INSHRAH ZIA

GROUP 13

5 TH SEM
PATHALOGIES OF LIVER

PRESENTED BY: INSHRAH ZIA

 HEPATITIS

• Hepatitis is an inflammation of the liver. It may be caused by viral infection, alcohol

consumption, several health conditions, or even some medications. Hepatitis refers to
an inflammatory condition of the liver. It is commonly the result of a viral infection,
but there are other possible causes of hepatitis.

• These include autoimmune hepatitis and hepatitis that occurs as a secondary result of
medications, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that
occurs when your body makes antibodies against your liver tissue.

• The five main viral classifications of hepatitis are hepatitis A, B, C, D, and E. A

different virus is responsible for each type of viral hepatitis.
 TYPES OF HAPATITIS
1. HAPATITIS A
Hepatitis A is the result of an infection
with the hepatitis A virus (HAV). This
type of hepatitis is an acute, short-term
disease.
2. HAPATITIS B
The hepatitis B virus (HBV) causes
hepatitis B. This is often an ongoing,
chronic condition.
 3. HEPATITIS C
Hepatitis C comes from the hepatitis C
virus (HCV). HCV is among the most
common bloodborne viral infections in
the United States and typically presents
as a long-term condition.
4. HEPATITIS D
This is a rare form of hepatitis that only
occurs in conjunction with hepatitis B
infection. The hepatitis D virus (HDV)
causes liver inflammation like other
strains, but a person cannot contract
HDV without an existing hepatitis B
infection.
 5. HEPATITIS E
Hepatitis E is a waterborne disease that
results from exposure to the hepatitis E
virus (HEV). Hepatitis E is mainly
found in areas with poor sanitation and
typically results from ingesting fecal
matter that contaminates the water
supply.
 CAUSESES OF HEPATITIS

HEPATITIS exposure to HAV in food or water

A
HEPATITIS contact with HBV in body fluids, such
B as blood, vaginal secretions, or semen
HEPATITIS contact with HCV in body fluids, such
C as blood, vaginal secretions, or semen
HEPATITIS contact with blood containing HDV
D
HEPATITIS exposure to HEV in food or water
E
 SYMPTOMS OF HEPATITIS

Common symptoms of infectious hepatitis include:

• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice
 ACUTE VIRAL HEPATITIS

Acute viral hepatitis refers to hepatic infection by the hepatotropic viruses

hepatitis A–E. The acute infections look similar with regard to histologic
features, with spotty necrosis throughout the lobules, hepatocyte unrest,
swelling and apoptosis, and portal tract and intrasinusoidal inflammation,
chiefly lymphocytes. The differential diagnosis histologically includes drug-
induced liver injury. Structural differences and epidemiology define the major
differences in the course of each of these viral infections. Hepatitis A and E
are similar in causing only acute hepatitis, while some cases of hepatitis B
and many of hepatitis C become chronic . Histologic cholestasis may be a
particular feature of acute hepatitis E. It should be noted that hepatitis E virus
has four major genotypes of which 1 and 2 infect humans.
 HEPATITIS A

Two main patterns are described, occurring separately or together. One is a histological picture of
perivenular cholestasis with little liver-cell damage or inflammation, easily mistaken for other
causes of cholestasis . The second is a hepatitis with periportal necrosis and a dense portal infiltrate
which includes abundant, often aggregated plasma cell. These two patterns may be related, the
cholestasis resulting from interruption of bile flow by the periportal necrosis. Other patterns of
hepatitis as described earlier are also found, but fulminant hepatitis with multilobular necrosis is
rare.
 HEPATITIS B

The histological appearances are broadly similar to those of other forms of viral hepatitis. Some of the
differences reported in the literature may well reflect patient selection rather than features specific for
hepatitis B virus (HBV) infection. However, lymphocytes and macrophages sometimes lie in close
contact with hepatocytes (peripolesis) or even invaginate them deeply (emperipolesis), which probably
reflects the immunological nature of the cell damage. In a comparative study, periportal inflammation
tended to be more severe in acute hepatitis B than in hepatitis C Liver cells and their nuclei may show
a moderate degree of pleomorphism.
 HEPATITIS C

Usually the histological features of hepatitis C are those of any acute hepatitis, but two
distinguishing features have been noted. First, there may be prominent infiltration of sinusoids by
lymphocytes in the absence of severe liver-cell damage, giving rise to a picture reminiscent of
infectious mononucleosis. Second, lymphoid follicles and bile-duct damage, features also associated
with chronic hepatitis, may be seen within a few weeks or months of onset.45 There may be
cholestasis.
 HEPATITIS E

Co-infection or superinfection with the hepatitis D virus (HDV) alters the course of
type B hepatitis. It encourages chronicity and enhances severity. except after liver
transplantation. The antigen, HDAg, can easily be demonstrated
immunohistochemically in paraffin sections and is mainly found in hepatocyte nuclei.
These may have finely granular eosinophilic centers Cytoplasmic and membrane-
associated staining is also sometimes seen.
 HEPATITIS E

Hepatitis E virus (HEV) is an RNA virus with eight currently described genotypes, five of which
can infect humans. Genotypes 1 and 2 are restricted to higher primates and humans and are
associated with epidemic outbreaks and an oral-faeal transmission mode, while genotypes show a
broad mammalian phylogenetic reservoir including pigs, boar, deer, rodents, ferrets, bats, cattle,
sheep, foxes, dromedary camels and horses and cause zoonotic, autochthonous. But sometimes is
misdiagnosed as drug-induced liver injury. Chronic hepatitis E has been described in organ
transplant recipients.
 CIRRHOSIS OF THE LIVER

Cirrhosis of the liver is a disorder

in which healthy liver cells are
gradually replaced by scar tissue.
It is a progressive illness that
might take several years to
develop.
Cirrhosis is classified into 4
stages.
 STAGES
STAGE 1
Steatosis
• The first stage of liver disease is characterized
by inflammation of the bile duct or liver.
• As the body strives to fight against the disease
or infection, abdominal discomfort is frequently
the first symptom of inflammation.
• If this inflammation is not managed, it might
cause damage to the liver, exacerbating the
illness.
• Symptoms and inflammation are generally
curable during stage I and can prevent liver
disease from escalating to stage II.
STAGE 2
Scarring (fibrosis) of the liver due to
inflammation
• Many people with liver illness don't realize they
have it until they are at stage II or III because
the first symptoms generally go unreported.
• In stage II, scarring or inflammation (damage)
begins to obstruct the natural flow of blood in
the liver.
• This causes the liver to be unable to function
properly, but with treatment, the liver may still
be capable of recovering, avoiding more
damage, and slowing the progression of the
liver disease.
• STAGE 3 STAGE 4
• develops due to the advancement of liver Liver failure or advanced liver disease or
disease, mainly due to lack of therapy, in hepatic failure
which scar tissue replaces good tissue in the
• Failure of the liver during the disease's
liver.
ultimate stage will signify the end of the liver's
• This process occurs when healthy liver cells functioning. This will necessitate quick
have been destroyed over time (often several medical intervention to avoid fatalities.
years) by a progressive illness or infection.
• This causes permanent scarring of the liver,
causing it to become hard and lumpy.
• The liver will eventually be unable to function
because the growing scar tissue will make
blood flow through the portal vein and into the
liver impossible.
• When this blood is prevented from accessing
the portal vein, it can flow into the spleen,
causing additional problems.
 CHOLECYTITIS

• Cholecystitis is a redness and swelling (inflammation) of the gallbladder. It happens when a

digestive juice called bile gets trapped in your gallbladder.
• The gallbladder is a small organ under your liver. It stores bile which is made in the liver.
• Normally bile drains out of your gallbladder and into your small intestine. If the bile is
blocked, it builds up in your gallbladder. This causes inflammation and can cause infection.
• Cholecystitis can be sudden (acute) or long-term (chronic).
 CAUSES

• Bacterial infection in the bile duct system. The bile duct system is the
drainage system that carries bile from your liver and gallbladder into
the first part of your small intestine (the duodenum).
• Tumors of the pancreas or liver. A tumor can stop bile from draining
out of your gallbladder.
• Reduced blood supply to the gallbladder. This may happen if you have
diabetes.
• Gallbladder sludge. This is a thick material that can’t be absorbed by
bile in your gallbladder. The sludge builds up in your gallbladder. It
happens mainly to pregnant women or to people who have had a very
fast weight loss.
 SYMPTOMS

• In most cases, an attack of cholecystitis lasts 2 to 3 days. Each person’s

symptoms may vary. Symptoms may include:
• Intense, sudden pain in the upper right part of your belly
• Pain (often worse with deep breaths) that spreads to your back or
below the right shoulder blade
• Nausea
• Vomiting
• Fever
• Yellowing of the skin and eyes (jaundice)
• Loose, light-colored bowel movements
• Belly bloating
 TREATMENT

You will likely be admitted to a hospital to rest your gallbladder. You may need surgery to remove your
gallbladder.
In the hospital your treatment may include:
• Taking bacteria-fighting medicines (antibiotics) to fight the infection
• Taking fluids and pain medicines by IV (through a vein or intravenously)
• Keeping your stomach empty until your symptoms ease
• Your symptoms may get better with this treatment.
• But if your cholecystitis is caused by gallstones in your gallbladder, your gallbladder will need to be removed.
Gallbladder removal (called cholecystectomy) is a common surgery. Your body will work well without your
gallbladder. It is not essential for a healthy life.
• You may have surgery done right away. If you are too sick to have surgery, a small tube may be put through
your skin and into your gallbladder. This will drain the bile and ease your symptoms until you can have surgery.
Other treatment options may include:
• Oral dissolution therapy. Medicines made from bile acid are used to dissolve the stones
• Medicines. These are used to prevent gallstones from forming
• Low-fat diet. When you are allowed to eat food again
GALLSTONE
 CHLELITHIASIS

Cholelithiasis, or gallstones, are hardened deposits of digestive fluid that form in the gallbladder. The
gallbladder is a small, pear-shaped organ that lies beneath the liver and stores bile made by the liver.
Bile is a digestive fluid made of cholesterol, bile salts, and bilirubin and gets released into the small
intestine through the cystic duct and common bile duct, to aid in fat digestion. Gallstones can range in
size and an individual may develop several small gallstones, one large gallstone, or a combination of
different sized gallstones.
Left untreated, cholelithiasis can lead to serious complications. These include tears in the gallbladder
and infection that spreads to other parts of your body. Seek immediate medical care (call 911) for
serious symptoms, such as high fever (higher than 101°F [38°C]), severe abdominal pain, abdominal
swelling, and nausea with or without vomiting.
 GALLSTONE

• Gallstones are hard deposits that form inside the gallbladder. These may be as small as a
grain of sand or as large as a golf ball.
 CAUSES

The cause of gallstones varies. There are two main types of gallstones:
• Stones made of cholesterol -- This is the most common type. Cholesterol gallstones are not related to cholesterol
level in the blood. In most cases, they are not visible on CT scans but are visible on a sonogram of the abdomen.
• Stones made of bilirubin -- These are called pigment stones. They occur when red blood cells are destroyed and
too much bilirubin is in the bile.
• Gallstones are more common in:
• Female sex
• Native Americans and people of Hispanic descent
• People over age 40
• People who are overweight
• People with family history of gallstones
 SYMPTOMS

Many people with gallstones do not have any symptoms. These are often found during a routine x-ray,
abdominal surgery, or other medical procedure.
However, if a large stone blocks a tube or duct that drains the gallbladder, you may have a cramping pain in the
middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the
first part of the small intestine.
• Symptoms that may occur include:
• Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant or
cramping. It can feel sharp or dull.
• Fever.
• Yellowing of skin and whites of the eyes (jaundice).
• Other symptoms may include:
• Clay-colored stools
• Nausea and vomiting
The following factors also make you more likely to develop gallstones:
Bone marrow or solid organ transplant
• Diabetes
• Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)
• Liver cirrhosis and biliary tract infections (pigmented stones)
• Medical conditions that cause too many red blood cells to be destroyed
• Rapid weight loss from eating a very low-calorie diet, or after weight loss surgery
• Receiving nutrition through a vein for a long period of time (intravenous feedings)
• Taking birth control pills
 ALCOHOLIC LIVER DISEASE

Alcoholic liver disease is common, but can be

prevented. There are 3 types. Many heavy
drinkers progress through these 3 types over time:
• Fatty liver. Fatty liver is the build-up of fat
inside the liver cells. It leads to an enlarged
liver. It’s the most common alcohol-induced
liver problem.
• Alcoholic hepatitis. Alcoholic hepatitis is an
acute inflammation of the liver. There is death
of liver cells, often followed by permanent
scarring.
• Alcoholic cirrhosis. Alcoholic cirrhosis is the
destruction of normal liver tissue. It leaves scar
tissue in place of the working liver tissue.
 CAUSES

• Alcoholic liver disease is caused by heavy use of alcohol. The liver’s

job is to break down alcohol. If you drink more than it can process, it
can become badly damaged.

• Fatty liver can happen in anyone who drinks a lot. Alcoholic hepatitis
and alcoholic cirrhosis are linked to the long-term alcohol abuse seen
in alcoholics.

• Healthcare providers don’t know why some people who drink alcohol
get liver disease while others do not. Research suggests there may be a
genetic link, but this is not yet clear.
 SYMPTOMS

The effects of alcohol on the liver depend on how much and how long you have been drinking alcohol. These
are the most common symptoms and signs:
Fatty liver
• Often causes no symptoms
• Build-up of fat inside the liver cells enlarges the liver, causing upper abdominal (belly) discomfort on the
right side
• Tiredness and weakness
• Weight loss
Alcoholic hepatitis
• Pain over the liver
• Fever
• Weakness
• Nausea and vomiting
• Appetite loss
• Yellowing of the skin and eyes (jaundice)
Alcoholic cirrhosis, all of the symptoms of alcoholic hepatitis ;
• Enlarged spleen
• Poor nutrition
• Bleeding in the intestines
• Ascites (fluid build-up in the belly)
• Kidney failure
• Confusion
• Liver cancer
• The symptoms of alcoholic liver disease may look like other health problems. Always see a doctor for a diagnosis.
 NON-ALCOHOLIC LIVER DISEASE

• Non-alcoholic fatty liver disease (NAFLD) is the term for a range of conditions
caused by a build-up of fat in the liver. It's usually seen in people who are
overweight or obese.
• A healthy liver should contain little or no fat.
 STAGES

• NAFLD develops in 4 main stages

• simple fatty liver (steatosis) – a largely harmless build-up of fat in the liver cells that may only be
diagnosed during tests carried out for another reason
• non-alcoholic steatohepatitis (NASH)– a more serious form of NAFLD, where the liver has become
inflamed; this is estimated to affect up to 5% of the UK population
• fibrosis – where persistent inflammation causes scar tissue around the liver and nearby blood vessels,
but the liver is still able to function normally
• cirrhosis – the most severe stage, occurring after years of inflammation, where the liver shrinks and
becomes scarred and lumpy; this damage is permanent and can lead to liver failure (where your liver
stops working properly) and liver cancer
• It can take years for fibrosis or cirrhosis to develop. It's important to make lifestyle changes to
prevent the disease from getting worse.
 SYMPTOMS

There aren't usually any symptoms of NAFLD in the early stages. You probably won't know you have it unless it's
diagnosed during tests carried out for another reason.
• Occasionally, people with NASH or fibrosis (more advanced stages of the disease) may experience:
• a dull or aching pain in the top right of the tummy (over the lower right side of the ribs)
• fatigue (extreme tiredness)
• unexplained weight loss
• Weakness
• If cirrhosis (the most advanced stage) develops, you can get more
severe symptoms such as yellowing of the skin and the whites of the
eyes (jaundice), itchy skin, and swelling in the legs, ankles, feet or
tummy.
 LIVER TUMOR

• Liver tumors, also called hepatic tumors, are growths on or in the liver. Benign
(non-cancerous) tumors sometimes grow large enough to cause health
problems. Liver tumors that are malignant – growing into nearby tissue or
spreading to other parts of the body – are liver cancer.
Benign Liver Tumors
• Hemangiomas: non-cancerous growths that form due to an abnormal
collection of blood vessels
• Liver cysts: fluid-filled sacs that usually don’t show symptoms and require no
treatment unless they grow large and cause discomfort
• Adenoma: a non-cancerous tumor that starts in tissues like skin or glands
• Focal nodules: benign liver tumors that mainly occur in women between ages
20 and 30
 MALIGNANT TUMOR

• Hepatocellular carcinoma (HCC): a type of liver cancer

that occurs more often in men and is usually diagnosed in
people age 50 or older
• Cholangiocarcinoma: a rare cancer that affects the bile
ducts
• Gallbladder carcinoma: a a rare cancer that starts in the
gallbladder
• Hepatoblastoma, a malignant liver tumor that mostly
occurs in children less than five years of age, although it
has been diagnosed in older children and adult.
STAGES OF LIVER CANCER
 REFERENCE

• https://www.bidmc.org/conditions-and-treatments/kidney-liver-and-urin
ary/liver-tumors#:~:text=Liver%20tumors%2C%20also%20called%20h
epatic,the%20body%20%E2%80%93%20are%20liver%20cancer
• https://www.healthline.com/health/hepatitis#Hepatitis-C
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278535/#:~:text=Histo
logical%20variants,substantial%20area%20of%20the%20parenchyma
.
• https://www.medicinenet.com/what_are_the_4_stages_of_cirrhosis_of_t
he_liver/article.
htm
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/cholec
ystitis#:~:text=What%20causes%20cholecystitis%3F,builds%20up%20i
n%20your%20gallbladder
• https://images.app.goo.gl/5XVsheu4uFKPPBSm8