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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