Diseases of the Liver, Biliary System, and Exocrine Pancreas
29 topics with concise summaries: definitions, key facts, and classroom questions.
This section focuses on morphological changes in diseases of the hepatobiliary zone and the exocrine part of the pancreas. The liver bears the primary metabolic and toxic burden, making its structural alterations diverse and critical for the entire organism.
Here we examine the pathomorphology of viral (A, B, E, and less-common), autoimmune, drug-induced, and alcoholic hepatitis. The morphogenesis of liver cirrhosis is described in detail: from portal and post-necrotic to primary biliary. A separate module covers oncology: hepatocellular and cholangiocellular carcinoma, secondary metastatic lesions, as well as neoplasms of the biliary tract and pancreas. In addition, the morphology of cholelithiasis and sclerosing cholangitis is analyzed.
In practical classes and exams, instructors most frequently ask about microscopic markers of viral hepatitis B ("ground-glass" hepatocytes), the classification of cirrhosis, and gross specimens of hepatocellular carcinoma. Pay special attention to studying the complications of cirrhosis (portal hypertension, hepatic failure)—this is an absolute classic of pathological anatomy.
This is the histologic activity index (HAI). It is a scoring system for evaluating inflammatory infiltrate and fibrosis, which helps determine the severity of chronic hepatitis.
Does a chronic carrier state develop in viral hepatitis A?
No, viral hepatitis A has a completely reversible course. Carrier state and chronic hepatitis do not develop with this infection.
What mechanisms and routes of transmission are characteristic of viral hepatitis E?
The transmission mechanism is exclusively fecal-oral. Parenteral, vector-borne, and airborne routes are excluded. The leading transmission factor is water (drinking water or from open water bodies).
Does the hepatitis B virus destroy liver cells directly?
No, the virus lacks direct cytotoxicity. Hepatocyte death occurs due to an attack by the host's own immune system reacting to viral proteins.
Which cells predominate in the inflammatory infiltrate in hepatitis B?
The infiltrate within the acini consists predominantly of lymphocytes and macrophages. The admixture of conventional leukocytes in it is negligible.
How does the HGV virus affect the course of hepatitis B?
According to the existing hypothesis, hepatitis B virus (HBV) frequently causes a process with low or moderate activity. Superinfection with HGV sharply increases the inflammatory activity and accelerates the development of liver cirrhosis.
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