Clinical Summary This 54-year-old man with a long history of alcohol abuse had been admitted to the

hospital numerous times for abdominal pain thought to be due to gastritis or a peptic ulcer. On several occasions his serum amylase level was elevated into the range of 300-500 u/L indicating relapsing or recurrent pancreatitis. Three weeks prior to his demise, the patient began an alcoholic binge. The binge continued until three days prior to the patient's death at which time he developed fever and malaise, prompting him to cease drinking. He was brought to the hospital semi-comatose and with a fever of 105.4°F. Shortly after arriving at the hospital, the patient died from massive pneumonia. Autopsy Findings At autopsy, a necrotizing lobar pneumonia was present which contained organisms consistent with Klebsiella pneumoniae. The liver was enlarged--weighing 2700 grams-and had a yellow-orange color. The liver was firm to palpation and the cut surface had a slightly granular appearance suggestive of early cirrhosis. The pancreas showed multiple areas of fibrosis.

Compare this with the normal dark red color of liver. The yellow color indicates high fat content in this tissue. .This gross photograph of liver tissue illustrates the yellowish color of the liver parenchyma.

.This low-power photomicrograph of liver illustrates a very pale-staining section with a uniform appearance throughout the section.

Another low-power photomicrograph illustrates again the pale. Notice the numerous holes throughout the tissue. washed-out appearance of this tissue. There are accumulations of inflammatory cells (arrows) around portal tracts. .

A higher-power photomicrograph illustrates more clearly the inflammatory cells (arrows) around the portal areas. .

. Very few normal liver cells can be seen in this slide.This higher-power photomicrograph of the centrilobular area gives the appearance of fatty tissue. A few more normalappearing hepatocytes are present at the left portion of the slide (arrows). as indicated by many empty spaces.

Another view at the same power illustrates the proliferation of bile ducts in the interlobular and perichordal regions (arrows). .

the hepatocyte nucleus can be seen as well. '''Note that each empty space is surrounded by a thin rim of eosinophilic cytoplasm.A high-power photomicrograph of the liver parenchyma shows that each individual liver cell is filled with a large. . in many instances. The red body (arrow) seen within a cell in the center of the slide is an acidophilic body associated with alcoholic hepatitis. clear droplet which represents the space remaining after lipid was dissolved by the dehydration procedure used to embed the tissue.

An oil red O stain for fat was performed on a frozen section of this liver tissue. The red droplets represent fat in the tissue which is typical of fatty degeneration in the liver. By using frozen sections the tissues do not have to be dehydrated through alcohol solutions and thus the fat does not get washed out. .

Alcoholic hyalin is easily distinguished from red blood cells (3) that are also present in this section. There are some clear vacuoles indicating fat droplets (1) and there are numerous red-staining granular deposits within the cytoplasm of hepatocytes (2)--this is alcoholic hyalin.This photomicrograph of the liver is from another patient with a history of alcohol use. .

This is a low-power photomicrograph of liver stained with a trichrome stain. connective tissue stains green (arrows) and hepatic parenchymal cells are red. The proliferation of scar tissue between the liver lobules is the result of cirrhosis. In this section. . Note that many of the parenchymal cells have clear spaces indicating fatty degeneration.

The green color is due to the accumulation of bile pigment.This gross photograph of liver demonstrates severe nodular cirrhosis. . Note the extensive scarring of the capsule and the nodular projections of tissue through the uncut capsule in this tissue.

The paler-staining areas between the round nodules represent fibrous connective tissue.This is a cut surface of the same tissue seen in the previous slide. Note the marked nodular pattern. .

What can cause liver steatosis and what is the probable cause of fatty liver in this case? 3. Is the accumulation of fat in the liver a reversible or an irreversible event? .Study Questions 1. What is accumulate in hepatocytes to produce fatty liver? 2. Describe mechanism of hepatocellular steatosis in an alcoholic? 4.

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