1. Practical of Histopathology
Liver Necrosis
Prepared by:
Mr: Mahmoud El-Hindi
Miss: Afnan Abdelmoneim

2. Liver Necrosis

3. Objectives
1. Understand liver diseases. 2. Understand methods for diagnosis of liver diseases. 3. Liver: Tissue handling and evaluation.

4. 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.
There are over 300 billion specialized cells in the liver.

5. Cont.
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.

6. The liver performs several important functions including:
Stores vitamins, sugar and iron to help give your body energy.
Controls the production and removal of cholesterol.
Clears your blood of waste products, drugs, and other poisonous substances.
Makes clotting factors to stop excessive bleeding after cuts or injuries.

7. Cont.
Produces immune factors and removes bacteria from the bloodstream to combat infection.
Releases a substance called “bile” to help digest food and absorb important nutrients.

8. Human Liver

9. 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.

10. Cont…
The examination of liver tissue by a pathologist skilled and experienced in hepatopathology remains vitally important in the evaluation and care of the patient with liver abnormalities. In some disorders, such as autoimmune hepatitis, liver biopsy is considered mandatory..

11. Cont…
Liver samples come to the pathologist as aspiration biopsies for cytologic examination, tissue biopsies (fine needle, core), resections, and explants.
Each demands slightly different approaches for optimal handling and evaluation.

13. What is “hepatitis” and how does it affect my liver?
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 B virus.

14. Cont.
Hepatitis B is the most common serious liver infection in the world.
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.

15. Cont.
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.

16. 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.

17. Cont…
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.

20. Fig. 3 Chronic hepatitis C
Fig. 3 Chronic hepatitis C. (a) portal lymphohistiocytic infiltrate and minimal interface hepatitis (Hematoxylin– eosin 200×). (b) Portal lymphohistiocytic infi ltrate and minimal nterface hepatitis with germinal center formation (Hematoxylin–eosin 100×).

21. Cirrhosis
Cirrhosis is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly.

23. Cot…
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.

25. What Causes Cirrhosis of the Liver?
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;

26. Cont…
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.

27. Necrosis
Is a form of cell injury which results in the premature death of cells in living tissue by autolysis.
Necrosis 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.

28. Cont.
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.

32. Cont.
Acute hepatic necrosis is typically caused by a direct hepatotoxin.
Figure 1: Single-cell necrosis (arrows) in a male B6C3F1 mouse from subchronic study.

34. Methodology

37. Thanks a lot