Difference between revisions of "Medical liver disease"

[[File:1 asc chol 1 680x512px.tif|Rounded, clear (edematous) portal tracts (arrows) separated by hepatocytes with dilated sinusoids (Row 1 Left 40X).]]

[[File:2 asc chol 1 680x512px.tif|Neutrophils about hepatocytes (arrows) have spilled into the lobule from a portal tract (Row 1 Right 200X).]]

[[File:3 asc chol 1 680x512px.tif|Proliferated bile ductules (arrows) bearing neutrophils within epithelium and lumens are features of obstruction that should prompt a search for interlobular ducts with acute inflammation (Row 2 Left 400X).]]

[[File:4 asc chol 1 680x512px.tif|The epithelium of the ducts can be severely degenerated. Neutrophils (cyan arrows) invade epithelium of an interlobular duct that are recognizable mainly as a circle of rounded nuclei; the associated arteriole (red arrow) should be identified to ensure an interlobular duct is being evaluated. Note the proliferated bile ductules (blue arrows)  (Row 2 Right 400X).]]

Acute cholangitis in a patient with multiple bile duct procedures. After the biopsy, removal of bile duct stones released pus. Rounded, clear (edematous) portal tracts (arrows) separated by hepatocytes with dilated sinusoids (Row 1 Left 40X). Neutrophils about hepatocytes (arrows) have spilled into the lobule from a portal tract (Row 1 Right 200X). Proliferated bile ductules (arrows) bearing neutrophils within epithelium and lumens are features of obstruction that should prompt a search for interlobular ducts with acute inflammation (Row 2 Left 400X). The epithelium of the ducts can be severely degenerated. Neutrophils (cyan arrows) invade epithelium of an interlobular duct that are recognizable mainly as a circle of rounded nuclei; the associated arteriole (red arrow) should be identified to ensure an interlobular duct is being evaluated. Note the proliferated bile ductules (blue arrows) (Row 2 Right 400X). A PAS without diastase stain colors the arteriole (blue arrow), as well as the rim of the interlobular duct within which lies a neutrophil (cyan arrow) (Row 3 Left 400X). A PAS with diastase stain colors the arteriole (red arrow), as well as the rim of the interlobular duct within which lies a neutrophil (cyan arrow) (Row 3 Right 400X).

 

[[File:1 Sep Acu Cho 1 680x512px.tif|Low power shows variably sized inflamed portal tracts (40X)]]

[[File:2 Sep Acu Cho 1 680x512px.tif|Trichrome shows dilated sinusoids and space of Disse collagenization (200X)]]

[[File:3 Sep Acu Cho 1 680x512px.tif|Inflammatory focus with macrophages and neutrophils (400X).]]

[[File:4 Sep Acu Cho 1 680x512px.tif|PAS with diastase shows proliferated bile ductules at edge of triad with neutrophils, which should not be used to make a definite diagnosis of acute cholangitis (400X).]]

Patient with sepsis and acute cholangitis. Low power shows variably sized inflamed portal tracts (Row 1 Left 40X). Trichrome shows dilated sinusoids and space of Disse collagenization (Row 1 Right 200X). Inflammatory focus with macrophages and neutrophils (Row 2 Left 400X). PAS with diastase shows proliferated bile ductules at edge of triad with neutrophils, which should not be used to make a definite diagnosis of acute cholangitis (Row 2 Right 400X). PAS without diastase showing acutely inflamed bile duct, with accompanying blood vessel of similar size, diagnostic of acute cholangitis (Row 3 Left 400X). PAS with diastase showing neutrophil in bille duct lumen, diagnostic of acute cholangitis (Row 3 Right 400X).