Presentasi praktikum enterohepatik pbl

Entero- hepatic diseases

Liver, acute viral hepatitis (hepatitis B virus)

• portal area

Low power

Liver, acute viral hepatitis (hepatitis B virus)

• bile pigment

• hepatocytes

• liver sinusoid

• regenerating hepatocytes

• inflammatory infiltrate

High power

Liver, acute viral hepatitis (hepatitis B virus)

• balloning of degenerating hepatocytes

• inflammation

• councilman/ acidophilic body

Liver, fulminant hepatitis

• necrotic area

Gross Low power

Liver, viral hepatitis, carrier state (hepatitis B virus)

• ground- glass hepatocyteimmunohistochemical stain for HbsAg

Medium power High power

Liver, chronic viral hepatitis (hepatitis B virus)

• portal area

Medium power

• portal area

• inflammation surrounding hepatocites

Patient 1 Patient 2

Liver, chronic viral hepatitis (hepatitis C virus) - Low power

• portal area

• lymphoid agregate

• steatosis

Liver, cirrhosis from chronic viral hepatitis -

• Regenerative liver nodul

GrossCut surface

Liver, alcoholic cirrhosis

contains numerous, fairly uniform, small

nodules of regenerative hepatocytes separated by

depressed areas of fibrous scar tissue

Liver, biliary cirrhosis Gross, cut surface

This is a section of liver from a child who died of biliary cirrhosis secondary to biliary atresia. The cut surface is dark green, due to marked cholestasis within the liver. Regenerative nodules of liver parenchyma are separated by tan bands of fibrous tissue

Biliary tree, biliary atresia

Biliary atresia, a common cause of neonatal cholestasis,

results from progressive destruction of the hepatic and

common bile ducts. In this image, the common bile duct is reduced to a thin band

of fibrous tissue extending from the hilum of the liver, which is green due to the presence of cholestasis, to the duodenal

area. This leads to the development of cirrhosis in the first year of life. It is the most common cause of referral for

liver transplantation in children

Ascites - Clinical presentation Skin, spider telangiectasia

-

Ascites

Esophagus, varices - Gross, mucosal surface

• esophagus

• stomach

• erosion due to sclerosing th

Liver, hepatocellular carcinoma

a. hepatocellular carsinoma

b. satellite tumor nodule

Gross

Cut surface

• Cord of malignant hepatocites

Medium power

Liver, alcoholic hepatic steatosis (fatty liver)

cut surfaceGross,

Enlarged, soft, and yellow. a greasy texture

Low power

Medium power

• mallory bodies

• hepatocites

• high power view

• intracytoplasmic fat

• mallory bodies

Liver, nonalcoholic steatohepatitis, trichrome stain - High power

Conditions associated with the development of NAFL and NASH are Obesity and diabetes

mellitus

• central vein

• perivenular (chicken wire) type fibrosis

Liver neoplasia

• central stellata fibrous scar

focal nodular hyperplasiacavernous hemangioma

• low power image

• normal liver

• hemangioma

• liver cell adenoma

cholangiocarcinoma

• outer surface

• cut surface

gross Low power

• fibrostic tissue and tumor

• cholangiosarcoma

• uninvolved liver

congenital and metabolic disease

Liver, Wilson disease

accumulation of copper in the hepatocytes

Liver, hemochromatosis

• hemosiderin in ductullar cell

• hemosiderin in hepatocites

Liver, metastatic adenocarcinoma

there are numerous tan, sometimes hemorrhagic and necrotic, nodules of metastatic tumor throughout the liver. Also, there is bile staining of the

remaining liver

Most tumors metastasize to the liver hematogenously through the portal vein or hepatic artery. Biliary tract tumors directly and

contiguously spread to the liver.

Liver,

localized, pale, and typically subcapsular,

are rare

congestive heart failure

hepatic infarct

Trombosis

Thrombosis of the portal vein in the hilum of the liver,

owing to inflammation in the hilum of the liver or pylephlebitis.

The result will be the development of ascites and other stigmata of

portal hypertension

hepatic vein thrombosis portal vein thrombosis

Thrombotic occlusion of several branches of the hepatic vein has

occurred, resulting in marked congestion of hepatic sinusoids in the

area involved. The result is a localized dark area with

areas of centrilobular congestion visible on the cut surface of the liver

Gallbladder,

cholelithiasis and acute and chronic cholecystitis -

A section of a gallbladder from this case of acute and chronic cholecystitis shows marked fibrous thickening of the wall with areas of mucosal necrosis and ulceration. An inflammatory cellular infiltrate is present in the wall, especially in the areas of ulceration

Biliary ducts, choledocholithiasis - Gross, mucosal surface

• hepatic duct

• common bile duct

• gall stones

• liver

A serious complication of cholelithiasis is

choledocholithiasis. Gallstones pass from the

gallbladder and through the cystic duct to impact somewhere in the

common bile duct, causing choledocholithiasis.

This complication leads to dilation of the biliary tree proximal to the

obstruction

Pancreas, acute pancreatitis

Etiology= Alcoholism, along with biliary tract disease (cholelithiasis)(80%); idiopathic( 10- 20%); there is increasing evidence of several genetic defects.

Patogenesis= the result of release of pancreatic enzymes from acinar cells, causing proteolysis, lipolysis, and hemorrhage. Released elastase degrades elastic tissue in

vessel walls. Pancreatic amylase is also released. Proposed mechanisms of pancreatic injury and subsequent enzyme release include:

(1) duct obstruction, (2) direct acinar cell injury, and (3) deranged intracellular transport of pancreatic enzymes.

Common bile duct, stricture ERCP image

Endoscopic Retrograde Cholangiopancreatography (ERCP) shows a stricture of the distal common bile duct

• dilated common bile and hepatic duct

• pancreatic duct

• stricture area, distal common bile duct

Pancreas, carcinoma and chronic pancreatitis

Chronic pancreatitis is associated with only a slightly increased risk of cancer, so the finding is most likely coincidental.

Chronic pancreatitis results in destruction of the exocrine and, eventually, endocrine portions of the pancreas.

It usually follows repeated bouts of acute pancreatitis that are due to alcohol ingestion or obstruction of the pancreatic duct. Other causes include tropical pancreatitis, hereditary pancreatitis, and idiopathic

cases.

• etiology

• location • sign & symptoms