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Cirrhosis

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Notes

Show Notes

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,

Slide :

	SlidesOnline 1 Years ago. Category: Pathology

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Pathology of Hepatitis & Cirrhosis. Venkatesh Murthy ShashidharPathology of Alcoholic Liver Disease more Pathology of Hepatitis & Cirrhosis. Venkatesh Murthy ShashidharPathology of Alcoholic Liver Disease. Alcoholic Liver Injury: …www.socgastro.org.pe/biblioteca/presentacion/archivos/cirrosishepatica/Cirrhosis22008.ppt less

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