Cirrhosis


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Slide 1 : "With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas E. Buxton "Achievement is connected with action, not in genes..…!” - Conrad Hilton
Slide 2 : Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine A Commitment to Excellence…
Slide 3 : Normal Liver
Slide 4 : Autopsy 1.5 kg, wedge shape 4 lobes, Right, left, Caudate, Quadrate. Double blood supply Hepatic arteries Portal – Venous blood Acini / Portal triad. Lobules – central. V
Slide 5 : Normal Liver - Infant
Slide 6 : CT Upper abdomen - Normal
Slide 7 : VHP- Upper abdomen
Slide 8 :
Slide 9 : Normal Liver - Microscopy
Slide 10 : Liver Functions: Metabolism – Carbohydrate, Fat & Protein Secretory – bile, Bile acids, salts & pigments Excretory – Bilirubin, drugs, toxins Synthesis – Albumin, coagulation factors Storage – Vitamins, carbohydrates etc. Detoxification – toxins, ammonia, etc.
Slide 11 : Jaundice Yellow discoloration of skin & sclera due to excess serum bilirubin. >40umol/l, (3mg/dl) Conjugated & Unconjugated types Obstructive & Non Obstructive (clinical) Pre-Hepatic, Hepatic & Post Hepatic types Jaundice - Not necessarily liver disease *
Slide 12 : Pathology of Hepatitis
Slide 13 : Hepatitis: Hepatitis: Inflammation of Liver Viral, Alcohol, immune, Drugs & Toxins Biliary obstruction – gall stones. Acute, Chronic & Fulminant - types Viral Hepatitis – Specific – Heptitis A, B, C, D, E, & other Systemic - CMV, EBV, other.
Slide 14 : Pattern of Viral Hepatitis: Carrier state / Asymptomatic phase Acute hepatitis Chronic Hepatitis Chronic Persistent Hepatitis (CPH) Chronic Active Hepatitis (CAH) Fulminant hepatitis Cirrhosis Hepatocellular Carcinoma
Slide 15 : Acute - Hepatitis - Chronic
Slide 16 : Acute Hepatitis: Swelling and Apoptosis Piecemeal or Bridging, panacinar necrosis Inflammation – lymphocytes, Macrophages Ground glass hepatocytes – HBV Mild fatty change – HCV Portal inflammation and Cholestasis
Slide 17 : Fulminant Hepatitis: Hepatic failure with in 2-3 weeks. Reactivation of chronic or acute hepatitis Massive necrosis, shrinkage, wrinkled Collapsed reticulin network Only portal tracts visible Little or massive inflammation – time More than a week – regenerative activity Complete recovery – or - cirrhosis.
Slide 18 : Chronic Hepatitis: Persistent & Active types. CPH/CAH Lymphoid aggregates Periportal fibrosis Necrosis with fibrosis – bridging fibrosis. Cirrhosis – regenerating nodules.
Slide 19 : Acute viral Hepatitis:
Slide 20 : Acute viral Hepatitis:
Slide 21 : Acute viral Hepatitis:
Slide 22 : Acute viral Hepatitis C:
Slide 23 : Liver Biopsy – CPH:
Slide 24 : Liver Biopsy – Cirrhosis
Slide 25 : Viral Hepatitis: Microbiology
Slide 26 : Pathology of Alcoholic Liver Disease
Slide 27 : Alcoholic Liver Injury: Ethyl alcohol : Common cause of acute/Chronic liver disease Alcoholic Liver disease - Patterns Fatty change, Acute hepatitis (Mallory Hyalin) Chronic hepatitis with Portal fibrosis Cirrhosis, Chronic Liver failure All reversible except cirrhosis stage.
Slide 28 : Alcoholic Liver Injury: Pathogenesis Acetaldehyde – metabolite – hepatotoxic Diversion of metabolism – fat storage. Oxidation of ethanol NAD to NADH. NAD is required for the oxidation of fat.. Increased peripheral release of fatty acids. Inflammation, Portal bridging fibrosis Stimulates collagen synthesis – fibrosis. Micronodular cirrhosis.
Slide 29 : Alcoholic Liver Damage
Slide 30 : Alcoholic Fatty Liver
Slide 31 : Steatosis in Alcoholism
Slide 32 : Alcoholic Fatty Liver
Slide 33 : Alcoholic Fatty Liver
Slide 34 : Cirrhosis in Alcoholism
Slide 35 : Alcoholic Cirrhosis
Slide 36 : Bilirubin Metabolism Blood Conjugated & Conjugated Urine – Urobilinogen Stool – Stercobilin
Slide 37 : Common Causes of Jaundice Pre Hepatic (Acholuric) - Hemolytic Unconjugated/Indirect Bil, pale urine Hepatic – Viral, alcohol, toxins, drugs Liver damage - unconjugated Swelling, canalicular obstruction - Conjugated Post Hepatic (Obstructive) – Stone, tumor Conjugated/Direct Bil, High colored urine,
Slide 38 : Jaundice
Slide 39 : Jaundice
Slide 40 : ‘Time’ is the best kept secret of the rich..! – Jim Rohn
Slide 41 : Pathology of Alcoholic Liver Disease
Slide 42 : Definition: Diffuse disorder of liver characterised by; Complete loss of normal architecture, Replaced by extensive fibrosis with, Regenerating parenchymal nodules.
Slide 43 : Introduction Cirrhosis is common end result of many chronic liver disorders. Diffuse scarring of liver – follows hepatocellular necrosis of hepatitis. Inflammtion – healing with fibrosis - Regeneration of remaining hepatocytes form regenerating nodules. Loss of normal architecture & function.
Slide 44 : Normal Liver
Slide 45 : Cirrhosis
Slide 46 : Normal Liver Histology CV PT
Slide 47 : Cirrhosis Fibrosis Regenerating Nodule
Slide 48 : Etiology of Cirrhosis Alcoholic liver disease 60-70% Viral hepatitis 10% Biliary disease 5-10% Primary hemochromatosis 5% Cryptogenic cirrhosis 10-15% Wilson’s, ?1AT def rare
Slide 49 : Pathogenesis: Hepatocyte injury leading to necrosis. Alcohol, virus, drugs, toxins, genetic etc.. Chronic inflammation - (hepatitis). Bridging fibrosis. Regeneration of remaining hepatocytes Proliferate as round nodules. Loss of vascular arrangement results in regenerating hepatocytes ineffective.
Slide 50 : Cirrhosis Features: Liver Failure Parenchymal regeneration but why …..??. Portal obstruction, Porta systemic shunts… Portal hypertension, Splenomegaly Jaundice, Coagulopathy, hypoproteinemia, toxemia, Encephalopathy,
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