Entero- hepatic diseases

Liver, acute viral hepatitis

(hepatitis B virus)
Low power

• portal area
 Liver, acute viral hepatitis
(hepatitis B virus)
High power

• bile pigment • regenerating hepatocytes

• hepatocytes • inflammatory infiltrate

• liver sinusoid
 Liver, acute viral hepatitis
(hepatitis B virus)

• balloning of degenerating hepatocytes • councilman/ acidophilic body

• inflammation
Liver, fulminant hepatitis
Gross Low power

• necrotic area
Liver, viral hepatitis, carrier state
(hepatitis B virus)
Medium power High power

immunohistochemical stain for HbsAg • ground- glass hepatocyte

 Liver, chronic viral hepatitis
(hepatitis B virus)
Patient 1 Medium power
Patient 2

• portal area • portal area

• inflammation surrounding hepatocites

 Liver, chronic viral hepatitis
(hepatitis C virus) - Low power

• portal area

• lymphoid agregate

• steatosis
 Liver, cirrhosis from chronic viral
hepatitis -
Gross
Cut surface

Liver, alcoholic cirrhosis

contains numerous,
fairly uniform, small
nodules of • Regenerative liver nodul
regenerative
hepatocytes
separated by
depressed areas of
fibrous scar tissue
 Liver, biliary cirrhosis
Gross, cut surface
This is a section of liver from a child who died
of biliary cirrhosis secondary to biliary atresia.
The cut surface is dark green, due to marked
cholestasis within the liver. Regenerative
nodules of liver parenchyma are separated by
tan bands of fibrous tissue
Biliary tree, biliary atresia
Biliary atresia, a common
cause of neonatal cholestasis,
results from progressive
destruction of the hepatic and
common bile ducts.
In this image, the common bile
duct is reduced to a thin band
of fibrous tissue extending from
the hilum of the liver, which is
green due to the presence of
cholestasis, to the duodenal
area. This leads to the
development of cirrhosis in the
first year of life. It is the most
common cause of referral for
liver transplantation in children
Ascites - Clinical presentation
-
Skin, spider telangiectasia
Ascites

Esophagus, varices - Gross, mucosal surface

• esophagus

• stomach

• erosion due to sclerosing th

Liver, hepatocellular carcinoma
Gross
Cut surface

Medium power

a. hepatocellular carsinoma

b. satellite tumor nodule

• Cord of malignant hepatocites

 Liver,
alcoholic hepatic steatosis (fatty liver)
Gross, cut surface Low power

Medium power

• mallory bodies
Enlarged, soft,
and yellow. • hepatocites
a greasy texture • high power view
• intracytoplasmic fat

• mallory bodies
Liver, nonalcoholic steatohepatitis,
trichrome stain - High power

• central vein

• perivenular (chicken
wire) type fibrosis

Conditions associated with the development of

NAFL and NASH are Obesity and diabetes
mellitus
 Liver neoplasia
cavernous hemangioma focal nodular hyperplasia

• central stellata
• liver cell adenoma fibrous scar

• low power image

• normal liver
• hemangioma
 cholangiocarcinoma
gross Low power

• outer surface • fibrostic tissue and tumor

• cut surface • cholangiosarcoma

• uninvolved liver
congenital and metabolic disease
Liver, Wilson disease Liver, hemochromatosis

accumulation of copper
in the hepatocytes • hemosiderin in ductullar cell

• hemosiderin in hepatocites
Liver, metastatic adenocarcinoma

there are numerous tan, sometimes hemorrhagic and necrotic, nodules of

metastatic tumor throughout the liver. Also, there is bile staining of the
remaining liver

Most tumors metastasize to the liver hematogenously through the

portal vein or hepatic artery. Biliary tract tumors directly and
contiguously spread to the liver.
 Liver,
congestive heart failure

hepatic infarct

localized, pale,
and typically subcapsular,
are rare
 Trombosis
portal vein thrombosis
Thrombosis of the portal vein
in the hilum of the liver,
owing to inflammation in the hilum
of the liver or pylephlebitis.
The result will be the development
of ascites and other stigmata of
portal hypertension
hepatic vein thrombosis
Thrombotic occlusion of several
branches of the hepatic vein has
occurred, resulting in marked
congestion of hepatic sinusoids in the
area involved.
The result is a localized dark area with
areas of centrilobular congestion
visible on the cut surface of the liver
 Gallbladder,

cholelithiasis and acute and chronic cholecystitis -

A section of a gallbladder from this case of acute and

chronic cholecystitis shows marked fibrous thickening
of the wall with areas of mucosal necrosis and
ulceration. An inflammatory cellular infiltrate is present
in the wall, especially in the areas of ulceration
Biliary ducts, choledocholithiasis -
Gross, mucosal surface
A serious complication of
cholelithiasis is
choledocholithiasis.
Gallstones pass from the
gallbladder and through the cystic
duct to impact somewhere in the
common bile duct, causing
choledocholithiasis.
This complication leads to dilation
• hepatic duct of the biliary tree proximal to the
obstruction
• common bile duct
• gall stones
• liver
 Pancreas, acute pancreatitis

Etiology= Alcoholism, along with biliary tract disease (cholelithiasis)(80%); idiopathic(

10- 20%); there is increasing evidence of several genetic defects.
Patogenesis= the result of release of pancreatic enzymes from acinar cells, causing
proteolysis, lipolysis, and hemorrhage. Released elastase degrades elastic tissue in
vessel walls. Pancreatic amylase is also released.
Proposed mechanisms of pancreatic injury and subsequent enzyme release include:
(1) duct obstruction, (2) direct acinar cell injury, and (3) deranged intracellular
transport of pancreatic enzymes.
 Common bile duct, stricture
ERCP image

• dilated common bile and hepatic duct

• pancreatic duct

• stricture area, distal common bile duct

Endoscopic Retrograde Cholangiopancreatography (ERCP) shows a

stricture of the distal common bile duct
Pancreas, carcinoma and chronic
pancreatitis
• etiology

• location • sign & symptoms

Chronic pancreatitis is associated with only a slightly increased risk of

cancer, so the finding is most likely coincidental.
Chronic pancreatitis results in destruction of the exocrine and,
eventually, endocrine portions of the pancreas.
It usually follows repeated bouts of acute pancreatitis that are due to
alcohol ingestion or obstruction of the pancreatic duct. Other causes
include tropical pancreatitis, hereditary pancreatitis, and idiopathic
cases.