1 / 135

Normal structure of liver

Normal structure of liver. Normal function of liver. Metabolic (glucose homeostasis…) Synthetic (albumin, coagulation factors) Storage (glycogen, triglycerides, Fe, Cu, vitamins soluble in fat) Catabolic (endogenous substances – hormones…, exogenous substances – drugs, alcohol…)

bryony
Download Presentation

Normal structure of liver

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Normal structure of liver

  2. Normal function of liver • Metabolic (glucose homeostasis…) • Synthetic (albumin, coagulation factors) • Storage (glycogen, triglycerides, Fe, Cu, vitamins soluble in fat) • Catabolic (endogenous substances – hormones…, exogenous substances – drugs, alcohol…) • Excretoric (bile)

  3. Histologic examination • Necropsy • Excision during laparotomy • Fine needle punction • Percutaneous punction biopsy • unguided • laparoscopic • guided (Sono, CT) • transjugular

  4. Representativeness • Biopsy represents approx. 1/500 000 of organ • Ideal biopsy (Scheuer, MacSween) • 2 cm length • more than 4 (8) portal tracts • Borderline representativeness • contact CLINICIAN!! • Non-representative

  5. QualityClinical data • Clear and sufficient • clinical outcome, history • etiology • biochemical findings, other markers (oncomarkers, markers of autoimmunity…) • treatment • previous histology • preliminary diagnosis! • Unclear • contact CLINICIAN!! • Insufficient and confusing

  6. Quality Diagnosis • Diagnosis • recent diagnostic praxis (grading and staging of chronic hepatitis…) • recent diagnostic textbooks - contact CLINICIAN!! • Methods • biopsy - contact CLINICIAN!! • immunohistochemistry, ELMI -contact CLINICIAN!! • experimental

  7. Recently used diagnostic textbooks

  8. Histologic examination – special stains and methods • Haematoxylin/eosin • Fouchet – bile (green), collagen (red) • Fe, Cu – Fe pigment, Cu pigment • Gömori – reticulin mesh • Orcein – HBsAg • PAS, Müller – mucopolysaccharides • Immunohistochemistry (HBsAg, HBcAg, a1 fetoprotein, CEA, hepatocytes – OCH1E5) • ELMI (metabolic diseases) • PCR (HBV DNA, HCV RNA,…)

  9. Damage of hepatocytes • Type (ischemic-coagulation necrosis, piecemal necrosis, apoptosis) • Extent (monocellular, focal, submassive, massive, bridging: C-C; C-P) • Localization (centrolobular, periportal, midzonal) • Course • regeneration, healing ad integrum • regeneration + fibrosis: cirrhosis • acute liver failure: coma and death

  10. Liver failure • Jaundice • Hypoalbuminemia • Coagulopathy • Hyperamonemia • Increase of levels of cytosolic enzymes • Endocrine complications • Hepatoencephalopathy • Hepatorenal syndrome • Coma

  11. Necrosis of liver: damage of hepatocytes

  12. Cirrhosis • Nodular rearrangement • Morphology • micronodular • macronodular

  13. Cirrhosis: etiology • Alcohol (60-70%) • Chronic hepatitis (10%) • Cryptogenic (10-15%) • Biliary (primary, secondary) • Haemochromatosis (primary, secondary) • Metabolic diseases (tyrosinemia, galactosemia) -very rare

  14. Cirrhosis: complications • Portal hypertension • Liver failure • Hepatocellular carcinoma

  15. Portal hypertension • Prehepatic (tumor, infection, pancreatitis, pregnancy, peroral contraceptives) • Intrahepatic – most frequent (cirrhosis, fibrosis) • Posthepatic (congestive cardiac failure, Budd-Chiari syndrome, venoocclusive disease) • Signs: • portosystemic shunts • splenomegaly • ascites

  16. Cirrhosis

  17. Cirrhosis

  18. Cirrhosis

  19. Cirrhosis + hepatocellular carcinoma

  20. Cirrhosis: Masson staining

  21. Cirrhosis: Fouchet staining

  22. Cirrhosis

  23. Cirrhosis: active

  24. Cirrhosis: biliary

  25. Dysplasia

  26. Dysplasia

  27. Hepatitis: etiology • Infectious (acute, chronic) • viruses (most often) • bacteria (TBC, malaria, salmonelosis, leptospirosis,…) • parazites (ecchinococcus) • protozoal (amebiasis) • Non-infectious (acute, chronic) • autoimmune • metabolic • drug induced • cryptogenic

  28. Viral hepatitis

  29. Viral hepatitis: HBV+HDV

  30. Viral hepatitis: HBsAg, ground glass

  31. Viral hepatitis: HBsAg, Orcein staining

  32. Viral hepatitis: HBcAg, immunohistochemistry

  33. Viral hepatitis: HBcAg, electron microscopy

  34. Viral hepatitis: course • Acute (HAV, HBV, HCV, HDV, HEV) • Chronic (HBV, HBV + HDV, HCV) • risk of cirrhosis development • risk of hepatocellular carcinoma development • Fulminant (HBV, HCV)

  35. Acute hepatitis • Gross finding – oedematous, red liver • Microscopic finding • focal necrosis • bridging necrosis • panacinar/multiacinar necrosis • periportal necrosis • Hepatocytes • polymorphism • balooning degeneration

  36. Acute hepatitis • Inflammation • polynuclear/mononuclear infiltration • activation of Kupfer’s cells • Other changes • cholestasis • damage of bile ducts • Regeneration

  37. Fulminant hepatitis • Gross finding - softconsistency • Microscopic finding – complete necrosis of parenchyma • Course • liver failure-coma - death • regeneration – postnecrotic cirrhosis

  38. Acute hepatitis: HBV

  39. Acute hepatitis

  40. Acute hepatitis

  41. Acute hepatitis

  42. Acute hepatitis: regeneration

  43. Fulminant hepatitis: HBV

  44. Fulminant hepatitis: HBsAg, Orcein staining

  45. Chronic hepatitis: etiology • HBV, HBV+HDV, HCV • Autoimmune • Drug induced • Wilson’sdisease • a1 anti-trypsin deficiency • Cryptogenic

  46. Chronichepatitis: clinical definition Clinical symptoms of hepatitis more than: • 6 months • 12 months in HCV

  47. Chronic hepatitis: morphology • Inflammation • portal • periportal • lobular • Necrosis/apoptosis • piecemal • bridging • focal • Fibrosis • Deposits (Cu, PAS globules,…)

  48. Chronic hepatitis - portal + steatosis, HCV

  49. Chronichepatitis: portal

More Related