Impaired Flow THROUGH

  • Passive Congestion

  • Centrolobular Necrosis

  • Peliosis Hepatis


Impaired hepatic vein outflow
Impaired Hepatic Vein OUTFLOW

  • Hepatic Vein Thrombosis

  • IVC Thrombosis

  • Veno-Occlusive Disease


Pregnancy associated disorders
PREGNANCY-AssociatedDisorders

  • Preeclampsia

  • Eclampsia

  • Acute Fatty Liver

  • Intrahepatic Cholestasis


Transplantation complications
TRANSPLANTATIONCOMPLICATIONS

  • Drug Toxicity

  • GVH (Graft Vs. Host)

  • NON-Immunologic Damage


Tumors
TUMORS

  • Nodular Hyperplasia

  • Benign

  • Malignant




Malignant tumors
MALIGNANTTUMORS

  • Hepatocellular Carcinoma (Hepatoma)

  • Cholangiocarcinoma

  • Metastatic


Hepatocellular carcinoma
HEPATOCELLULARCARCINOMA



Metastatic tumors
METASTATICTUMORS


Biliary tract
BILIARY TRACT

  • Normal

  • Pathology


Pathology1
PATHOLOGY

  • Congenital

  • Gallbladder

  • EXTRA-Hepatic Bile Ducts

  • Carcinoma of the Gallbladder

  • Carcinoma of the EXTRA-Hepatic Bile Ducts

  • IATROGENIC INJURY to the BILIARY TREE


Gallbladder
GALLBLADDER

  • Cholelithiasis

  • Cholecystitis


Cholelithiasis
CHOLELITHIASIS

  • Prevalence

  • Risk Factors

  • Ethnic/Geographic

  • Age/Sex

  • Environment

  • Acquired

  • Hereditary Factors

  • Stones


Cholecystitis
CHOLECYSTITIS

  • Acute

  • Chronic


Extra hepatic bile ducts
EXTRA-HEPATICBILE DUCTS

  • Choledocholithiasis

  • Biliary Atresia

  • Choledochal Cysts





Carcinoma of the gallbladder
CARCINOMA of the GALLBLADDER


Carcinoma of the extra hepatic bile ducts
CARCINOMA of theEXTRA-Hepatic Bile Ducts


Iatrogenic biliary tree injury
IATROGENICBILIARY TREE INJURY


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