Difference between revisions of "Liver"

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===Basic gross examination===
 
===Basic gross examination===
 
*Inspect the color and texture of the surfaces, including external and cut surfaces. Potential pathologies:
 
*Inspect the color and texture of the surfaces, including external and cut surfaces. Potential pathologies:
<gallery>
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<gallery mode=packed>
 
File:Gross pathology of alcoholic liver cirrhosis.jpg|Diffuse areas of pallor in cirrhosis, see '''[[Cirrhosis]]'''
 
File:Gross pathology of alcoholic liver cirrhosis.jpg|Diffuse areas of pallor in cirrhosis, see '''[[Cirrhosis]]'''
 
File:Wątroba marska (Ultima Thule).jpg|Pale macronodules of cirrhosis, see '''[[Cirrhosis]]'''
 
File:Wątroba marska (Ultima Thule).jpg|Pale macronodules of cirrhosis, see '''[[Cirrhosis]]'''
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*Color and texture of cut surfaces
 
*Color and texture of cut surfaces
 
*Any focal change
 
*Any focal change
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==Microscopic evaluation in autopsy==
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[[File:Histopathology of liver zones.jpg|thumb|Pathologies can be topographically classified by liver zones. P: portal tract. V: central vein.]]
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A minimal screening of autopsy specimens include:
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*A severity grading of previously known liver diseases. Quantify any '''[[cirrhosis]]''', at least if the patient had alcohol abuse.
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*Signs of acute liver failure.
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===Cirrhosis===
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Quantification:
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File:Histopathology of mild zone 3 steatosis without fibrosis (van Gieson).jpg|'''No fibrosis''', but mild zone 3 steatosis (van Gieson's stain)<ref name="BoydCain2020"/>
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File:Histopathology of steatohepatitis with mild fibrosis in the form of fibrous expansion (van Gieson).jpg|Histopathology of steatohepatitis with '''mild fibrosis''' in the form of fibrous expansion (van Gieson's stain)<ref name="BoydCain2020"/>
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File:Histopathology of steatohepatitis with moderate fibrosis, with thin fibrous bridges (van Gieson).jpg|Histopathology of steatohepatitis with '''moderate fibrosis''', with thin fibrous bridges (van Gieson's stain)<ref name="BoydCain2020"/>
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File:Histopathology of steatohepatitis with established cirrhosis, with thick bands of fibrosis (van Gieson).jpg|Histopathology of steatohepatitis with '''established cirrhosis''', with thick bands of fibrosis (van Gieson's stain)<ref name="BoydCain2020"/>
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</gallery>
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===Acute liver failure===
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Acute liver failure has multiple etiologies, and hence various presentations. Regardless of etiology, the initial hepatic insult that leads to acute liver failure is “hepatitis” in the broadest sense, with extensive hepatocyte injury and necrosis. The initiating process may damage the liver by zonal necrosis (with a centrilobular or acinar zones 3 necrosis being typical of acetaminophen hepatotoxicity), or it may damage the liver by a diffuse hepatitis with necrosis and inflammation as exemplified by acute viral hepatitis A, B, or E infections or other drug hepatotoxicities.<ref name="Lefkowitch2016">{{cite journal|last1=Lefkowitch|first1=Jay H.|title=The Pathology of Acute Liver Failure|journal=Advances In Anatomic Pathology|volume=23|issue=3|year=2016|pages=144–158|issn=1072-4109|doi=10.1097/PAP.0000000000000112}}</ref>
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{{Bottom}}
 
{{Bottom}}

Revision as of 05:43, 20 December 2019

Author: Mikael Häggström [note 1]

Tissue sampling

Fixation

Generally 10% neutral buffered formalin. Non–formalin-fixed tissue may be needed for tests such as microbiological analysis or copper quantification studies.[1]

Gross processing in autopsy

Make consecutive liver slices, such as in the sagittal or coronal plane.

Basic gross examination

  • Inspect the color and texture of the surfaces, including external and cut surfaces. Potential pathologies:
  • Look for any focal change in the liver volume, mainly any tumor.
  • Determine liver weight.

Gross report

  • Weight
  • Color and texture of cut surfaces
  • Any focal change

Microscopic evaluation in autopsy

Pathologies can be topographically classified by liver zones. P: portal tract. V: central vein.

A minimal screening of autopsy specimens include:

  • A severity grading of previously known liver diseases. Quantify any cirrhosis, at least if the patient had alcohol abuse.
  • Signs of acute liver failure.

Cirrhosis

Quantification:

Acute liver failure

Acute liver failure has multiple etiologies, and hence various presentations. Regardless of etiology, the initial hepatic insult that leads to acute liver failure is “hepatitis” in the broadest sense, with extensive hepatocyte injury and necrosis. The initiating process may damage the liver by zonal necrosis (with a centrilobular or acinar zones 3 necrosis being typical of acetaminophen hepatotoxicity), or it may damage the liver by a diffuse hepatitis with necrosis and inflammation as exemplified by acute viral hepatitis A, B, or E infections or other drug hepatotoxicities.[2]


Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 1.2 1.3 1.4 Boyd, Alexander; Cain, Owen; Chauhan, Abhishek; Webb, Gwilym James (2020). "Medical liver biopsy: background, indications, procedure and histopathology ". Frontline Gastroenterology 11 (1): 40–47. doi:10.1136/flgastro-2018-101139. ISSN 2041-4137. 
  2. Lefkowitch, Jay H. (2016). "The Pathology of Acute Liver Failure ". Advances In Anatomic Pathology 23 (3): 144–158. doi:10.1097/PAP.0000000000000112. ISSN 1072-4109. 

Image sources