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with ordinary talent and extraordinary perseverance, all things are attainable. - thomas e. buxton achievement is co

Pathology of Hepatitis

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with ordinary talent and extraordinary perseverance, all things are attainable. - thomas e. buxton achievement is co

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    2. Pathology of Hepatitis & Cirrhosis Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine

    3. Normal Liver

    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

    5. Normal Liver - Infant

    6. CT Upper abdomen - Normal

    7. VHP- Upper abdomen

    9. Normal Liver - Microscopy

    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.

    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 *

    12. Pathology of Hepatitis

    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.

    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

    15. Acute - Hepatitis - Chronic

    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

    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.

    18. Chronic Hepatitis: Persistent & Active types. CPH/CAH Lymphoid aggregates Periportal fibrosis Necrosis with fibrosis bridging fibrosis. Cirrhosis regenerating nodules.

    19. Acute viral Hepatitis:

    20. Acute viral Hepatitis:

    21. Acute viral Hepatitis:

    22. Acute viral Hepatitis C:

    23. Liver Biopsy CPH:

    24. Liver Biopsy Cirrhosis

    25. Viral Hepatitis: Microbiology

    26. Pathology of Alcoholic Liver Disease

    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.

    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.

    29. Alcoholic Liver Damage

    30. Alcoholic Fatty Liver

    31. Steatosis in Alcoholism

    32. Alcoholic Fatty Liver

    33. Alcoholic Fatty Liver

    34. Cirrhosis in Alcoholism

    35. Alcoholic Cirrhosis

    36. Bilirubin Metabolism

    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,

    41. Pathology of Alcoholic Liver Disease

    42. Definition: Diffuse disorder of liver characterised by; Complete loss of normal architecture, Replaced by extensive fibrosis with, Regenerating parenchymal nodules.

    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.

    44. Normal Liver

    45. Cirrhosis

    46. Normal Liver Histology

    47. Cirrhosis

    48. Etiology of Cirrhosis Alcoholic liver disease 60-70% Viral hepatitis 10% Biliary disease 5-10% Primary hemochromatosis 5% Cryptogenic cirrhosis 10-15% Wilsons, ?1AT def rare

    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.

    50. Cirrhosis Features: Liver Failure Parenchymal regeneration but why ..??. Portal obstruction, Porta systemic shunts Portal hypertension, Splenomegaly Jaundice, Coagulopathy, hypoproteinemia, toxemia, Encephalopathy,

    51. Pathogenesis of Hepatic Encephalopathy

    52. Micronodular cirrhosis

    53. Ascitis in Cirrhosis

    54. Ascitis in Cirrhosis

    55. Micronodular cirrhosis:

    56. Micronodular cirrhosis:

    57. Alcoholic Hepatitis

    58. Macronodular Cirrhosis

    59. Liver Biopsy Cirrhosis

    60. Liver Biopsy Cirrhosis:

    61. Nutmeg Liver-Cardiac Sclerosis

    62. Clinical Features Hepatocellular failure. Malnutrition, low albumin & clotting factors, bleeding. Hepatic encephalopathy. Portal hypertension. Ascites, Porta systemic shunts, varices, splenomegaly.

    63. Bleeding in Liver disease: vitamin K in liver ?gamma-carboxyglutamic acid for coagulation factors II, VII, IX, and X. Liver disease ? factor VII is the first to go ? so the defect will appear initially in the extrinsic pathway, i.e., abnormal PT. When severe it affects both pathways.

    64. CirrhosisClinical Features

    65. Gynaecomastia in cirrhosis

    66. Porta-systemic anastomosis: Prominent abdominal veins.

    67. MRI Cirrhosis

    68. Complications: Congestive splenomegaly. Bleeding varices. Hepatocellular failure. Hepatic encephalitis / hepatic coma. Hepatocellular carcinoma.

    69. Hepatocellular Carcinoma

    70. Conclusions: Common end result of diffuse liver damage. (Viral hepatitis, Alcohol, congenital, drugs, toxins & Idiopathic) Characterised by diffuse loss of architecture. Fibrous bands & regenerating nodules distort and abstruct blood flow. (inefficient function) Hepatocellular insufficiency & portal hypertension. Shrunken, scarred liver, ascitis, spleenomegaly, liver failure, CNS toxicity.

    71. Conclusions: Hepatitis. Hepatitis Alcohol, Virus (ABCD), Drugs Hepatocyte damage inflammation Acute / Chronic (Active / Persistent) Fever, Jaundice, Malaise, Fat intolerance. Complications. Alcohol NAD, Acetaldehyde metabolism Fatty liver ? Necrosis ? Cirrhosis.

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