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Hepatobiliary system

Hepatobiliary system. Integrated practical 17-12-2013 Dr Shaesta Naseem. Normal anatomy and histology. Normal Liver. Gross and histopathology. Chronic hepatitis. Chiefly Portal Inflammation. Viral Hepatitis. “FULMINANT” Acute Viral Hepatitis.

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Hepatobiliary system

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  1. Hepatobiliary system Integrated practical 17-12-2013 Dr ShaestaNaseem

  2. Normal anatomy and histology

  3. Normal Liver

  4. Gross and histopathology

  5. Chronic hepatitis

  6. Chiefly Portal Inflammation

  7. Viral Hepatitis

  8. “FULMINANT” Acute Viral Hepatitis

  9. Chronic hepatitis:Section from this liver biopsy show: • Moderate chronic inflammatory cells infiltration consisting of lymphocytes and histiocytesin both portal tracts and liver parenchyma. • Piecemeal necrosis, hepatocytes swelling and “spotty” hepatocytes necrosis are also noticed.

  10. Hepatic cirrhosis

  11. Organ: Liver Dx: macronudular cirrhosis (HBV)

  12. IRREGULAR NODULES SEPARATED BY PORTAL-to-PORTAL FIBROUS BANDS

  13. Cirrhosis • Very low power microscopic view of the liver. • The parenchyma shows darker tan nodules of varying sizes. • These nodules are composed of hepatocytes. • The paler areas in between are collagen.

  14. CIRRHOSIS, TRICHROME STAIN

  15. Cirrhosis of the liver:Section of liver show: • Loss of lobular architecture and formation of regenerative nodules of variable size and shape, surrounded by fibrous tissue. • Each nodules consists of liver cells without any arrangement and with no central vein. • Large number of proliferated bile ducts and chronic inflammatory cells are present in fibrous tissue.

  16. Hepatocellular carcinoma

  17. Liver tissue containing a pale and yellowish nodular hepatic mass with areas of hemorrhage and necrosis.

  18. This example of well-differentiated HCC shows a trabecular pattern with intervening sinusoids.

  19. Well differentiated hepatocellular carcinoma showing: Distorted hepatic architecture, thick hepatic trabeculae , with mildly atypical hepatocytes showing large nuclei and prominent nucleoli.

  20. The malignant liver cells are pleomorphic, binucleated or forming giant cells with hyperchromatic nuclei. Mitoses are numerous. g

  21. Hepatocellular carcinoma:Section show tumour consisting of: • Thick cords, trabeculaeand nests of malignant liver cells separated by sinusoidal spaces. • Malignant liver cells are atypical hepatocytes showing large nuclei and prominent nucleoli. • Patients with Hepatitis B and C have a risk to develop hepatic carcinoma, (Serology for hepatitis B and C status). • Tumor marker: Alpha-fetoprotein.

  22. Chronic cholecystitis with stones

  23. CHRONIC CHOLECYSTITIS

  24. Chronic cholecystitis:Section of gallbladder wall shows: • Irregular mucosal folds and foci of ulceration in mucosa. • Wall is penetrated by mucosal glands which are present in muscle coat ( Rokitansky- Aschoff sinuses). • All layers show chronic inflammatory cells infiltration and fibrosis.

  25. Drug toxicity

  26. Hepatocellular necrosis due to paracetamol (acetaminophen).  Confluent necrosis with little inflammation is seen in a perivenular area.

  27. Drug Toxicity • Liver injury due to medications or other toxic agents. • Can resemble any liver process; clinical correlation essential in diagnosis. Histopathology: Changes that can be seen are: • Cholestasis • Steatosis • Granulomas • HepatocellularNecrosis

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