Lecture 26 diseases of liver and pancreas

Prof.Dr.
Khalil Hassan Zenad
Aljeboori
Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Lecture 26
DISEASES OF LIVER AND
PANCREAS

Cholecystitis:
Inflammation of gallbladder, may be from blood, lymph, from duodenum extension
through biliary tract.
 Acute:Thick gallbladder wall and adematous congested, fibrin, clotted blood and
necrosis in mucosa.
 Chronic:It extended from acute or complicated cholelithiasis, the wall fibrosed and
thickened, if the bile duct obstructed the gallbladder is distended with mucus,
ulceration of mucosa and inflammatory cells infiltrate the wall and fibrois then termed
fibrotic cholecystitis. In other cases the epith. Lining mucosa of gallbladder
proliferated then termed proliferating glandular cholecystitis.
Diseases of Gallbladder and bile ducts:

Cholesterolosis:
masses of cholesterol accumulate in mucosa of chronic inflamed gallbladder
with yellowish “curds” are visible red congested mucosa the condition
termed strawberry gallbladder. It causes unknown.
Cholelithiasis:
Gall stone, biliary calculi:
It is concretion of cholesterol, calcium, bile salts and pigments, with
variable size or number, the stone due to deposition of cholesterol or bile
components.

Factors contribute stone formation:
1. Slow of bile flow
2. Increase cholesterol content in bile
3. Excessive bile pigment formation
4. Inflammation of gallbladder
5. In multipara women occur due to increase cholesterol in blood and slow bile flow.
6. Obesity in diabetes
7. Ingestion diet rich cholesterol.
Symptoms:
Mainly biliary colic in some patients discomfort, jaundice ,pair radiate to right
shoulder.

Types of stones:
1. Pure stone: 10% either cholesterol or calcium bilirubinate (pigment stone) or
calcium carbonate.
2. Mixed 90% cholesterol, bile pigment, calcium salts and protein matrix derived
from gallbladder, it associated with cholecystits, brown- gray in color.
 Benign tumors:
1. Fibroma, adenoma.
2. Lipoma-very rare
 Malignant tumors:
Carcinoma- cholangio carcinoma associated with cholecystitis.

Jaundice:
Jaundice or icterus, a condition in which hyperbilirubinemia, and deposition bile pigment in tissues, so
yellow to orange and even greenish coloration of skin, mucous membrane and sclera.
Types of jaundice:
1. Hemolytic (prehapatic) Jaundice:
The rate of biliruben formation greater than the rate at which it can excreted by liver cells , jaundice in this
type is due to increase breakdown of hemoglobin and due to retention, the bilirubin is not conjugated with
glucuronic acid and not pass through kidney into the urine.
Causes:
1)infection.
2)chemical.
3)blood diseases (hemolytic anemia) and polycythemia.
4)incomplete blood transfusion and erythroblastosis fetalis.
5)allergy.

2. Hepatotoxic, infective jaundice:
biliruben production is normal, but liver cells incapable of excertion the bile pigment,
also retention jaundice, some of pigment reabsorbed into blood due intralobular
obstruction and damage, biliruben is of conjugated and unconjugated type.
Causes:
1)infections
2)chemicals
3)toxemia in pregnancy
4) x-ray exposure

3. Obstructive (posthepatic) jaundice:
Biliruben production is normal but the pigment excreted by liver cells is
prevented from reaching the intestine by obstruction of the biliary tract.
Thus the biliruben is mainly of conjugated type giving direct vanden
bergh reaction, it pass through kidney and in urine, obstruction of
biliary tract cause reabsorption of conjugated biliruben into blood.

Obstruction may be:
1) complete tumor
2) incomplete with stricture or calculus
3)intermittent
e.g: stones in common bile duct.
Causes:
1. Caculi in lumen of biliary tract
2. Stricture or atresia, tumor, biliary cirrhosis, all affect the wall of biliary tract
3. External due to tumor of pancreas and duodenum and metastatic tumor in liver or
lymph node, and also in case of chronic pancreatitis and ligature.

Jaundice in new born infant
Jaundic occur in:
1. Neonatal period
2. Infancy
3. Childhood
In neonates many disorders occur responsible for janndice either:
1. Congenital obliteration of extra hepatic bile duct.
2. Neonates hepatitis
3. Hemolytic disease due to Rh or ABO group incompatability.
4. Infections, herpes simplex, coxsackie virus, cytomegalo virus, congenital syphilis, bacterial sepsis.
5. Genetic disorder. Such galactosemia and Crigler najjar syndrome glucuronide.
6. Lack of glucuronyl transferase necessary to form bilirubin glucuronide so lead to an acholuric non
hemolytic jaundice.
7. Transient type of hyperbilirubinemia after birth seen.

 Crigler-najjar syndrome:
In which failure of liver to form bilirubin glucuronide so high level of unconjugated
bilirubin, child death before 1 year.
 Hemolytic jaundice of new born:
(erythroblastosis fetalis): in liver unable to secrete large amount of unconjugated
biliruben that result from hemolysis of R.B.C.S.
• The most common causes of jaundice are;
atresia of bile ducts and neonatal hepatitis.
 Congenital syphilis:
There is fibrosis and chronic inflammatory reaction cause bile stasis and jaundice.

 Cytomegalo virus infections:
Bile stasis is prominent, some multinucleated giant hepatic cells seen.
 In case of herpes simplex and coxsackie viruses:
Necrosis of the liver and jaundice resulted.
 In case of galactosemia:
the infant if given cow milk the liver enlarged and jaundice supervene. The diagnosis
of this condition is highly important because removal of galactose from the diet result in
relief of symptoms.

Acute hemorrhagic pancreatitis:
It caused by sudden enzymatic destruction of pancreatic tissue associated
with increase serum amylase level.
Microscopically- loss of pancreatic lobular tissue pattern, areas of
hemorrhage liberation of lipase result in the digestion of adipose tissue, fat
necrosis.
Microscopically: coagulative necrosis fat necrosis, hemorrhage,
inflammatory cellular infiltrate.
Disease of pancreas

Acute interstitial pancreatitis:
Occur in case of typhoid fever, mumps, scarlet fever and with coxsackie
virus.
Chronic pancreatitis:
There is marked fibrosis, acinar atrophy may associated with diabetis
mellitus.
Causes:
Following acute pancreatitis, hematochromatosis and duct obstruction.
 Results-steatorrhea, obstructive jaundice, in case of acute pancreatitis
death, suppuration and gangrene .

1. Congenital, solitary or multiple, associated with liver and kidneys cysts.
2. Retention cysts-multiple associated with chronic pancreatitis.
3. Neoplastic cysts: cystadenoma or cystadenocarcinoma.
4. Pseudocysts: outside the pancreas.
Fibrocystic disease:
Result from excessive formation of mucus or failure to produce mucolytic enzymes, it's cause unknown
may be hereditary transmitted by gene.
Clinical manifestation:
1. Birth-meconium ileum, viscid mucus in intestinal lumen, cause intestinal obstruction.
2. At neonatal and adolescene-respiratory infection, failure to thrive.
Cysts:

Shrinkage of pancreas, replacement by fibrous tissue, duct dilatation, blocking of ducts by
mucus, atrophy of acini, chronic inflammatory reaction, lung also affected with
bronchopneumonia, bronchiectasia and atrophy and fibrosis of salivary glands.
Effects: steatorrhea and malabsorption syndrome, respiratory infections and biliary
cirrhosis.
Pancreatic duct obstruction:
Lumen (mucus) in fibrocystic disease, gall stone, calculi.
Wall-stricture due to fibrosis. Tumors of pancreatic duct (carcinoma)
External, pancreatitis, acute and chronic, ligature, carcinoma of pancreatic acini.
Lesions:

Diabetes mellitus
It is divided into juvenile D.M and maturity onset D.M. the juvenile D.M controlled by insulin, whereas, maturity
onset D.M control by sulfonylurea it occur at over 40 years old, whereas juvenile bellow 15 years old.
Etiology:
An inherited tendency and transfer the disease by recessive gene . Experimentally by
treatment of laboratory animals by alloxan, growth hormone, cortisone, glucagon,
pancreatectomy, injection of anti insulin serum , other factors include the.
1. Pancreatic destruction
2. Adrenal causes
3. Pituitary causes
4. Obesity
5. Racial as the disease is common in jews and rare in Chinese.
 Clinically: excessive apetite, recurrent urination, glycosuria, hyperglycemia…
 Lesions: hyalinization and hydropic degeneration of B-cells, loss of B-cells.

Lesions in kidneys:
Pyelonephritis, glycogen infiltration of tubular epithelia, nephrosclerosis.
Lesions in cardiovascular system:
atherosclerosis, coronary atheroma, myocardial infarction, hypertension thrombosis,
nephrosclerosis, gangrene.
Hematochromatosis:
A disorder of iron metabolism characterized by:
Pigmentation of skin mostly due to increase melanine in basal layer and hemosidrin in
upper dermis.
Cirrhosis of liver
Diabetis mellitus due to hematochromatosis in pancreas in which hemosiderin
deposition in acini, duct epithelia, islets, so fibrosis and hyalinization of islets.

TUMORS
 Benign: fibroma, lipoma, adenoma, hemangioma.
 Malignant: pancreatic carcinoma.
Effects:
 Biliary obstruction, pancreatic obstruction portal vein
obstruction, diabetes mellitus.
 Tumor of islet (adenoma) hyperinsulinism, hypoglycemia.

Lecture 26 diseases of liver and pancreas

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