Biliary diseasesBiliary diseases Vascular diseasesVascular diseases ParasitesParasites TumorsTumors...

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Transcript of Biliary diseasesBiliary diseases Vascular diseasesVascular diseases ParasitesParasites TumorsTumors...

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  • Biliary diseasesBiliary diseases Vascular diseasesVascular diseases ParasitesParasites TumorsTumors Liver transplantationLiver transplantation Liver Pathology 4:
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  • Causes of Large Bile Duct Obstruction
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  • Extrahepatic Biliary Atresia (EHBA) Reovirus 3 Rotavirus Immune targeting?
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  • Kasai Hepatic Portoenterostomy Loop of small intestine EHBA Rx Liver Transplantation
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  • Primary Sclerosing Cholangitis (PSC) ERCP: endoscopic retrograde cholangiopancreatography
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  • , fewer Crohns
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  • Mrs. Elizabeth Peacock Primary Biliary Cirrhosis (PBC) Guys Hospital Report London, 1851 Addison & Gull
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  • PBC: Primary biliary cirrhosis---- Chronic nonsuppurative destructive cholangitis middle-aged women + AMA (anti-mitochondrial antibodies); M2 subtype Alkaline Phosphatase IgM AMA directed against inner mitochondrial membrane PDC-E2 (pyruvate dehydrogenase complex-E2) florid bile duct lesion bile duct PDC-E2 HLA II AMA T T T Assoc. with other autoimmune dis: e.g. RA, sicca, celiac, scleroderma Molecular Mimicry? Gram bacteria
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  • Vascular Disease & the Liver Veins Sinusoids Arteries Liver is often involved in heart disease or other outflow problems (hepatic venous outflow obstruction)
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  • Budd-Chiari Syndrome (Hepatic venous outflow obstruction) ascites oral contraceptives coagulopathy (prot. S, C, factor V Leiden def., anti-cardiolipin Abs tumor invasion of hep. Vs or IVC: renal cell CA + HCC small vein disease: VOD
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  • Peliosis hepatis : blood lakes of the liver -HIV, C17-alkylated steroids (OCs, anabolic steroids; systemic inflamm.
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  • Infarct: Arterial disease (PAN, ligation, chemoRx installation) Portal vein: Zahn infarct
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  • P.V. Pylephlebitis : -perforated ulcer, -ruptured appendix, etc. Pylephlebitis : -perforated ulcer, -ruptured appendix, etc.
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  • Schistosomiasis: Pre-sinusoidal, intrahepatic portal hypertension (Symmers clay pipestem fibrosis)
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  • pancreas
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  • LIVER-CELL ADENOMA -oral contraceptives -hepatocyte nuclear factor 1 (HNF-1) mutations -benign hepatocytes, bld vessels, NO b.d.s
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  • FOCAL NODULAR HYPERPLASIA (FNH) -malformation: central scar with artery, outgrowth of cirrhosis-like mass
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  • HCC 75% of pts have cirrhosis 75% are serum AFP + Risks: Cirrhosis due to HBV, HCV, alcohol, hemochromatosis Invades veins: portal vein/hepatic vein/IVC- to lungs
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  • FIBROLAMELLAR Ca: young, no risks -better prognosis with resection/tx No cirrhosis
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  • Cholangiocarcinoma associated with: Liver flukes: - Clonorchis sinensis -Opisthorcis viverrini PSC Gallstone disease, hepatolithiasis
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  • Liver Transplantation Cirrhosis - HBV, HCV PBC PSC Extrahepatic biliary atresia AFLD/NAFLD Metabolic disorders
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  • Portal tract HLA II T Acute Rejection BD endothelium
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  • 1.Acute rejection: triad 2.Preservation injury (ischemia/reperfusion) 3.CMV hepatitis 4.Recurrent original disease 5.De novo autoimmune hepatitis 6.Chronic rejection 6 mos. inflammation bile duct damage endotheliitis Liver Transplantation Pathology
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  • Dame Sheila Sherlock The Royal Free Hospital London, U.K. Diseases of the Liver & Biliary System
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  • Peter J. ScheuerHans Popper
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  • Peter J. Scheuer, M.D. Royal Free Hospital Prof. of Histopathology Liver Biopsy Interpretation -1 st Edition: 1968 -7 th Edition: 2005
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