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DISEASES OF THE LIVER ANDPANCREAS

Section 10

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Case 1. FAT NECROSIS IN ACUTE

PANCREATITIS

26 year old maleSevere abdominal pain after attending a dinner party (ate a heavy meal & indulgedin a drinking spree)PE:

±

sclera slightly jaundiced ± Upper abdomen had marked muscle guarding and tenderness

Lab exam: ± Leukocytosis, elevated serum amylase and lipase

Developed shocked and expired the following day

Post mortem exam: ± 300 cc of chicken-fat-broth like ascitic fluid ± Pancreas was swollen and hemorrhagic ± Peripancreatic fat and omentum had speckles of opaque, chalky white lesions

Microsections: Pancreatic tissue infiltrated with inflammatory cells with areas of fat necrosis, characterized by semidigested blurred fat cells

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FAT NECROSIS IN ACUTE PANCREATITIS

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Case 2 . FATTY LIVER

Severely malnourished 9 year old boy

Difficulty of breathing (started 7 days prior to consult, with feverand cough)

3 weeks of on and off diarrheaPE:

± High grade fever ± Rales over all lung fields ± Liver was enlarged and palpable 2 .5 cm below the right costal

marginMicroscopic sections of liver:

± diffuse vacuolization of hepatocytes with preservation of lobulararchitecture

± Lymphocytes infiltrated portal areas

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FATTY LIVER

hepatocytes

Lipid vacuoles

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FATTY LIVER

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Case 3. LIVER CIRRHOSIS4 5 year old alcoholic maleHospitalized for hematemesis

3 years PTA: jaundice and low grade fever2 months PTA: abdominal enlargement, dependent edema, occasional melena

PE: palpable spleen, positive fluid wave, prominent superficial veins alongabdomen, hemorrhoidsLab results: slight increase in serum bilirubin, transaminases and inverted A/GratioGross exam:

± small liver with diffuse nodularities along surface ± Splenomegaly and ascitis (1 liter) ± Esophageal and hemorrhoidal varices

Microsections of liver: ± large pseudolobules surrounded by fibrous bridges ± significant lymphocytic infiltrates and fatty changes

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LIVER CIRRHOSIS

Fibrous bridgesPseudo lobulation

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Case 4 . HEPATOCELLULAR CARCINOMA

4 2 year old maleRight upper quadrant pain, abdominal enlargement, and

jaundice6 months PTA: illness started, body weakness, anorexia, andweight lossPE: palpable spleen and positive fluid waveLab results: elevated direct and indirect bilirubin, low albumin,and positive HbsAg.Liver was enlarged with massive tan mass with areas of greenishcholestasis, hemorrhage, and yellow-brown necrotic areasSpleen enlarged; 6 00cc of ascitic fluidMicrosections of liver: trabeculae and sheets of atypical cellswith large nuclei, coarse chromatin and pleomorphic

multinucleated cells

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HEPATOCELLULAR CARCINOMA