LIVER_102317.pptx latest published by doctors

Liver gross liver cirrhosis

1. LIVER CIRRHOSIS,METS & HEPATOMA GUIDED BY: DR. AMBRISH KUMAR

2. NORMAL LIVER IS Wedge shaped 4 Lobes: Right, Left, Caudate and Quadrate Blood Supply: Hepatic artery & portal vein Have True and False ligaments

3. LIVER CIRRHOSIS Cirrhosis is diffuse scarring of liver and is characterized by fibrous scar tissue and regenerative nodules formation. It is a consequence of chronic liver disease

4. CAUSES: A lcohol, Autoimmune B iliary obstruction C hronic viral hepatitis D rugs and Toxins H emochromatosis I diopathic W ilsons disease

5. PATHOPHYSIOLOGY

6. TYPES- Alcoholic Post Necrotic Biliary Cardiac

7. Alcoholic Cirrhosis M ost common type of cirrhosis Alcohol causes inflammation to liver cells Fatty deposits and hepatomegaly Scar tissue forms and surrounds the portal area .

8. ALCOHOLIC CIRRHOSIS

9. Alcoholic Cirrhosis showing fibrotic changes ARROWS SHOWS FATTY CHANGES WITH MALLORY BODIES

10. Post-Necrotic Cirrhosis (Macro-nodular) Caused by viral hepatitis or hepatotoxins Scar tissue formed destroys liver lobes. Have broad bands of scar tissue Liver initially enlarges but then SHRINKS in size.

11. POST NECROTIC CIRRHOSIS

12. Most nodules>3 mm fibrous bands are thin. Nodules<3mm

13. BILIARY CIRRHOSIS Rare autosomal disease Characterized by destruction of bile ductules within the triads of liver Intense chronic inflammatory infiltrates Excessive bile leads to liver cell destruction and nodules formation in lobes. Incidence: 5-10%

14. Greenish discoloration due to cholestasis Biliary sludge in dilated bile ducts with thick fibrotic walls.

15. CARDIAC CIRRHOSIS Seen along with right sided heart failure Liver gets engorged with venous blood Liver gets enlarged, edematous and dark Anoxia occurs d\t venous congestion

16. Cut surface of the congested liver reminiscent of the classic “nutmeg appearance” which is caused by chronic passive congestion of the central veins with hemorrhage and necrosis. Red cells pool and distend the sinusoids around the central vein. These regions develop a darker red-violet color, in contrast to the surrounding tan liver parenchyma.

17. LIVER METASTASES Colorectal tumors Neuroendocrine tumors Others

18. Colorectal Hepatic Metastasis Colorectal cancer(CRC) is 3 rd most prevalent cancer in world. Almost 20% to 25% of patients with CRC present with distant metastasis at the time of diagnosis. 10% to 30% patients with CRC with newly diagnosed disease and liver only deposits have resectable metastases.

19. Liver is m\c site for hematogenous metastasis from colorectal cancers. In pts with liver metastasis, extent of liver disease is the prime determinant of survival

20. Outcome of Untreated Metastatic Colorectal Ca Median Survival is 5 to 10 months 2 year survival is unusual 5 year survival is extremely rare

21. Neuroendocrine Hepatic Metastasis Slowly progressive tx Higher Resectability Metastases occurs through portal tract Intrahepatic long time Extra hepatic metastasis

22. GROSS- Single or multiple Solid or cystic Size >2cm

23. Hepatic Mets-: FROM BREAST CA Breast cancer can spread to liver through Lymphatic Hematogenous

24. HEPATOMA It is a malignancy arising from parenchyma of liver. It is 6 th most common primary tumor and 3 rd leading cause of cancer related mortality

25. Microscopically, classified into Fibrolamella Pseudoglandular Pleomorphic Clear Cell

26. Hyperchromatic Clear Cells With Large Reddish Cytoplasm

27. Pale Mass within the Liver and it may be unifocal , multifocal or difuse