SYSTEMIC PATHOLOGY EXAM 2 LECTURE 2: LIVER AND PANCREAS Morphological Classification What dictates nature & distribution of inflammatory lesions? Route of entry Host inflammatory response Nature of infectious agent Patterns of distribution Hematogenous route - random multifocal Ascending biliary tree - discrete Penetrating wound - discrete Toxin - zonal Neoplasia - varies Liver injury should be classified by: Pattern of involvement - random, zonal, massive Type of inflammatory cells - neutrophilic Necrosis or fibrosis? Severity Evidence of regeneration Ethologic agents - bacteria, fungi Acute Hepatitis Inflammation of liver parenchyma Inflammation + hepatocellular necrosis Characterization requires microscope Random neutrophilic hepatitis Neonates - umbilical vein - E.coli Older animals - Salmonella Viral infections - less inflammation Nonspecific Reactive Hepatitis Grossly - looks fine Microscopically - see signs Inflammation: Cholangitis: biliary tract Cholecystitis: gallbladder Cholangiohepatitis: biliary tract + hepatic parenchyma Chronic Hepatitis Acute progresses to chronic Continued inflammation Regeneration may occur Mononuclear inflammation Granulomatous hepatitis - granulomas Chronic suppurative hepatitis - pus Response to Liver Injury Regeneration of mature hepatocytes Replication of mature hepatocytes No new lobe formation - size of existing Oval cells replace lost hepatocytes TGF-α hepatocyte GF, TGF-β stops replacement by fibrosis

Lecture 2 Liver and Pancreas

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