Coupon Accepted Successfully!



Weight: 1400 - 1600 gm 2.5 % of Body weight

Incoming blood  - Portal vein (60-70%)

                   - Hepatic artery (30% - 40%)

Outgoing  - Hepatic vein   IVC


A. Acinus

  1. Hexagonal
  2. Morphologic unit,
  3. Diameter: 1-2 mm
  4. CV/THV in center
  5. PT at apices

Liver cell plates: 1 cell thick (after 5-6 years of age)

Limiting plate - hepatocytes abutting portal tract

Bile canaliculi- 1-2 μm in diameter channels b/w abutting hepatocytes Q

Benign in centrilobular region  canals of hering   Bile duct   Bile duct in portal tracts


B.   MPS:

  1. Kupffer cells: Triangular / star shaped cells with bean shaped nucleus Q
  2. Attached to luminar surface of endothelial cells

Two BD may be seen / PT

Paucity of BD's:

Mild- moderate: < 0.9 BD/PT

Sever"         : < 0.6 BD/PT

Adequate Liver Biopsy: At least 3 PTs

Pattens of hepatic injury

1.  Degeneration & Intracellular accumulation

Ballooning degeneration Q: Swollen edematous appearance with irreg. clumped cytoplasm & large clear space

Viral hepatitis (toxic / immunologic insult)

2. Foamy degeneration Q: Bile Retention


3. Steatosis Microvesicular Q:

Ac. fatty liver of pregnancy, Reyes syndrome, valproic acid toxicity


4.  Macrovesicular Q :       

 Obese pts. / Diabetic individuals / Hepatitis C infection

 Alcoholic liver disease: Both microvesicular and macro vesicular fatty change Q


D. Causes of fatly changes in liver Q

  1. DM              
  2. Alcoholism                                
  3. Anoxia
  4. Toxins - CCl4
  5. Starvation                                 
  6. Obesity
  7. Chronic illness
  8. Acute fatly liver of pregnancy      
  9. Reyes syndrome 

FFA (diet, adipose tissue)

CCl4 & Protein malnutrition: synthesis of apoprotein Anoxia (-) FA oxidation


Alcohol- shunting of (n) substances away from catabolism & towards lipid biosynthesis (:.of NADH)

  1. Impaired assembly & secretion of Lipoproteins due to apoprotein deficiency
  2. Increased peripheral catabolism of fat. Q


E. Necrosis & Apoptosis

- Coagulative necrosis (ischemic)

- Apoptosis   Councilman bodies   (Toxic immunologic injury)

               - Lytic necrosis


  1. Centrilobular Necrosis Q: Ischemic injury, drugs, toxin
  2. Mid zonal necrosis Q: Rare, yellow fever
  3. Periportal Necrosis Q: Eclampsia
  4. Focal necrosis Q: Spotty necrosis
  5. Submassive necrosisQ, massive necrosis, Liver abscess
  6. Bridging necrosisQ: Necrosis of contiguous hepatocytes bridging portal- to portal, portal-to central ­or central -to -central
  7. Interface hepatitis: Necrosis of limiting plate hepatocytes 

F. Inflammation: Hepatitis [commonly by sensitized T cells]


G. Regeneration: mitosis, thickening of hepatocyte cords, disorganization of parenchymal structure


H. Fibrosis: Irreversible Q          



I. Laboratory evaluation of liver disease

Test category                     

1. Serum Measurement


a. Cytosolic hepatocellular enzymes

  1. Serum aspartate aminotransferase (AST)*
  2. Serum alanine aminotransferase (ALT)*
  3. Serum lactate dehydrogenase (LDH)*  

b. Biliary excretory function Substances normally secreted in bile

  1. Serum bilirubin
  • Total: unconjugated plus conjugated*
  • Direct: conjugated only*
  • Delta: covalently linked to albumin*
  1. Urine bilirubin*
  2. Serum bile acids
  3. Plasma membrane enzymes (from damage to bile canaliculus)
  • Serum alkaline phosphatase*
  • Serum γ-glutamyl transpeptidase* Q
  • Serum 5' - nucleotidase* 

c. Hepatocyte function Proteins secreted into the blood

  1. Serum albumin
  2. Prothrombin time'" (factors V, VIII, X, Prothrombin, fibrinogen)

d. Hepatocyte metabolism

  1. Serum ammonia'"
  2. Aminopyrine breath test (hepatic demethylation)
  3. Galactose elimination (intravenous injection) 


Test Your Skills Now!
Take a Quiz now
Reviewer Name