Histopathology and cytology

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Faculty of allied medical sciences

• Histopathology and cytology
• (MLHC-201)

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Liver Pathology

• Supervision
• Prof.Dr.Noha Ragab

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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

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• 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.

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• 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.

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Jaundice
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Jaundice

• Clinically jaundice occurs with bilirubin levels
  gt2-3 mg/dl
• Clinical presentation
• Yellow skin (jaundice) and sclera (icterus)

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Yellow skin (jaundice)
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Yellow sclera (icterus)
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Causes of jaundice

1. Overproduction of bilirubin
2. Defective hepatic bilirubin uptake
3. Defective conjugation
4. Defective execretion

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Increased RBCs 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

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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

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Biliary tract obstruction
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Biliary tract obstruction

• Eitiology
• Gallstones
• Tumors (pancreatic, gallbladder and bile duct)
• Strictures
• Parasites (liver flukes or fasciola)

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

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• Laboratory investigation
• Elevated conjugated bilirubin
• Elevated alkaline phosphatase

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CIRRHOSIS
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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

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

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• 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

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Macronodular" cirrhosis
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Micronodular cirrhosis
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CIRRHOSIS
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Complications

• A- Portal hypertension
• Ascitis
• Splenomegaly
• Esophageal varices
• Haemorrhoids
• Caput Medusa

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Splenomegaly
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• 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.

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Caput medusae" which consists of dilated veins
seen on the abdomen of a patient with cirrhosis
of the liver
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• B- Decreased detoxification
• Hepatic encephalopathy
• Spider angiomata
• Palmar erythema
• Gynecomastia
• C- Decreased synthesis
• Hypoalbuminemia
• Decreased clotting factors
• D- Hepato-renal syndrome

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VIRAL HEPATITIS
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Clinical presentation

• Asymptomatic
• Malaise and weakness
• Nausea and anorexia
• Jaundice
• Urine may be dark

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

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Acute viral hepatitis

• Definition
• Signs and symptoms less than six months
• Eitiology
• Any hepatitis viruses

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Microscopically

• Lobar disarray
• Hepatocytes swelling (balloon cells)
• Apoptotic hepatocytes (councilmans bodies)
• Lymphocytes in portal tract and in the lobules
• Hepatocytes regeneration
• cholestasis

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Chronic viral hepatitis

• Definition
• Signs and symptoms more than six months
• Eitiology
• Caused by hepatitis virus B, C and D

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• 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

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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.

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Questions

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

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THANK YOUANDGOOD LUCK