Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Pathology of the Liver 2
Document related concepts
Transcript
Pathology of the Liver 2 Dr. Shaun Walsh Dept. of Pathology Ninewells Hospital. Lecture Plan • • • • • • Normal liver structure and injury Acute liver failure Cirrhosis Alcoholic liver disease Viral hepatitis Other causes of chronic Hepatitis…. PBC,AIH, PSC • Storage diseases • Tumours of the liver Viral Hepatitis • May cause acute liver injury or chronic liver injury • Many agents • Common and rare causes exist Hepatitis A Hepatitis B Hepatitis C Hepatitis E Delta agent Ebstein-Barr virus Yellow fever virus Herpes Simplex virus Cytomegalovirus Hepatitis A • Faecal-oral spread • Short incubation period • Sporadic or endemic • Directly cytopathic • No carrier state • Mild illness, usually full recovery Hepatitis A Hepatitis B • Spread by blood, blood products, sexually, vertically (in utero) • Long incubation period • Liver damage is by antiviral immune response • Carriers exist • Outcome is variable Hepatitis C • Spread by blood, blood products, possibly sexually • Short incubation period • Often assymptomatic • Disease waxes and wanes • Tends to become chronic Chronic Viral Hepatitis Dense portal chronic inflammation Chronic Viral Hepatitis Portal inflammation Chronic Viral Hepatitis Interface Hepatitis (piecemeal necrosis) Chronic Viral Hepatitis Lobular inflammation Arrow shows a councilman body. Small amount of steatosis is present Chronic Viral Hepatitis Fibrosis Chronic Viral Hepatitis Cirrhosis Hepatitis B Outcome • • • • • Fulminant acute infection (Death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma Assymptomatic (Carrier) Hepatitis C Outcome • Chronic Hepatitis • Cirrhosis Lecture Plan • • • • • • Normal liver structure and injury Acute liver failure Cirrhosis Alcoholic liver disease Viral hepatitis Other causes of chronic Hepatitis…. PBC,AIH, PSC • Storage diseases • Tumours of the liver Chronic Hepatitis Aetiology: Autoimmune diseases • • • • • • Hepatitis B Hepatitis C Primary Biliary Cirrhosis Autoimmune hepatitis Drug induced hepatitis Primary Sclerosing Cholangitis Primary Biliary Cirrhosis • Rare autoimmune disease, unknown aetiology • Associated with autoantibodies to mitochondria • Females (90%) • Indication for biopsy: Stage the disease • May see granulomas and bile duct loss Primary Biliary Cirrhosis Chronic Portal Inflammation Primary Biliary Cirrhosis Bile ducts inflamed Primary Biliary Cirrhosis Granuloma around duct Primary Biliary Cirrhosis Cirrhosis If untreated bile duct loss leads to cholestasis liver injury, inflammation, fibrosis and cirrhosis Autoimmune Hepatitis • • • • • Commoner in females Associated with other AI diseases Chronic hepatitis pattern Numerous plasma cells Autoantibodies to smooth muscle, nuclear or LKM, raised IgG • May have triggers, including some drugs Chronic Drug-induced Hepatitis • Similar features to all other types of chronic hepatitis • May trigger an autoimmune hepatitis • Chronic active process • Causes are too many to list Drugs and the liver! General points • Innumerable drugs can damage the liver • May be dose related or idiosyncratic • Can cause hepatitis, granulomas, fibrosis, necrosis, failure, cholestasis or cirrhosis • Can mimic any liver disease Primary Sclerosing Cholangitis • Chronic inflammatory process affecting intra - and extra-hepatic bile ducts • Leads to periductal fibrosis, duct destruction, jaundice and fibrosis • Associated with Ulcerative Colitis • Males • Increased risk of malignancy in bile ducts and colon Primary Sclerosing Cholangitis Periductal onion-skinning fibrosis Lecture Plan • • • • • • Normal liver structure and injury Acute liver failure Cirrhosis Alcoholic liver disease Viral hepatitis Other causes of chronic Hepatitis…. PBC,AIH, PSC • Storage diseases • Tumours of the liver Storage diseases • Haemochromatosis • Wilsons disease • Alpha-1-antitrypsin deficiency Iron and the Liver • Haemochromatosis is excess iron within the liver • Primary: Genetic condition, increased absorption of iron • Secondary: Iron overload from diet, transfusions, iron therapy Primary Haemochromatosis A iron handling/storage disorder • Inherited autosomal recessive condition • Gene defect v.complex • Excess absorbtion of iron from intestine, abnormal iron metabolism • Worse in homozygotes, men Primary Haemochromatosis • Iron deposited in liver, assymptomatic for years • Eventually deposited in portal connective tissue and stimulates fibrosis • Cirrhosis if not treated • Predisposes to carcinoma • Also causes diabetes, cardiac failure and impotence Haemochromatosis Iron accumulates in Hepatocytes Haemochromatosis Iron is confirmed by Perls stain Haemochromatosis Outcome • Outcome depends on genetics, therapy (venesection) and cofactors such as alcohol • Cirrhosis • Hepatocellular carcinoma If untreated may lead to fibrosis and cirrhosis Wilson’s Disease • Inherited autosomal recessive disorder of copper metabolism • Copper accumulates in liver and brain (basal ganglia) • Kayser-Fleischer rings at corneal limbus • Low serum caeruloplasmin • Causes chronic hepatitis and neurological deterioration Alpha-1-antitrypsin deficiency • Inherited autosomal recessive disorder of production of an enzyme inhibitor • Causes empysema and cirrhosis • Cytoplasmic globules of unsecreted globules of protein in liver cells Alpha-1-antitrypsin deficiency Lecture Plan • • • • • • Normal liver structure and injury Acute liver failure Cirrhosis Alcoholic liver disease Viral hepatitis Other causes of chronic Hepatitis…. PBC,AIH, PSC • Storage diseases • Tumours of the liver Tumours of Liver • Primary (rare) - Hepatocellular adenoma - Hepatocellular carcinoma (Hepatoma) • Secondary (common) - Multiple - Metastases from colon, pancreas, stomach breast, lung, others…. Hepatocellular Adenoma • Benign • Females • May become large…can rupture or bleed • Most remain assymptomatic Hepatocellular Adenoma Hepatocellular Adenoma Hepatocellular Carcinoma • Rare in Europe • Associated with HBV, HCV and Cirrhosis • Usually presents as a mass, pain, obstruction • Usually advanced unless discovered incidentally • Poor prognosis Hepatocellular Carcinoma Hepatocellular Carcinoma Multifocal (rare) Hepatocellular Carcinoma Histopathological types Cholangio- Hepatocytic A. B. Metastatic Carcinoma Usually incurable disease unless single solitary metastasis Lecture Plan • • • • • • Normal liver structure and injury Acute liver failure Cirrhosis Alcoholic liver disease Viral hepatitis Other causes of chronic Hepatitis…. PBC,AIH, PSC • Storage diseases • Tumours of the liver
