lecture 1 - basic princ liver path-jhl livlef1.2009 · 2010. 3. 19. · liver function tests ......
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CVCV
Kiernan’s lobulePTPT
Limiting platePortal fibroblast / myofibroblast
Portal tract
Bile ductArtery
PortalVeinCanal of
Hering
Progenitor /Stem cell
g
Pit cell (NK cell)Stellate cell(Ito cell) Normal
Sinusoid
Kupffer cell( ) Normal
microanatomyof the liver
Central Vein
Space of Disse
sieve
of the liver
Central Veinsieveplate
T t t iTransporter proteinsBSEP (bile salt export pump)
FIC-1(familial intrahepatic cholestasis-1)
OATP(organic aniontransport pump)p p p)
tightjunction
Cholestatic enzymes• Total bilirubin/direct bilirubin• AP (alkaline phosphatase)• GGT (gamma glutamyl transferase)• 5’NT (5’ nucleotidase)Liver Function Tests
(LFT’s)
Hepatitic enzymesHepatitic enzymes• AST (aspartate aminotransferase)• ALT (alanine aminotransferase)
Synthetic proteins• Total protein• Albumin
CVCV
PTPTPTPT
HepatitisHepatitisI fl tiInflammation
+Hepatocyte Apoptosis/Necrosis
Time Course: Acute / ChronicCauses: Virus / DrugsCauses: Virus / Drugs
Acute Hepatitis
Chronic Hepatitis
Def.: Inflammation of the liver continuing without improvementcontinuing without improvement for 6 mos. or longerf g
Causes of Chronic Hepatitis
1 Hepatitis viruses: HBV HCV1. Hepatitis viruses: HBV, HCV2. Autoimmune hepatitisp3. Drugs 4 M t b li di4. Metabolic diseases:
-AAT deficiencyy-Wilson’s disease
5 C t i5. Cryptogenic
PTPT
Classification of Chronic HepatitisClassification of Chronic Hepatitis
Ground-glass inclusions (HBsAg) in hepatocytes: chronic HBV
RERRER
PTPT plasmacellsplasmacells
LALA PTPT
interfaceinterfaceinterface hepatitisinterface hepatitis
Chronic HCV: portal Lymphoid aggregates Autoimmune chronic hepatitis
PTPTPTPTPTPT
copper andcopper-binding
protein(orcein stain)( )
Alpha-1-antitrypsin deficiency Wilson disease: copper overload
Fatty Liver•Triglyceride vacuoles in hepatocytes•Fatty liver is the most common cause ofyincreased serum AST & ALT in the U.S.
•MAJOR CAUSES:-alcohol—obesity—diabetes—steroids
TypesTypesTypesTypesLarge droplet (common) Small droplet (uncommon)(macrovesicular) (microvesicular)( ) ( )
Steatohepatitis
Ballooned hepatocytesBallooned hepatocytes
Mallory-DenkMallory-DenkCVCV
Mallory-DenkbodyMallory-Denkbody
fibrosis(pericentral)fibrosis(pericentral)
CV
Cholestasis
*Impaired bile secretionp(stagnation of bile flow in the liver)
CHOLESTASISCHOLESTASIS
CHOLESTASIS:impaired bile secretionimpaired bile secretion
Surgical Jaundice: Medical Jaundice:I t h ti diSurgical Jaundice:
Large bile duct obstructionIntrahepatic disease(sepsis/drugs/hepatitis/Bile salt transporter dis.)
PTPTPTPT
CirrhosisCirrhosis-Def.: 2 components:
diff fib idiffuse fibrosis +regenerative nodules
-Multifactorial etiology-Gross types: Micronodular (< 3mm)yp ( )
Macronodular (>3 mm)-Complications:-Complications:
-portal HTN-liver cell failure-HCC
Cirrhosis: Diffuse fibrosis + nodules of regenerative liver
diffuse fibrosisdiffuse fibrosis
thickened liver-cell platesthickened liver-cell platesthickened liver-cell plates(regenerative hyperplasia)thickened liver-cell plates(regenerative hyperplasia)
Activated stellate (Ito) cells in cirrhosis: smooth muscle actinimmunostain
Activated stellate (Ito) cells in cirrhosis: smooth muscle actinimmunostain
NormalNormalsplenoportogram
Cirrhotic liverCirrhotic liver
Enlarged shortgastric veinggastric + esoph.varices
Splenoportogram incirrhosis
RECAPRECAPRECAPRECAP1. Liver gross + lobule /acinus2. Micro: space of Disse / Stellate cells /
periportal limiting plate /progenitor cells in canal of Heringof Hering
3. Acute hepatitis: Hepatitis virus A-E, drugs4. Chronic hepatitis: def. /causes / grading + stagingp g g g g5. Fatty liver (large/small droplet), steatohepatitis6. Cholestasis: bile duct obstruct. / intrahepatic—
i l di t t t iincluding transporter proteins7. Cirrhosis: gross types, causes, complications8. Portal hypertension: pre-hepatic /8. Portal hypertension: pre hepatic /
INTRAHEPATIC / post-hepatic
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