Faculty of allied medical
sciences
Histopathology and cytology
(MLHC-201)
Liver Pathology
Supervision:
Prof.Dr.Noha Ragab
Outcomes
By the end of this lecture, the student will be
able to know:
1-The meaning and causes of jaundice
2-Bilary tract obstruction
3-Cirrhosis
4-Viral hepatitis and its types



The liver is the largest
parenchymal organ, lying
just
below
the
diaphragm.
The right lobe is larger
than the left lobe.
The falciform ligament is
the rough dividing line
between the two lobes .



This is the external
surface of a normal
liver.
The color is brown
and the surface is
smooth.
A normal liver weighs
about 1200 to 1600
grams.
Jaundice
Jaundice

Clinically jaundice occurs with bilirubin
levels >2-3 mg/dl
Clinical presentation:
 Yellow skin (jaundice) and sclera (icterus)
Yellow skin (jaundice)
Yellow sclera (icterus)
Causes of jaundice:
1.
2.
3.
4.
Overproduction of bilirubin
Defective hepatic bilirubin uptake
Defective conjugation
Defective execretion
Increased RBC’s turnover:

RBCs are a major source of bilirubin
Eitiology:
1.
2.
3.
Hemolytic anemia
Ineffective
erythropoiesis
(Thalassaemia,
megaloblastic aneamia, etc.)
Chronic hemolytic anemia patients often develop
pigmented bilirubinated gallstones
Laboratory:

increased unconjugated bilirubin
Physiological jaundice of the
new born


Definition:
transient
unconjugated
hyperbilirubinaemia due to the immaturity of
the liver
Risk factors:


Prematurity
Hemolytic disease of new born (erythroblastosis
fetalis)
Complication:
kernicterus

Biliary tract
obstruction
Biliary tract obstruction

Eitiology:
1.
2.
3.
4.
Gallstones
Tumors (pancreatic, gallbladder and bile
duct)
Strictures
Parasites (liver flukes or fasciola)

Clinical presentation:
1.
2.
3.
4.
5.
Jaundice
Pruritus due to increased plasma levels of
bile acids
Abdominal pain, fever and chills
Dark urine (bilirubinuria)
Pale clay colored stools

Laboratory investigation:


Elevated conjugated bilirubin
Elevated alkaline phosphatase
CIRRHOSIS
CIRRHOSIS
Definition:
End stage liver disease characterized by
distruption of the liver architecture by
bands of fibrosis that divide the liver into
nodules of regenerating liver parenchyma


Etiology (Causes of Cirrhosis):
1.
2.
3.
4.
5.
Alcohol
Viral hepatitis
Biliary tract disease
Hemochromatosis
Idiopathic

Grossly:
1.
2.
3.
4.
Micronodular nodules
Macronodular nodules
Mixed micronodular and macronodular
At the end stage , the disease results in
mixed pattern, and the etiology may not be
distinguished based on the appearance
“Macronodular" cirrhosis
Micronodular cirrhosis
CIRRHOSIS
Complications:
A- Portal hypertension:
1.
2.
3.
4.
5.
Ascitis
Splenomegaly
Esophageal varices
Haemorrhoids
Caput Medusa
Splenomegaly



Esophageal Varices are
seen here in the lower
esophagus as linear blue
dilated veins.
There is hemorrhage
around one of them.
Such varices are easily
eroded, leading to
massive gastrointestinal
hemorrhage .
“Caput medusae" which consists of dilated veins seen on the
abdomen of a patient with cirrhosis of the liver
B- Decreased detoxification:
1.
2.
3.
4.
Hepatic encephalopathy
Spider angiomata
Palmar erythema
Gynecomastia
C- Decreased synthesis
1.
2.
Hypoalbuminemia
Decreased clotting factors
D- Hepato-renal syndrome
VIRAL HEPATITIS
Clinical presentation:
1.
2.
3.
4.
5.
Asymptomatic
Malaise and weakness
Nausea and anorexia
Jaundice
Urine may be dark
Laboratory investigations:
 Markedly elevated alanine
aminotransferase (ALT) and aspartate
aminotransferase (AST)
Acute viral hepatitis
Definition:
Signs and symptoms less than six months

Eitiology:
Any hepatitis viruses

Microscopically:
1.
2.
3.
4.
5.
6.
Lobar disarray
Hepatocytes swelling (balloon cells)
Apoptotic hepatocytes (councilman’s
bodies)
Lymphocytes in portal tract and in the
lobules
Hepatocytes regeneration
cholestasis
Chronic viral hepatitis
Definition:
Signs and symptoms more than six months

Eitiology:
Caused by hepatitis virus B, C and D

Microscopically:
 Chronic persistant hepatitis inflammation
confined to the portal tracts


Chronic active hepatitis inflammation spills
into the parenchyma causing interface
hepatitis (piecemeal necrosis)
Hepatitis B often has a ground glass
hepatocytes
councilman body
ballooning degeneration
• A large pink cell undergoing "ballooning degeneration" is seen below
the right arrow.
• At a later stage, a dying hepatocyte is seen shrinking down to form an
eosinophilic "councilman body" below the arrow on the left.
Questions:
Complete:
1-Causes of jaundice are…………………….
2-Causes of cirrhosis are……………………
3-…………. Transient unconjugated
hyperbilirubinaemia due to the immaturity of the
liver
4-Chronic active hepatitis inflammation spills into
the parenchyma causing …………….
5-Biliary tract obstruction is caused by…………
THANK YOU
AND
GOOD LUCK