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"With ordinary talent and "With ordinary talent and extraordinary perseverance, all extraordinary perseverance, all things are attainable."things are attainable."- Thomas E. Buxton
"Achievement is connected "Achievement is connected with action, with action, not in genes..…!”not in genes..…!”- Conrad Hilton
Pathology of Pathology of Hepatitis & CirrhosisHepatitis & Cirrhosis
Venkatesh Murthy ShashidharVenkatesh Murthy ShashidharAssociate Professor of Pathology
Fiji School of Medicine
A Commitment to Excellence… A Commitment to Excellence…
Normal Liver
Autopsy
1.5 kg, wedge shape
4 lobes, Right, left, Caudate, Quadrate.
Double blood supply
Hepatic arteries
Portal – Venous blood
Acini / Portal triad.
Lobules – central. V
Normal Liver - Infant
CT Upper abdomen - Normal
VHP- Upper abdomen
Normal Liver - Microscopy
Liver Functions:
Metabolism – Carbohydrate, Fat & Protein
Secretory – bile, Bile acids, salts & pigments
Excretory – Bilirubin, drugs, toxins
Synthesis – Albumin, coagulation factors
Storage – Vitamins, carbohydrates etc.
Detoxification – toxins, ammonia, etc.
Jaundice
Yellow discoloration of skin & sclera due to excess serum bilirubin. >40umol/l, (3mg/dl)
Conjugated & Unconjugated types
Obstructive & Non Obstructive (clinical)
Pre-Hepatic, Hepatic & Post Hepatic types
Jaundice - Not necessarily liver disease *
Pathology of Pathology of HepatitisHepatitis
Hepatitis:
Hepatitis: Inflammation of Liver
Viral, Alcohol, immune, Drugs & Toxins
Biliary obstruction – gall stones.
Acute, Chronic & Fulminant - types
Viral Hepatitis – Specific – Heptitis A, B, C, D, E, & other
Hepatocellular failure. Malnutrition, low albumin & clotting factors,
bleeding.
Hepatic encephalopathy.
Portal hypertension. Ascites, Porta systemic shunts, varices,
splenomegaly.
Bleeding in Liver disease:
vitamin K – in liver gamma-carboxyglutamic acid – for coagulation factors II, VII, IX, and X.
Liver disease factor VII is the first to go so the defect will appear initially in the extrinsic pathway, i.e., abnormal PT. When severe it affects both pathways.
Learn from the Learn from the mistakes of others. mistakes of others. You can't live long You can't live long enough to make them enough to make them all yourself…!all yourself…!