1. Practical histopathology
بسم الله الرحمن الرحيم
Practical histopathology
Lab 9 (Liver diseases)

2. Introduction The liver is the largest organ inside the body.
In an adult, it is about the size of a football and weighs close to three pounds.
It is located behind the ribs in the upper right-hand portion of the abdomen.
Shaped like a triangle, the liver is dark reddish-brown and consists of two main lobes.
The liver is such an important organ that we can survive only one or two days if it shuts down if the liver fails, your body will fail too.
The amazing ability to create new liver tissue (i.e. it can regenerate itself) from healthy liver cells that still exist.

4. Liver Functions Cleanses blood
Metabolizing alcohol and other drugs and chemicals.
Neutralizing and destroying poisonous substances.
2. Regulate the supply of body fuel
Producing ,storing and supplying quick energy to keep the mind alert and the body active.
Producing, storing and exporting fat.

5. 3. Manufactures many essential body proteins involved in:
Transporting substances in the blood.
Clotting of blood.
Providing resistance to infection.
4. Regulates the balance of many hormones:
Sex hormones.
Thyroid hormones.
Cortisone and other adrenal hormones.
Transporting substances مثل الترانسفرين الي بنقل الحديد وكذلك الالبيومين يصنع بالكبد وبشتغل كل ناقل لكثير من العناصر بالجسم مثل الهرمونات والكالسيوم
Clotting of blood مثل فاكتور 7و8و12و9و8
Providing resistance to infection مثلacute phase prtoteins
Regulation of hormone balance by transforming or removing excess hormones

6. 5. Regulates body cholesterol: Produces cholesterol, excretes and converts it to other essential substances. 6. Regulates the supply of essential vitamins and minerals such as iron and copper. 7. Produces bile which eliminates toxic substances from the body and aids digestion .
يساعد في تصنيع الكولسترول وكذلك تخزين الكولسترول يلي بالطعام واطلاق هذا الكولسترول وتكسيره عند الحاجه لانتاج الطاقه وايضا استخدام الكولسترول في تصنيع المواد الاخرى مثل الهرمونات الجنسيه بدخل في تركيبها الكولسترول

7. Overview
Liver diseases remain among the most important causes of morbidity and mortality worldwide.
Although the diagnostic tools (e.g., blood studies, imaging, genetic and molecular tests) available to clinicians have greatly expanded in number and increased in sensitivity.
The examination of liver tissue by a skilled pathologist in histopathology remains vitally important in the evaluation and care of the patient with liver abnormalities.
Morbidity refers to the unhealthy state of an individual, while mortality refers to the state of being mortal

8. In some disorders, such as autoimmune hepatitis, liver biopsy is considered mandatory.
Liver samples come to the pathologist as aspiration biopsies for cytological examination, tissue biopsies (fine needle, core, and wedge), resections, and explants.
Each demands slightly different approaches for optimal handling and evaluation.

9. Indications for Liver Biopsy
At one time liver biopsy was the most important technique available to quickly establish the diagnosis of large duct (“extra hepatic biliary”) obstruction (LDO); this no longer pertains.
Instead, LDO is almost always easily diagnosed because of chemistry test results or imaging studies.
Liver samples are obtained for a variety of increasingly difficult diagnostic problems including toxic/drug induced liver and autoimmune diseases.

10. Hepatitis
The medical term “hepatitis” literally means “inflammation of the liver.”
Chronic inflammation of the liver may result in liver damage or failure if left untreated.
“Hepatitis” can be caused by many different things - drinking too much alcohol, traumatic injury, autoimmune disorders, an adverse drug reaction, or a virus such as the hepatitis A, B, C viruses.
Hepatitis B is the most common serious liver infection in the world.

11. It is caused by the hepatitis B virus (HBV), which attacks liver cells and can lead to cirrhosis, liver cancer, or liver failure if it is not detected and managed.
Hepatitis B is no longer a scourge because of the highly effective vaccination available and hepatitis C is proving susceptible to newly developed antiviral agents.

12. Cirrhosis
It is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly.
The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver.

14. Causes of Liver Cirrhosis
Fatty liver associated with
obesity and diabetes.
Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare)
Blockage of the bile duct, which carries bile formed in the liver to the intestines, where it helps in the digestion of fats;
In babies, this can be caused by biliary atresia in which bile ducts are absent or damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked, or scarred, due to another liver disease called primary biliary cirrhosis.

15. Necrosis and apoptosis
Necrosis is a form of cell injury which results in the premature death of cells in living tissue by autolysis.
It is caused by factors external to the cell or tissue, such as infection, toxins, or trauma which result in the unregulated digestion of cell components.
In contrast, apoptosis is a naturally occurring programmed and targeted cause of cellular death.
While apoptosis often provides beneficial effects to the organism, necrosis is almost always detrimental and can be fatal.