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Difference between revisions of "Liver pathology"
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===Cholestasis=== | ===Cholestasis=== | ||
====General==== | |||
Short DDx - by etiology: | Short DDx - by etiology: | ||
*Congenital: Bile duct cyst, biliary atresia, liver cysts. | *Congenital: Bile duct cyst, biliary atresia, liver cysts. | ||
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**Cholestasis of pregnancy. | **Cholestasis of pregnancy. | ||
====Brown/yellow cytoplasmic inclusions==== | ====Microscopic==== | ||
Appearance of bile: | |||
*Smooth/homogenous. | |||
*Brown/yellow. | |||
*Globule/droplet - that is larger than an iron granule. | |||
Note: | |||
*Iron in bile ducts or endothelial cell = non-specific, used to be thought to be specific for [[hereditary hemochromatosis]]. | |||
=====Brown/yellow cytoplasmic inclusions===== | |||
Comparison of brown/yellow cytoplasmic inclusions:<ref>MG. September 2009.</ref> | Comparison of brown/yellow cytoplasmic inclusions:<ref>MG. September 2009.</ref> | ||
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=====Large duct obstruction===== | |||
Histologic findings of large-duct obstruction:<ref>{{Ref MacSween|565}}</ref> | |||
#Perivenular bilirubinostasis. | |||
#Portal tract edema & inflammation (neutrophils & macrophages). | |||
#Large bile plugs. | |||
#Bile duct proliferation.<ref name=pmid7439807>{{cite journal |author=Chapman RW, Arborgh BA, Rhodes JM, ''et al.'' |title=Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology |journal=Gut |volume=21 |issue=10 |pages=870–7 |year=1980 |month=October |pmid=7439807 |pmc=1419383 |doi= |url=}}</ref><ref name=pmid14594129>{{cite journal |author=Leuschner U |title=Primary biliary cirrhosis--presentation and diagnosis |journal=Clin Liver Dis |volume=7 |issue=4 |pages=741–58 |year=2003 |month=November |pmid=14594129 |doi= |url=}}</ref> | |||
Note: | |||
*''Ductular reaction'' = increased number of ducts + [[neutrophil]]s.<ref name=pmid9845427>{{Cite journal | last1 = Roskams | first1 = T. | last2 = Desmet | first2 = V. | title = Ductular reaction and its diagnostic significance. | journal = Semin Diagn Pathol | volume = 15 | issue = 4 | pages = 259-69 | month = Nov | year = 1998 | doi = | PMID = 9845427 }}</ref> | |||
=====Small duct obstruction===== | |||
Small-duct obstruction: | |||
*Abnormal liver plate architecture. (???) | |||
Images: | |||
*[http://commons.wikimedia.org/wiki/File:Cholestasis_high_mag.jpg Cholestasis (WC)]. | |||
*[http://www.humpath.com/spip.php?article4340&id_document=20040 Centrilobular cholestasis (humpath.com)]. | |||
====Sign out==== | |||
<pre> | |||
LIVER, CORE BIOPSY: | |||
- CENTRILOBULAR CHOLESTATSIS (MILD), SEE MICROSCOPIC DESCRIPTION AND COMMENT. | |||
- NEGATIVE FOR FIBROSIS. | |||
COMMENT: | |||
There is no apparent feathery degeneration. There is no bile ductular proliferation. No | |||
definite onion-skin lesions are identified. | |||
The centrilobular distribution of the bile favours a large duct obstruction. Possible | |||
causes include gallstones, other obstructing lesions, herbals and drugs. | |||
Clinical and radiologic correlation is suggested. | |||
</pre> | |||
=Diseases= | =Diseases= | ||