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Alcoholic Liver Disease

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Alcoholic Liver Disease

  1. 1. Alcoholic Liver Disease The Best Histopathology
  2. 2. Case Study Mr.T • 56 year old Male presented to A&E with Abdominal distension, somnolence and haematemesis • Orientated only to name • Family members disclose a history of alcohol abuse (100 units / wk) • O/E: BP 90/60, Pulse 120. Jaundiced with peripheral stigmata of liver disease and shifting dullness
  3. 3. Mr.T Cont… • Fluid resuscitation, abdominal paracentesis and sclerosis of oesophageal varices at endoscopy • CT scan revealed 6.0 cm homogenous liver mass with AFP level of 2500ng/ml (>50ng/ml = abnormal)
  4. 4. Pathology Ladder • Fatty liver (Alcoholic steatosis) • Alcoholic hepatitis • Fibrosis • Cirrhosis • Hepatocellular carcinoma
  5. 5. Steatosis (Macrovesicular) • 65% of chronic drinkers • Large sharp fat droplets in hepatocytes • Accumulation due to defect of secretion of lipoprotein by hepatocytes
  6. 6. Microvesicular (Foamy) Steatosis • Much rarer – first stage of hepatic decompensation • Groups of foamy hepatocytes containing small droplets throughout cytoplasm • Hepatocyte dropout due to apoptosis and pericellular fibrosis
  7. 7. Alcoholic Hepatitis • Necroinflammatoy lesion in centrolobular area • Characterised by - Necrosis, Inflammation and Fibrosis • Infiltrate of neutrophil polymorphs surrounding Mallory bodies • Acute alcoholic hepatitis has a mortality rate of 20-50%
  8. 8. Mallory Bodies
  9. 9. Fibrosis • Pericellular or “chicken wire” fibrosis in hepatitis • Venous lesions; sclerosing hyaline necrosis portal hypertension • Cytokine mediated transformation of Ito cells into transitional cells, myofibroblasts and fibroblasts • Interference with O2 and nutrient exchange between blood and hepatocyte = injury and dysfunction
  10. 10. Pericellular (Chicken Wire) Fibrosis
  11. 11. Prognosis • Initial fibrosis in steatosis will resolve with abstinence • Severe fibrosis may progress to cirrhosis even without continuation of alcohol consumption • Factors affecting progression to cirrhosis include; continued alcohol consumption, severity of lesion and sex (F>M). There is also thought to be a genetic component
  12. 12. Cirrhosis • 10-20 % of chronic drinkers; irreversible • Parenchymal necrosis, re-generation and fibrosis resulting in disorganisation of the acinar structure • Usually micronodular, with uniform regenerative nodules <3mm • 60-70% 5yr survival in abstinence • 40% in continued drinking • 5 - 10% develop Hepatocellular carcinoma
  13. 13. Micronodular Cirrhosis
  14. 14. Microscopic Micronodular
  15. 15. Hepatocellular Carcinoma • Progression of micro to macronodular cirrhosis (often after period of abstinence)! • Dysplasia in regenerative nodules -> Neoplasia • Increased risk with Hepatitis • Fatal within 10 months
  16. 16. Conclusion • Patient may present with a mixed picture of pathology • Important to remember that changes are often reversible • Serious consequences of continued drinking – irreversible damage • Cirrhosis and hepatocellular carcinoma
  17. 17. Questions?
  18. 18. References • Alcoholic liver disease, Pathology and Pathogenesis, 2nd Edition 1995 Ed. Pauline Hall • Cpmenet.columbia.edu • Gastroresource.com • Lieben CS.Pathogenesis and treatment of alcoholic liver disease: progress over the last 50 years.Rocz Akad Med Bialymst. 2005;50:7- 20. • meddean.luc.edu • merck.com • Oxford Handbook Clinical Medicine • Sougioultzis S, Dalakas E, Hayes PC, Plevris JN. Alcoholic hepatitis: from pathogenesis to treatment. Current Medical Research and Opinion, Volume 21, Number 9, September 2005, pp. 1337-1346(10)

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