322
UNIT 3
Organ Systems
CLINICAL CORRELATIONS
Portal area
with chronic
inflammation
and fibrosis
Periportal
hepatitis
Necrotic
hepatocyte
A
Figure 16-16A.
Hepatitis C.
H&E,
3
53
Hepatitis C
is an infectious liver disease caused by the
hepatitis
C virus
, which may result in
chronic hepatitis
and
cirrhosis
.
The hepatitis C virus is spread primarily by blood-to-blood
contact. Common signs and symptoms may include fatigue,
nausea, poor appetite, muscle and joint pains, jaundice, low
fever, and tenderness in the liver. In some patients, the disease is
self-limiting, but in others it becomes chronic with serious con-
sequences. In the later stages of the disease,
cirrhosis
may ensue
with resultant liver failure and ascites. Pathologic changes to
the liver include
portal tract expansion
with
lymphocytes
,
por-
tal f brosis
,
periportal hepatitis
,
steatosis
(fatty change), and
lobular parenchymal infl ammation
. In time, F brosis becomes
marked, surrounding nodules of regenerating hepatocytes to
produce hepatic cirrhosis. Treatment options include injections
of pegylated interferon-
a
, the antiviral drug ribavirin, and liver
transplantation. This image shows a portal area and adjacent
hepatocytes with
portal f brosis
and a lymphocytic infl amma-
tory inF ltrate along with
periportal hepatitis
(or
“piecemeal”
necrosis
) and scattered necrotic hepatocytes.
Cholesterol
stones
B
Figure 16-16B.
Gallstones.
Gallstones
are a condition in which stones are formed in
the gallbladder or in the bile ducts. There are two major
types of gallstones:
cholesterol stones
and
pigment stones
.
Cholesterol stones
are far more common than
pigment stones
in Western countries and the United States. Risk factors for
gallstones include female gender, obesity, oral contraceptives,
and being of Northern European, Mexican American, or
Native American descent. Most patients are asymptomatic
until stones obstruct the
cystic
or
common bile ducts
, causing
severe pain, called
biliary colic
, because of smooth muscle
contraction of the duct against the stone. The pain is colicky
(wavelike) because of the intermittent nature of the contrac-
tion. Gallstones can cause acute or chronic
cholecystitis
, and
blockage of the
hepatopancreatic ampulla
(
ampulla o± Vater
)
may lead to
acute pancreatitis
. The size of gallstones can
range from that of a grain of sand to a golf ball. Cholesterol
stones are pale yellow, radiolucent, and large (1–3 cm),
whereas pigment stones are black, radiopaque, and smaller
(<1 cm). Open surgical or laparoscopic removal of the gall-
bladder is the most common treatment for gallstones. This
gross photograph shows a fresh cholecystectomy specimen
containing multiple
cholesterol stones
.
SYNOPSIS 16-2
Pathological and Clinical Terms for the Digestive Glands and Associated Organs
Sialolithiasis
: the presence of sialoliths, or stones within the ducts of salivary glands; may cause obstruction resulting in
inspissated secretions and swelling as well as infection (see ±ig. 16-8C).
Autodigestion
: in reference to acute pancreatitis, the destruction of pancreatic tissues and surrounding adipose tissues by
the release of pancreatic enzymes as a result of damage to exocrine pancreas cells (see ±ig. 16-9C).
Saponif
cation
: in reference to acute pancreatitis, the necrosis of adipose tissues by lipolytic pancreatic enzymes released as
a result of damage to exocrine pancreas cells; free fatty acids react with calcium to form insoluble salts (see ±ig. 16-9C).
Mallory body
: an intracellular accumulation of intermediate keratin F
laments seen in hepatocytes in cases of alcoholic
hepatitis (see ±ig. 16-12C).
Periportal hepatitis
: also called “
piecemeal
necrosis
in cases of hepatitis; infl
ammatory process in a portal area trans-
gresses the limiting plate and involves the surrounding hepatocytes causing cell injury and death (see ±ig. 16-16A).
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