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Biliary diseases Vascular diseases Parasites Tumors Liver transplantation

Liver Pathology 4:. Biliary diseases Vascular diseases Parasites Tumors Liver transplantation. Causes of Large Bile Duct Obstruction. Extrahepatic Biliary Atresia (EHBA). Reovirus 3 Rotavirus Immune targeting?. Loop of small intestine. Kasai Hepatic Portoenterostomy. EHBA Rx.

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Biliary diseases Vascular diseases Parasites Tumors Liver transplantation

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  1. Liver Pathology 4: • Biliary diseases • Vascular diseases • Parasites • Tumors • Liver transplantation

  2. Causes of Large Bile Duct Obstruction

  3. Extrahepatic Biliary Atresia (EHBA) • Reovirus 3 • Rotavirus • Immune • targeting?

  4. Loop of small intestine Kasai Hepatic Portoenterostomy EHBA Rx Liver Transplantation

  5. Primary Sclerosing Cholangitis (PSC) ERCP: endoscopic retrograde cholangiopancreatography

  6. , fewer Crohn’s

  7. Primary Biliary Cirrhosis (PBC) Guys’ Hospital Report London, 1851 Addison & Gull Mrs. Elizabeth Peacock

  8. 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) PDC-E2 Molecular Mimicry? Gram – bacteria HLA II • Assoc. with other autoimmune • dis: e.g. RA, sicca, celiac, scleroderma bile duct T T AMA florid bile duct lesion T

  9. Vascular Disease & • the Liver • Veins • Sinusoids • Arteries • Liver is often involved in heart disease or other outflow problems • (“hepatic venous • outflow obstruction”)

  10. Budd-Chiari Syndrome (Hepatic venous outflow obstruction) • oral contraceptives • coagulopathy (prot. S, C, • factor V Leiden def., • anti-cardiolipin Ab’s • tumor invasion of hep. V’s • or IVC: renal cell CA + HCC • small vein disease: VOD ascites

  11. Peliosis hepatis: blood lakes of the liver -HIV, C17-alkylated steroids (OC’s, anabolic steroids; systemic inflamm.

  12. Infarct: Arterial disease (PAN, ligation, chemoRx installation) Portal vein: Zahn infarct

  13. P.V. Pylephlebitis: -perforated ulcer, -ruptured appendix, etc.

  14. Schistosomiasis: Pre-sinusoidal, intrahepatic portal hypertension (Symmers’ “clay pipestem fibrosis”)

  15. pancreas

  16. LIVER-CELL ADENOMA -oral contraceptives -hepatocyte nuclear factor 1α (HNF-1α) mutations -benign hepatocytes, bld vessels, NO b.d.’s

  17. FOCAL NODULAR HYPERPLASIA (FNH) -malformation: central scar with artery, outgrowth of cirrhosis-like mass

  18. 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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