Difference between revisions of "Liver pathology"

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Liver pathology (view source)

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===Cholestasis===
===Cholestasis===
:''Cholestatic [[hepatitis]]'' redirects here.
{{Main|Cholestasis}}
====General====
Clinical - classic:<ref>URL: [http://www.patient.co.uk/doctor/cholestasis http://www.patient.co.uk/doctor/cholestasis]. Accessed on: 28 November 2013.</ref>
*Dark urine and light stools.
 
Short DDx - by etiology:
*Congenital: Bile duct cyst, biliary atresia, liver cysts.
*Infectious: Worm.
*Tumour: pancreas, bile duct, liver.
*Endocrine: cholestasis of pregnancy.
*Trauma -> sepsis.
*Autoimmune: PSC, PBC.
*Toxins: alcohol -> cirrhosis.
*Everything else: drugs, e.g. [[NSAID]]s.
 
Short DDx - structural:
*Obstruction - large duct:
**Tumour.
**Gallstone.
**Worm.
**PSC.
*Small duct - autoimmune:
**PBC.
*Other:
**Rx.
**Toxins.
**Cholestasis of pregnancy.
 
====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>Guindi, M. September 2009.</ref>
{| class="wikitable sortable" border="1"
! Finding
! Colour
! Granularity
! Refractile
! Usual location
! Association
! Stain
! Image
|-
| Iron||Brown||Coarse granules||Yes - shinny||Periportal<br>(zone I)||Hemolysis, hereditary hemochromatosis || [[Prussian blue stain|Prussian blue]] +ve || [[Image:Sickle_cell_disease_and_cirrhosis_-_very_high_mag.jpg|thumb|center|100px|Iron and bile. (WC)]]
|-
| Bile||Brown - coffee stained||Not granular||No - dull||Portal||Duct injury/obstruction
| None || [[Image:Cholestasis_high_mag.jpg|thumb|100px|center|Bile. (WC)]]
|-
| Lipofuscin||Yellow||Fine granules||No||Centrilobular<br>(zone III)||Advanced age || [[PAS stain]] +ve || [[Image:Ground_glass_hepatocytes_high_mag_cropped.jpg|thumb|100px|center|Lipofuscin. (WC)]]
|-
|}
 
=====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======
<gallery>
Image:Cholestasis_high_mag.jpg | Cholestasis. (WC/Nephron)
</gallery>
www:
*[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=
Michael
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