HEPATITIS

The liver has only three major disorders: hepatitis, cirrhosis, carcinoma.

Alcoholic liver disease (Robbins pp 869)

• Chronic alcohol consumption will lead to three distinctive forms of alcoholic liver disease: hepatic steatosis, alcoholic hepatitis, cirrhosis. Cirrhosis is the most dangerous of the lot.

Hepatic steatosis (Fatty liver):

• After drinking even small amounts of alcohol, there is accumulation of lipid droplets within the hepatocytes. This is termed microvesicular accumulation. If alcohol consumption continues, then more lipid droplets accumulate leading to macrovesicular accumulation, where the nuclei are displaced to one pole . Fibrosis begins to occur around the central veins and drives into sinusoids, and the liver is heading towards cirrhosis. Up until fibrosis occurs – the fatty liver process is completely reversible if abstinence is observed.
  

• Macroscopic: The liver is greasy, yellowy, and large.

Alcoholic hepatitis:

• This occurs after severe exposure to alcohol.
  
• This is marked by four microscopic features: 1) hepatocyte swelling and necrosis, 2) Mallory bodies (accumulation of intermediate filaments within necrosed hepatocytes), 3) neutrophilic reaction (especially around necrosed hepatocytes), 4) fibrosis (cirrhosis slowly taking over).
  
• Macroscopic: The liver is mottled red in appearance with areas of bile substance (greeny tinge). This is reversible if abstinence if observed.

Alcoholic cirrhosis:

• This occurs after chronic severe exposure to alcohol. The liver is shrunk in size, weighing less than 1kg.micronodules. More and more mitosis results in macronodules being formed. Eventually, the fibrosis squeezes out the blood supply ≫ ischaemic necrosis. Alcoholic cirrhosis is irreversible.

Category: Pathology Notes