Difference between revisions of "Liver pathology"

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Liver pathology (view source)

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===Steatosis of the liver===
===Steatosis===
Can be divided into:
{{Main|Steatosis}}
#Microvesicular steatosis.
#*Rare.
#*Nucleus is central.<ref>STC. 6 December 2010.</ref>
#Macrovesicular steatosis.
#*Common.
#*Nucleus is eccentric.
 
Microvescicular is considered potentially life threatening.<ref name=pmid15503661>{{Cite journal  | last1 = Jolly | first1 = RA. | last2 = Ciurlionis | first2 = R. | last3 = Morfitt | first3 = D. | last4 = Helgren | first4 = M. | last5 = Patterson | first5 = R. | last6 = Ulrich | first6 = RG. | last7 = Waring | first7 = JF. | title = Microvesicular steatosis induced by a short chain fatty acid: effects on mitochondrial function and correlation with gene expression. | journal = Toxicol Pathol | volume = 32 Suppl 2 | issue =  | pages = 19-25 | month =  | year =  | doi =  | PMID = 15503661 | URL = http://tpx.sagepub.com/cgi/pmidlookup?view=long&pmid=15503661 }}</ref>
 
Quantity of fat is usually given as a percentage and graded ''mild'', ''moderate'', or ''marked''.
*Mild <33%, moderate >33% & <66%, marked >66%.<ref>Guindi, M. September 17, 2009.</ref>
 
Notes:
*It is considered technically incorrect to say the liver, in steatosis/steatohepatitis, contains ''adipocytes''; they are ''lipid-laden hepatocytes'',<ref>Guindi, M. September 2009.</ref> despite that:
**Histologically, these cells look like adipocytes.
**Lipid-laden hepatocytes have gene activations suggestive of adipogenic-like transformation.<ref>URL: [http://www.jci.org/articles/view/20513/version/1 http://www.jci.org/articles/view/20513/version/1]. Accessed on: 23 September 2009.</ref>
 
====Microvesicular steatosis====
Microvesicular steatosis DDx:<ref name=pmid2177300>{{cite journal |author=Hautekeete ML, Degott C, Benhamou JP |title=Microvesicular steatosis of the liver |journal=Acta Clin Belg |volume=45 |issue=5 |pages=311–26 |year=1990 |pmid=2177300 |doi= |url=}}</ref>
*Acute fatty liver of pregnancy,
*Reye's syndrome.
*Drug toxicity:
**Sodium valproate toxicity.
**High-dose tetracycline toxicity.
*Jamaican vomiting sickness.
*Congenital defects of urea cycle enzymes.
 
Less common causes:
*Alcoholism.
*Hepatitis D.
*Weird stuff:
**Congenital defects of fatty acid beta oxidation,
**Cholesterol ester storage disease,
**Wolman disease and Alpers syndrome.
 
The classic causes of microvesicular steatosis are:<ref>[http://www.mailman.srv.ualberta.ca/pipermail/patho-l/1996-June/001788.html http://www.mailman.srv.ualberta.ca/pipermail/patho-l/1996-June/001788.html]</ref>
*Fatty liver of pregnancy.
*Aspirin (Reye's syndrome).
*Tetracycline.
It was once thought that all other causes of fatty liver produce macrovesicular steatosis.
 
====Macrovesicular steatosis====
Can sometimes be divided into ''centrilobular'' predominant and ''periportal'' predominant.<ref name=pcddx_steatosis>Steatosis. pathconsultddx.com. URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970840-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970840-3]. Accessed on: 2 Sep 2009.</ref>
 
Centrilobular predominant (zone III) - ''DOA'':<ref name=pcddx_steatosis/>
*[[Diabetes mellitus]].
*Obesity, non-alcoholic steatohepatitis (NASH).
*Alcoholic liver disease, alcoholic steatohepatitis (ASH).
 
Image:
<gallery>
Image:Non-alcoholic_fatty_liver_disease1.jpg | Centrilobular steatosis. (WC/Nephron)
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Periportal predominant (zone I) - ''TAPES'':<ref name=pcddx_steatosis/>
*Total parenteral nutrition (TPN).
*AIDS.
*Phosphorus poisoning.
*Exogenous steroids.
*[[Starvation]].<ref name=pmid10600264>{{Cite journal  | last1 = Nagy | first1 = I. | last2 = Németh | first2 = J. | last3 = Lászik | first3 = Z. | title = Effect of L-aminocarnitine, an inhibitor of mitochondrial fatty acid oxidation, on the exocrine pancreas and liver in fasted rats. | journal = Pharmacol Res | volume = 41 | issue = 1 | pages = 9-17 | month = Jan | year = 2000 | doi = 10.1006/phrs.1999.0565 | PMID = 10600264 }}</ref>
 
Notes:
*HCV genotype 3 is reported to cause periportal steatosis.<ref name=pmid16614743>Yoon EJ, Hu KQ. Hepatitis C virus (HCV) infection and hepatic steatosis. Int J Med Sci. 2006;3(2):53-6. Epub 2006 Apr 1. PMID 16614743. Avialable at: [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1415843 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1415843]. Accessed on: September 9, 2009.</ref>
*Donor livers with more ''macrovescicular steatosis'' = worse outcome.
**More than 30% means the liver is undesirable for [[Liver transplantation pathology|transplantation]].<ref>STC. 6 December 2010.</ref>
 
Image:
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Image:Periportal_hepatosteatosis_intermed_mag.jpg | Periportal steatosis. (WC/Nephron)
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===Cholestasis===
===Cholestasis===
Michael
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