Difference between revisions of "Medical liver disease"

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Medical liver disease (view source)

Revision as of 05:14, 2 September 2016

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→‎Hepatitis C: split out
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==Hepatitis C==
==Hepatitis C==
===General===
{{Main|Hepatitis C}}
*Leads to hepatocellular carcinoma in the setting of cirrhosis.
*Tends to be chronic; the "C" in "hepatitis C" stands for ''chronic''.
*Diagnosis is by serology.
 
Associated pathology:
*[[Membranoproliferative glomerulonephritis]].
*[[Membranous nephropathy]].
*[[Cryoglobulinemia]].
 
===Microscopic===
Features:
*Lobular inflammation - this is non-specific finding.
**Usually Grade 1, rarely Grade 2 and almost never Grade 3 or Grade 4.<ref>STC. 6 December 2010.</ref>
*Periportal steatosis in genotype 3.<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>
**Steatosis in hepatitis C is usually a secondary pathology, i.e. a separate pathologic process.<ref>OA. September 2009.</ref>
 
====Images====
{|
[[File:1 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
[[File:2 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
<br>
[[File:3 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
[[File:4 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
<br>
[[File:5 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
[[File:6 HCV 9 680x512px.tif| Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).]]
|}
Hepatitis C virus. Metavir Activity Index 1 (PMN 0 LN 1).
Preserved architecture shows small, inflamed triads [red arrows] and foci of spotty necrosis [blue arrows] (Row 1 Left 40X). Trichrome shows periportal fibrosis [blue arrow] and central venous sclerosis [green arrow] (Row 1 Right 100X). A higher power view of an inflamed triad with interface hepatitis, but a smooth outline, suggesting no piecemeal necrosis (Row 2 Left 200X). A focus of spotty necrosis near an unafflicted triad below it  (Row 2 Right 200X). Reticulin shows collapse [arrows] extending from/near portal triad without piecemeal necrosis (Row 3 Left 200X).  Reticulin shows collapse [arrows] extending from/near central vein  (Row 3 Right 200X).
 
{|
[[File:1 hcv 6 680x512px.tif|Inflamed bands cross hepatocytes with steatosis (Row 1 Left 40X).]]
[[File:2 hcv 6 680x512px.tif|Trichrome shows extensive bridges  (Row 1 Right 40X).]]
<br>
[[File:3 hcv 6 680x512px.tif|Trichrome also documents early nodule formation (Row 2 Left 40X).]]
[[File:4 hcv 6 680x512px.tif|Reticulin shows regeneration (two nuclei per cord) in a nodule, but not throughout (Row 2 Right 200X).]]
<br>
[[File:5 hcv 6 680x512px.tif|Hematoxylin and eosin shows piecemeal necrosis as inflammatory cells surrounding hepatocytes (Row 3 Left 400X).]]
[[File:6 hcv 6 680x512px.tif|Reticulin shows black lines about hepatocytes, indicating confluent piecemeal necrosis (Row 3 Right 400X).]]
|}
Hepatitis C with metavir stage IV fibrosis (advanced fibrosis/cirrhosis) and confluent piecemeal necrosis.
Inflamed bands cross hepatocytes with steatosis (Row 1 Left 40X). Trichrome shows extensive bridges  (Row 1 Right 40X). Trichrome also documents early nodule formation (Row 2 Left 40X). Reticulin shows regeneration (two nuclei per cord) in a nodule, but not throughout (Row 2 Right 200X). Hematoxylin and eosin shows piecemeal necrosis as inflammatory cells surrounding hepatocytes (Row 3 Left 400X). Reticulin shows black lines about hepatocytes, indicating confluent piecemeal necrosis (Row 3 Right 400X).
{|
[[File:1 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
[[File:2 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
<br>
[[File:3 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
[[File:4 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
<br>
[[File:5 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
[[File:6 HCV 7 680x512px.tif|Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3]]
|}
Hepatitis C. Metavir Activity Index 2 (PMN2, LN1), Metavir fibrosis stage 3.
Expanded dark triads, indicating interface hepatitis [red arrows], foci of steatosis [green arros], potential bridge [blue arrow] (Row 1 Left 20X). Extending from triad are stretches of apparent necrosis [green arrows], inflammatory cells bound hepatocytes afflicted by piecemeal necrosis [yellow arrows], ballooning degeneration denoted by cytoplasmic tufts [blue arrows] (Row 1 Right 400X). Reticulin shows collapse (necrosis) with thick bands [red arrows], as well as rosettes [green arrows] indicating dilated cholangioles (Row 2 Left 200X). Reticulin here shows continuous piecemeal necrosis with black bounded hepatocyte islets [arrows] (Row 2 Right 200X). Reticulin here shows a bridge with regeneration, wherein two or more nuclei lie between reticulin lines [arrows] (Row 3 Left 200X). Trichrome demarcates one of the bridges (Row 3 Right 200X).
 
DDx:
*[[Hepatitis B]] (without ground glass hepatocytes).
*[[Autoimmune hepatitis]].
*[[Primary biliary cirrhosis]] without granulomas.
*[[Drug-induced liver disease|Drug reaction]].


=Other infections=
=Other infections=
Michael
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