Diseases of the liver - pancreas- and gallbladder -1- 2.ppt

Diseases of the liver - pancreas- and gallbladder -1- 2.ppt

1. Diseases of the liver , pancreas,
and gallbladder

2. Questions for self- training
•Liver disease. Etiology. Classification according to the mechanism of development. The role of biopsy in the diagnosis
of liver diseases
•1. Liver steatosis (fatty hepatosis, fatty liver dystrophy). Definition. The reasons for the development. Morphological
characteristic. Outcomes.
•2. Massive necrosis of the liver. Definition. The reasons for the development. Stages, their macro-and microscopic
characteristics. Outcomes.
•3. Hepatitises. Definition. Classification: by pathogenesis, by etiology, by flow. Parameters of chronic hepatitis (etiology,
degree of histological activity of the process, stage of the disease):a) acute viral hepatitis. Definition. Forms: hepatitis A,
B, C, D and others. Transmission routes for hepatitis A and E, hepatitis B, C and D. Periods of acute hepatitis, and
timing. Clinical and morphological forms, their macro-and microscopic characteristics.Histological features of hepatitis
C. Outcomes depending on the form of hepatitis.b) chronic hepatitis. Definition. Classification: by etiology, by
development conditions, by the nature of inflammatory changes. Morphological characteristic. Criteria for the activity of
chronic hepatitis. Systemic manifestations of chronic hepatitis.
•4. Cirrhosis. Definition. Classification: by etiology, according to the macroscopic picture, in the microscopic picture, on
morphogenesis. The concept of cirrhosis activity (according to histological research, clinical manifestations, results of
biochemical research), the stage of the disease:
•a) postnecrotic cirrhosis of the liver. Etiopathogenesis. Rate of development. Macro-and microscopic characteristics.
Morphological feature. Outcomes;
•b) portal cirrhosis of the liver. Reasons. Rate of development. Macro-and microscopic characteristics. Distinctive
feature;
•c) mixed cirrhosis of the liver (a combination of manifestations of postnecrotic and portal cirrhosis of the liver);
•d) biliary cirrhosis of the liver. Types (primary, secondary). Causes (autoimmune reactions, long-term cholestasis of the
bile ducts due to gallstone disease, fibrotic-indurative pancreatitis, strictures of the bile ducts, tumors of the
hepatopancreoduodenal zone, malformations of the bile ducts, etc.).
•Clinical manifestations of cirrhosis of the liver – portal hypertension syndrome (ascites, congestive splenomegaly,
varicose veins of the lower third of the esophagus and the cardiac Department of the stomach, middle and lower
hemorrhoidal veins, veins of the anterior abdominal wall), hepatic cell insufficiency (jaundice, encephalopathy,
hepatorenal syndrome, coagulopathy, hypoalbuminemia, endocrine disorders).
•Complications of liver cirrhosis (hepatic coma, bleeding from varicose veins of the esophagus and / or stomach,
hemorrhoid veins, ascites-peritonitis, portal vein thrombosis, development of hepatocellular carcinoma).
•5. Alcoholic liver disease (alcoholic steatosis, alcoholic hepatitis, alcoholic liver fibrosis, alcoholic liver cirrhosis). Acute
alcoholic massive liver necrosis as a result of alcohol poisoning and its surrogates.
•2. Gall-stone disease. Definition. Composition of bile stones (cholesterol, pigment, calcium, mixed). Complications of
bile duct blockage (subhepatic jaundice, pancreatitis, intestinal obstruction, fistulas between the small intestine and bile
ducts, liver abscesses, secondary biliary cirrhosis, gallbladder cancer). Manifestations of subhepatic jaundice in the
Orofacial area (yellowish-green spots on the lower surface of the tongue and soft palate, petechiae on the oral mucosa
and on the skin, skin scratches).Cholecystitis. Definition. Types (acute, chronic).Acalculous cholecystitis. Causes
(stress, operations, massive injuries). Acute cholecystitis. Types (catarrhal, phlegmonous, gangrenous), their
morphological characteristics. Complications (empyema of the gallbladder, perforation with bile peritonitis).

3. •Gross specimens
•Fatty hepatosis (steatosis of the liver, fatty liver dystrophy)
•Small- node cirrhosis of the liver
•Stones in the gallbladder
•Phlegmonous cholecystitis
•Micropreparations
•Chronic hepatitis
•Chronic hepatitis, cirrhotic stage
•Chronic pancreatitis
•Chronic alcoholic hepatitis
•Vacuole dystrophy of hepatocytes

4. Gross specimen «Steatosis (fatty liver)»

5. Gross specimen «Cirrhosis of the liver»
Small- node cirrhosis
3 мм

6. Gross specimen «Purulent (phlegmonous)
cholecystitis»

7. Gross specimen «Stones in the gallbladder»

8. «Vacuole dystrophy of hepatocytes» №3, hematoxylin and eosin
Hepatocytes with vacuoles of
different sizes in the
cytoplasm
Hepatocytes are enlarged in size, the
nucleus is shifted to the periphery

9. «Chronic alcoholic hepatitis» №151, hematoxylin and eosin
Infiltration of portal tractsFat dystrophy of hepatocytes
The growth of connective tissue within the lobules and in portal tracts
regenerate nodes

10. Mallory's bodies
Group of necrotic
hepatocytes
«Chronic alcoholic hepatitis» №151, hematoxylin and eosin

11. «Chronic hepatitis» №99ч, hematoxylin and eosin
False lobes
The growth of connective
tissue
Violation of the normal structure of liver
tissue

12. «Chronic hepatitis, cirrhotic stage» №32ч, van Gieson stain
The growth of
connective tissue

13. «Chronic pancreatitis» №112, hematoxylin and eosin
Atrophy of the parenchyma of the pancreas, the
lipomatosis
The growth of connective
tissue
Inflammatory infiltrate