Hepato-biliary diseases
For the approach to a patient with liver disease, please click here.

# Normal Liver

## Histopathological Findings of a Normal Liver

# Viral hepatitis
- Acute hepatitis A
- Acute hepatitis B
- Acute Hepatitis D
- Acute hepatitis C
- Acute hepatitis E
- Chronic viral hepatitis
- Other viral hepatitis viruses may exist but are not so firmly established as the previous ones: hepatitis G.

## Histopathological Findings in Viral hepatitis

## Histopathological Findings in Viral hepatitis with Fulminant Necrosis

# Liver Dysfunction in other Infectious Diseases   
- Hepatitis:
Cytomegalovirus infection
Herpesviral: Herpes simplex infection
- Cytomegalovirus infection
- Herpesviral: Herpes simplex infection
- Toxoplasmosis
- Hepatosplenic schistosomiasis
- Portal hypertension in schistosomiasis
- Liver disease in syphilis
- Epstein-Barr virus infection
- Yellow fever virus infection
- Rubella virus infection
- Leptospirosis
- Echinococcosis
- Amoebiasis

# Other Inflammatory Liver Diseases
- Liver abscess
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Phlebitis of the portal vein
- Granulomatous hepatitis
- Hepatic granulomas in:
Berylliosis
Sarcoidosis
- Berylliosis
- Sarcoidosis

# Alcoholic liver disease
This may cause fatty liver, hepatitis, fibrosis and sclerosis leading to cirrhosis and finally hepatic failure.

## Histopathological Findings of Alcoholic Liver Disease

# Toxic Liver Disease
This includes mostly drug-induced hepatotoxicity, which may generate many different patterns over liver disease, including;
- Cholestasis
- Necrosis
- Acute hepatitis and chronic hepatitis of different forms,
- Cirrhosis
- Effects of Acetaminophen (Tylenol)
- Other rare disorders like focal nodular hyperplasia, hepatic granulomas, peliosis hepatis and veno-occlusive disease.
Liver damage is part of Reye's syndrome.

## Histopathological Findings: Liver: Centrilobular Necrosis from Chloroform

# Liver tumors
Malignant neoplasm of liver and intrahepatic bile ducts. The most frequent forms are metastatic malignant neoplasm of liver)
- Liver cell carcinoma
Hepatocellular carcinoma
Hepatoma
- Hepatocellular carcinoma
- Hepatoma
- Cholangiocarcinoma
- Hepatoblastoma
- Angiosarcoma of liver
- Kupffer cell sarcoma
- Other sarcomas of liver
Benign neoplasm of liver include hepatic hemangiomas, hepatic adenomas, and focal nodular hyperplasia (FNH).

# End-stage liver disease
Chronic liver diseases like chronic hepatitis, chronic alcohol abuse or chronic toxic liver disease may cause
- Hepatic failure and hepatorenal syndrome
- Fibrosis and cirrhosis of liver
Cirrhosis may also occur in primary biliary cirrhosis. Rarely, cirrhosis is congenital.

# Metabolic diseases (Chapter E in ICD-10)
- Haemochromatosis
- Wilson's disease
- Gilbert's syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson syndrome
- Rotor's syndrome

# Vascular Disorders
- Chronic passive congestion of liver
- Central haemorrhagic necrosis of liver
- Infarction of liver
- Peliosis hepatis
- Veno-occlusive disease
- Portal hypertension
- Budd-Chiari syndrome

# Cysts
- Congenital cystic disease of liver
- Cysts caused by Echinococcus

# Others
Amyloid degeneration of liver

# Gallbladder and biliary tract diseases
- Malignant neoplasm of the gallbladder
- Malignant neoplasm of other parts of biliary tract
Extrahepatic bile duct
Ampulla of Vater
- Extrahepatic bile duct
- Ampulla of Vater
- Cholelithiasis
- Cholecystitis
- Others (excluding postcholecystectomy syndrome), but including
Other obstructions of the gallbladder (like strictures
Hydrops, perforation, fistula
Cholesterolosis
Biliary dyskinesia
- Other obstructions of the gallbladder (like strictures
- Hydrops, perforation, fistula
- Cholesterolosis
- Biliary dyskinesia
- K83: other diseases of the biliary tract:
Cholangitis (including ascending cholangitis and primary sclerosing cholangitis)
Obstruction, perforation, fistula of biliary tract
Spasm of sphincter of Oddi
Biliary cyst
Biliary atresia
- Cholangitis (including ascending cholangitis and primary sclerosing cholangitis)
- Obstruction, perforation, fistula of biliary tract
- Spasm of sphincter of Oddi
- Biliary cyst
- Biliary atresia

# Diagnosis
In hepatology, important signs and symptoms include:
- History of alcohol abuse
- Liver function tests
- Hepatomegaly
- Hypoalbuminemia and ascites
- Jaundice or icterus
- Murphy's sign
- Liver biopsy

# Complete Differential Diagnosis of Causes of Hepato-biliary diseases

## Autoimmune, Systemic
- Amyloidosis
- Autoimmune hepatitis
- Burns
- Chronic Myelogenous Leukemia
- Hodgkin's Lymphoma
- Hyperthermia
- Inflammatory Bowel Disease
- Non-Hodgkin's lymphoma
- Osteomyelofibrosis
- Polycythemia
- Primary Biliary Cirrhosis
- Primary sclerosing cholangitis
- Sarcoidosis

## Cholestatic
- Extrahepatic cholestasis
- Intrahepatic cholestasis

## Infection
- Amebiasis
- Ascaris lumbricoides
- Brucellosis
- Canine roundworm
- Coxsackie virus
- Cytomegalovirus
- Echinococcus granulosus
- Echinococcus multilocularis
- E.Coli
- Entamoeba histolytica
- Epstein-Barr Virus
- German Measles
- Hepatitis A-G
- Herpes simplex
- Human Herpesvirus Six (HHV6)
- Klebsiella
- Leptospirosis
- Liver flukes
- Malaria
- Measles
- Mumps
- Parainfluenza
- Plasmodium falciparum
- Plasmodium ovale
- Plasmodium vivax
- Proteus
- Rickettsia
- Rickettsiosis
- Rubella
- Salmonella
- Schistosoma japonicum
- Schistosoma mansoni
- Schistosomiasis
- Staphylococcus aureus
- Toxoplasma gondii
- Toxoplasmosis
- Trichinella spiralis
- Trypanosoma cruzi
- Tuberculosis
- Varicella zoster
- Yellow Fever

## Liver Changes
- Abscess
- Adenomas
- Alcoholic Hepatitis
- Angiosarcoma
- Autoimmune hepatitis
- Biliary hepatitis
- Cholangiocarcinoma
- Chronic viral hepatitis
- Cirrhosis
- Colon Cancer
- Cysts
- Drug-induced hepatitis
- Fatty liver
- Focal nodular hyperplasia
- Gastric carcinoma
- Granulomatous hepatitis
- Hemangiomas
- Hematoma
- Hepatitis in systemic diseases
- Hepatocellular carcinoma
- Hepatomas
- Hodgkin's Lymphoma
- Non-Hodgkin's lymphoma
- Pancreatic Cancer
- Postoperative hematoma
- Trauma
- Wilson's Disease

## Metabolic
- Alpha-1 Antitrypsin Deficiency
- Budd-Chiari Syndrome
- Congestive Heart Failure
- Constrictive pericarditis
- Cystic Fibrosis
- Drugs, toxins
- Fructose intolerance
- Galactosemia
- Gaucher's Disease
- Glycogenosis
- Hemochromatosis
- Histiocytosis X
- Hypertyrosinemia
- Hypothyroidism
- Hypoxia
- Inferior vena cava web
- Neimann-Pick Disease
- Protoporphyria
- Shock
- Thrombosis
- Tumor
- Wilson's Disease

## Other
- Alcoholic Hepatitis
- Fatty liver

# Treatment
Includes:
- Motivate patient to stop drinking alcohol
- Vaccination for hepatitis
- Eradication of causative pathogens
- Liver transplantion
- Cholecystectomy
Active liver disease is considered an absolute contraindication to the use of the following medications:
- Amlodipine besylate and Atorvastatin calcium trihydrate
- Methyldopa
- Rosuvastatin
- Hydroxyprogesterone caproate
Marked liver dysfunction is considered an absolute contraindication to the use of the following medications:
- Danazol
- Methazolamide
Liver dysfunction is considered an absolute contraindication to the use of the following medications:
- Clomifene
- Medroxyprogesterone
- Progesterone

# Histopathological Findings in Liver Diseases

## Liver: Cryptococcosis

## Liver: Cytomegalic inclusion disease

## Liver: Echinococcus cyst

## Liver: Histoplasmosis

## Liver & Spleen in Malaria

## Liver: Alpha-1-antitrypsin deficiency

## Liver: Cardiac sclerosis (cardiac cirrhosis)

## Liver: Centrilobular necrosis from chloroform

## Liver: Chronic active hepatitis, cirrhosis

## Liver: Cirrhosis (micronodular)

## Liver: Congenital cytomegalovirus disease

## Liver: Erythroblastosis fetalis

## Fulminant hepatitis (massive hepatic necrosis)

## Liver: Hepatitis, yellow fever virus

## Herpes hepatitis

## Liver: Traumatic hemorrhage

## Liver: Viral hepatitis

## Liver: Viral hepatitis with fulminant necrosis
Fulminant hepatitis (massive hepatic necrosis) is an acute liver failure (<1 month) resulting in rapid hepatic compensation characterized by synthetic dysfunction (hypoglycemia, coagulopathy), coma (cerebral edema, hepatic encephalopathy) and associated with infectious, renal, pulmonary and metabolic complications.
Active liver disease is considered an absolute contraindication to the use of the following medications:
- Rosuvastatin

## Liver: Wilson disease