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Difference between revisions of "Liver pathology"
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Almost every differential in liver pathology has "drugs" -- if it isn't clearly malignancy. | Almost every differential in liver pathology has "drugs" -- if it isn't clearly malignancy. | ||
=Review of liver blood work= | |||
===Inflammation activity=== | ===Inflammation activity=== | ||
*ALT. | *ALT. | ||
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*Cirrhosis. | *Cirrhosis. | ||
=Normal histology= | |||
Liver has a dual blood supply: | Liver has a dual blood supply: | ||
#Portal vein. | #Portal vein. | ||
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#Interconnecting sinusoids - connect branching sinusoids. | #Interconnecting sinusoids - connect branching sinusoids. | ||
=Structural approach= | |||
Examine: | Examine: | ||
*Portal triad normal. | *Portal triad normal. | ||
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*Central vein - has a ''collagen collar'' (seen on trichrome). | *Central vein - has a ''collagen collar'' (seen on trichrome). | ||
=Pattern approach= | |||
<!-- | <!-- | ||
COMMON LIVER PATTERNS | COMMON LIVER PATTERNS | ||
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**Clinical correlate: toxin ingestion. | **Clinical correlate: toxin ingestion. | ||
=Biopsy= | |||
===Adequacy=== | ===Adequacy=== | ||
Liver biopsy specimens should be:<ref>{{Ref MacSween|418}}</ref> | Liver biopsy specimens should be:<ref>{{Ref MacSween|418}}</ref> | ||
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*In the liver: neutrophils ''is not'' acute -- unlike most elsewhere in the body.<ref>OA. September 2009.</ref> | *In the liver: neutrophils ''is not'' acute -- unlike most elsewhere in the body.<ref>OA. September 2009.</ref> | ||
=Stains= | |||
*[[Oil red O]] | *[[Oil red O]] | ||
**Useful for steatosis, not commonly done. | **Useful for steatosis, not commonly done. | ||
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**CD34 marks endothelial cells - these are not present in a healthy liver lobule. | **CD34 marks endothelial cells - these are not present in a healthy liver lobule. | ||
=Liver injury terms/histologic findings= | |||
==="Ballooning degeneration"=== | ==="Ballooning degeneration"=== | ||
*Central nucleus. | *Central nucleus. | ||
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*[http://commons.wikimedia.org/wiki/File:Bile_duct_hamartoma_intermed_mag.jpg Bile duct hamartoma - intermed. mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Bile_duct_hamartoma_intermed_mag.jpg Bile duct hamartoma - intermed. mag. (WC)]. | ||
=Diseases= | |||
{{main|Medical liver disease}} | {{main|Medical liver disease}} | ||
The liver is an organ of many medical diseases. | The liver is an organ of many medical diseases. | ||
=Liver lesions= | |||
{{main|Liver neoplasms}} | {{main|Liver neoplasms}} | ||
Includes pre-malignant lesions, i.e. dysplastic lesions, and malignant lesions, e.g. [[hepatocellular carcinoma]] (HCC). | Includes pre-malignant lesions, i.e. dysplastic lesions, and malignant lesions, e.g. [[hepatocellular carcinoma]] (HCC). | ||
==Liver mass DDx (simple)== | |||
Basic DDx of a liver mass (5 Hs):<ref>Toronto Notes 2007. DM16.</ref> | Basic DDx of a liver mass (5 Hs):<ref>Toronto Notes 2007. DM16.</ref> | ||
*Hepatocellular carcinoma (HCC). | *Hepatocellular carcinoma (HCC). | ||
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*[[Focal nodular hyperplasia|Hyperplasia, focal nodular]]. | *[[Focal nodular hyperplasia|Hyperplasia, focal nodular]]. | ||
==Cystic liver lesions== | |||
Radiologic DDx:<ref name=pmid11452064>{{Cite journal | last1 = Mortelé | first1 = KJ. | last2 = Ros | first2 = PR. | title = Cystic focal liver lesions in the adult: differential CT and MR imaging features. | journal = Radiographics | volume = 21 | issue = 4 | pages = 895-910 | month = | year = | doi = | PMID = 11452064 | url=http://radiographics.rsnajnls.org/cgi/content/abstract/21/4/895 }}</ref> | Radiologic DDx:<ref name=pmid11452064>{{Cite journal | last1 = Mortelé | first1 = KJ. | last2 = Ros | first2 = PR. | title = Cystic focal liver lesions in the adult: differential CT and MR imaging features. | journal = Radiographics | volume = 21 | issue = 4 | pages = 895-910 | month = | year = | doi = | PMID = 11452064 | url=http://radiographics.rsnajnls.org/cgi/content/abstract/21/4/895 }}</ref> | ||
*Bile duct cyst. | *Bile duct cyst. | ||
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*Intrahepatic hematoma. | *Intrahepatic hematoma. | ||
=See also= | |||
*[[Pancreas]]. | *[[Pancreas]]. | ||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
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*[[Medical liver disease]]. | *[[Medical liver disease]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||
[[Category:Liver pathology]] | [[Category:Liver pathology]] | ||