Difference between revisions of "Medical liver disease"

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==Steatohepatitis==
==Steatohepatitis==
===General===
{{Main|Steatohepatitis}}
*''Steatohepatitis'' is a label for a set of histopathologic findings.
*Fat accumulation in hepatocytes. 
**It may be a pattern seen in drug toxicity, e.g. methotrexate toxicity.<ref>MG. 22 September 2009.</ref>
 
Etiology:
#Alcohol = alcoholic steatohepatitis (ASH).
#Not alcohol = non-alcoholic steatohepatitis (NASH).
#Drug/toxin.<ref name=pmid12016549>{{Cite journal  | last1 = Farrell | first1 = GC. | title = Drugs and steatohepatitis. | journal = Semin Liver Dis | volume = 22 | issue = 2 | pages = 185-94 | month =  | year = 2002 | doi = 10.1055/s-2002-30106 | PMID = 12016549 }}</ref>
 
Notes:
*Pathologists can comment on the etiology; however, the histomorphology is not distinctive. In other words, ''ASH'' and ''NASH'' are clinical diagnoses.
*''Steatohepatitis'' is a misnomer.  It is '''not''' an ''-itis''; inflammation is '''not''' the (predominant) pathologic process.
 
===Microscopic===
Features:
*Steatosis (usually macrovesicular) - '''key feature'''.
**If less than 10% ... consider alt. diagnosis/disease process.
*Hepatocyte injury:
**Ballooning degeneration - '''key feature''' (see [[liver|introduction to liver]]).
**Mallory bodies.
***Mallory body wannabes: "occasional cytoplasmic clumping".
*+/-''Chicken-wire'' perisinusoidal fibrosis +/- zone III (centrilobular) fibrosis (early).
**Late-stage disease - portal bridging.<ref name=pmid14991537>{{Cite journal  | last1 = Gramlich | first1 = T. | last2 = Kleiner | first2 = DE. | last3 = McCullough | first3 = AJ. | last4 = Matteoni | first4 = CA. | last5 = Boparai | first5 = N. | last6 = Younossi | first6 = ZM. | title = Pathologic features associated with fibrosis in nonalcoholic fatty liver disease. | journal = Hum Pathol | volume = 35 | issue = 2 | pages = 196-9 | month = Feb | year = 2004 | doi =  | PMID = 14991537 }}</ref>
 
DDx:
*[[Wilson disease]].
*[[Hepatitis C]].
*[[Drug-induced liver disease]].
 
====Image====
<gallery>
Image:Steatohepatitis_high_mag.jpg | Steatohepatitis. (WC)
</gallery>
===Grading steatohepatitis===
Grading inflammation:<ref name=pmid10484010>Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Am J Gastroenterol. 1999 Sep;94(9):2467-74. PMID 10484010.</ref>
*Grade 1 - steatosis, occasional ballooning degeneration, PMNs.
*Grade 2 - obvious ballooning, obvious PMNs, chronic inflammation.
*Grade 3 - panacinar steatosis.


=Autoimmune=
=Autoimmune=
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