Hepatobiliary system Dr. Snehal Kosale
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Transcript of Hepatobiliary system Dr. Snehal Kosale
Hepatobiliary System
Topics
Liver CirrhosisAmoebic Liver AbscessActinomycotic GranulomaHepatocellular Carcinoma
Diffuse scarring of liver characterized by loss of lobular architecture and formation of regenerative nodules.
Characteristics Involves entire liver Loss of normal architecture Regenerative nodules separated by fibrotic bands Alternate necrotic and regenerative areas
Cirrhosis
AlcoholViral hepatitis (HBV, HCV)(POST NECROTIC)Biliary obstruction (BILIARY)Hemochromatosis (PIGMENT)Wilson’s diseaseAutoimmuneDrugs and toxinsIdiopathic
Causes of Cirrhosis
A lcohol, AutoimmuneB iliary obstruction (biliary)Chronic viral hepatitis (HBV, HCV) (post-necrotic)Drugs and toxinsHemochromatosis (pigment)IdiopathicW ilson’s disease
Causes of Cirrhosis
WHO divided cirrhosis into 3 categories based on morphological characteristics of the hepatic nodules
Micronodular Nodules <3 mm Uniform no portal tract or central vein identified Alcoholic, biliary, hemochromatosis
Macronodular Nodules >3mm Variably sized (not uniform) Nodules may contain portal tract and central vein Post necrotic
Mixed
Classification of cirrhosis
Micronodular cirrhosis
Macronodular cirrhosis
Gross
Microscopy
Micronodular cirrhosis
3 major forms of hepatic abscess identified by their causative microorganisms:
Pyogenic Polymicrobial - 80% E. coli, Klebsiella pneumoniiae, Proteus spp., pseudomonas, Streptococcus
milleri
Amoebic Entamoeba histolytica - 10%
Fungal Candida species <10%
Hepatic Abscess
Caused by a gram positive anaerobic filamentous bacteria, Actinomyces israelii.
A chronic, suppurative and granulomatous disease
The organism spreads to liver from intestinal lesion via the portal channels.
GROSS Multiple, Small, Ragged Contain colonies of these organisms (sulphur granules)
Actinomycotic abscess
Gross
Microscopy
Splendore- Hoeppeli phenomenon
Caused by spread of the trophozoites of Entamoeba histolytica from intestinal lesions through portal vein.
Common in developing countries.
GROSS Solitary lesion Superoposterior right lobe Lining of abcess is gray white Because of haemorrhage into the abscess cavity it shows a
Chocolate colored, Odourless, Pasty material resembling anchovy sauce.
Amoebic Liver Abscess
Amoebic Liver Abscess
Anchovies
Anchovy Sauce
Amoebic Liver Abscess
Primary
Hepatocellular carcinoma(90%)—arises from hepatocytes
Cholangiocarcinoma(10%)—arises from intrahepatic bile duct epithelium.
Mixed--uncommon
Metastatic
Carcinoma Of Liver
Unifocal (expanding type) Large mass Yellow brown Right lobe of liver
Multifocal Widely distributed nodules of variable sizes
Diffusely infiltrative Involving the entire liver
Hepatocellular Carcinoma
Gross
Gross
Microscopy
Small cell variant Large cell variant
Microscopy
Flask shaped undermined ulcer in colon ameba with ingested rbcs
MICRONODULAR MACRONODULAR(HOBNAIL LIVER)
Liver shrinks Nodules >3mmNodules <3mm, diffuse, vary little in size not uniform in size
PATHOPHYSIOLOGY
IN A CUT SECTION, THE UNIFORM SMALL NODULES OF REGENERATING HEPATOCYTES ARE MORE OBVIOUS
STAGES ALCOHOLIC STEATOSIS
Droplets of fat in hepatocytes displacing nuclei to periphery ALCOHOLIC HEPATITIS
Centrilobular necrosis Ballooning degeneration Mallory bodies Pericellular and perivenular fibrosis
ALCOHOLIC CIRRHOSISMallory bodies – intracytoplasmic eosinophilic inclusion seen in perinuclear locations, d/t
accumulation of intermediate filaments
CIRRHOSIS - ALCOHOL
Normal liver fatty liver regenerative nodules in cirrhosis surrounded by fibrosis
HBV infection (MACRONODULAR)Chemicals
Alfatoxin, vinyl chlorideMetal storage disases
Hemochromatosis or Wilson’s diseaseFood additives like nitrosamines and butter yellowAlpha 1 antitrypsin deficiency.
RISK FACTORS FOR HCC
HEPATOCELLULAR CARCINOMA- GROSS
HEPATOCELLULAR CARCINOMA
THE ENTIRE SURFACE OF THE LEFT LOBE AND MOST OF THE RIGHT LOBE OF THE LIVER HAVE AN IRREGULAR NODULAR APPEARANCE, DUE TO THE PRESENCE OF CIRRHOSIS AND
HEPATOCELLULAR CARCINOMA.
Ranges from well differentiated to highly anaplastic lesions. In well differentiated HCC cells resembling normal hepatocytes are
present in trabecular, acinar or pseudoglandular pattern. In poorly differentiated HCC cells are pleomorphic with anaplastic giant
cells.
HEPATOCELLULAR CARCINOMA-MICROSCOPY
THIS BIOPSY SPECIMEN SHOWS IRREGULAR TRABECULAE OR CORDS OF MALIGNANT HEPATOCYTES WITH ENLARGED NUCLEI THAT CONTAIN NUCLEOLI, CONSISTENT WITH A WELL-DIFFERENTIATED HEPATOCELLULAR CARCINOMA.
AMEBIC LIVER ABCESS
ANCHOVY SAUCE APPEARANCE
Most common in cecum and ascending colon.E – histolytica cysts are infectious forms, ingested, resistant to gastric
acid.Ameba attach to the colonic epithelium and burrow into lamina propria.They create a flask shaped ulcer with narrow neck and broad base.
AMEBIC ULCER - COLON
ENTAMOEBA HISTOLYTICA TROPHOZOITE WITH INGESTED RBCS