Difference between revisions of "Liver"

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File:Histopathology of acute hepatitis.jpg|Histopathology of acute hepatitis with lobular disarray and associated lymphocytic inflammation, acidophil acidophil body formation (arrow) and bilirubinostasis (H&E stain)<ref name="BoydCain2020"/>
 
File:Histopathology of acute hepatitis.jpg|Histopathology of acute hepatitis with lobular disarray and associated lymphocytic inflammation, acidophil acidophil body formation (arrow) and bilirubinostasis (H&E stain)<ref name="BoydCain2020"/>
File:Histopathology of massive hepatic necrosis in hepatitis B.jpg|Massive hepatic necrosis: Liver cell dropout, residual hepatocytes and intact portal tract pattern.<ref>{{cite journal|last1=Xue|first1=Ran|last2=Zhu|first2=Yueke|last3=Liu|first3=Hui|last4=Meng|first4=Qinghua|title=The clinical parameters for the diagnosis of hepatitis B virus related acute-on-chronic liver failure with sepsis|journal=Scientific Reports|volume=9|issue=1|year=2019|issn=2045-2322|doi=10.1038/s41598-019-38866-3}}<br>-"This article is licensed under a Creative Commons Attribution 4.0 International
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File:Histopathology of massive hepatic necrosis in hepatitis B.jpg|Massive hepatic necrosis: Liver cell dropout, residual hepatocytes and intact portal tract pattern.<ref>{{cite journal|last1=Xue|first1=Ran|last2=Zhu|first2=Yueke|last3=Liu|first3=Hui|last4=Meng|first4=Qinghua|title=The clinical parameters for the diagnosis of hepatitis B virus related acute-on-chronic liver failure with sepsis|journal=Scientific Reports|volume=9|issue=1|year=2019|issn=2045-2322|doi=10.1038/s41598-019-38866-3}}<br>-"This article is licensed under a Creative Commons Attribution 4.0 International License"</ref>
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Revision as of 07:17, 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.
Trichrome stain, showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue).

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. Further information: Cirrhosis
  • Signs of acute liver failure.
  • Signs of congestive hepatopathy (indicating heart failure).

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]

Congestive hepatopathy

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 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. 
    • "This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"
  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. 
  3. Xue, Ran; Zhu, Yueke; Liu, Hui; Meng, Qinghua (2019). "The clinical parameters for the diagnosis of hepatitis B virus related acute-on-chronic liver failure with sepsis ". Scientific Reports 9 (1). doi:10.1038/s41598-019-38866-3. ISSN 2045-2322. 
    -"This article is licensed under a Creative Commons Attribution 4.0 International License"
  4. Shah, Shailja C.; Sass, David A. (2015). "“Cardiac Hepatopathy”: A Review of Liver Dysfunction in Heart Failure ". Liver Research - Open Journal 1 (1): 1–10. doi:10.17140/LROJ-1-101. ISSN 23794038. 
    -"This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0),"

Image sources