The Liver and Biliary System

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The Liver and Biliary System

• Major Topics for Discussion
• Mechanisms of jaundice
• Hepatic failure
• Viral hepatitis
• Alcoholic liver disease
• Portal hypertension
• Hepatocellular carcinoma
• Gallstones

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What is the diagnosis?
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Bilirubin is conjugated in the liver and excreted
in bile.
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Causes of extra-hepatic bile duct obstruction
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Bile lakes in liver due to obstruction.
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Complications of Hepatic (Liver) Failure
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Jaundice (Hyper-Bilirubinemia) is a Manifestation
of Hepatic Failure
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What can cause hepatic failure?
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Cirrhosis
What causes this?
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Hepatitis B Virus (schematic)
Hepatitis C Virus
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Serologic findings in patients with acute and
chronic hepatitis C
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Cirrhosis Represents End-Stage Liver Disease
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Histopathologic findings in cirrhosis. Note
collagen scar tissue and regenerative nodules
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Serologic findings in patients with acute
hepatitis A
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Are there other causes of cirrhosis and liver
failure?
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?
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Fatty liver
What causes this?
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Liver Biopsy Shows Fatty Change
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Cirrhotic liver from a patient who died of
complications of alcoholic liver disease
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Linear relationship between total lifetime
ethanol consumption and cirrhosis of liver
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Cirrhosis leads to portal hypertension, and its
varied clinical complications.
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Hemochromatosis
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Clinical Features of Long-Standing Hemochromatosis
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Hepatocellular Carcinoma

• Risk factors include HBV, HCV, Hemochromatosis,
  and Environmental Carcinogens

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Metastatic Liver Cancer
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Pathology of the Gallbladder

• Gallstones
• Cholecystitis
• Choleocarcinoma

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Pigmented Gallstones (bilirubin stones)
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Cholesterol Gallstones
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Path Key Words

• Alcoholic hepatitis
• Bilirubin
• Cholelithiasis
• Cirrhosis
• Esophageal varices
• Hepatic failure
• Hepatocellular carcinoma

• Jaundice
• Portal hypertension
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Viral hepatitis