Hepatobiliary System And Pancreas Pathology Situational Anal

PATHOLOGY OF THE HEPATOBILIARY SYSTEM AND PANCREAS SITUATIONAL ANALYSIS Mennen A. Alsol, MD Normando C. Gonzaga, MD Lorna B. Lioanag, MD

Instructions: 1. Give the differential diagnosis and discuss pathophysiology of the disease process. 2. Correlate the signs and symptoms of the patient with the morphologic changes in the organ(s) involved. 3. Discuss the morphologic features of each condition. 4. Enumerate laboratory tests that may help in prognostication of the condition(s).

Case I A 40 y/o chronic renal patient complained of anorexia, upper abdominal quadrant, fullness, and tea-colored urine which he noted since 2 yrs after he was started on dialysis. 1. Give your clinical differential diagnosis. 2. Liver biopsy is contemplated. Give the indications and contraindications for the procedure. 3. Discuss the serologic markers associated with the condition. 4. What is prognosis of the patient?

Chronic HBV infection

Hepatitis B: homogenous, pale, glassy cytoplasm due to accumulation of HBsAg

A. Acute hepatitis with resolution

B. Progression to chronic hepatitis.

Case II A 66 y/o bus driver was rushed to the emergency room because of hematemesis. He has 20 yr history of intake of gin PE findings include pallor, spider angiomas, gynecomastia, impotence, ascites and bipedal edema. 1. Explain the etiopathogenesis of the signs and symptoms. 2. Give the laboratory tests required for the diagnosis. 3. Liver biopsy was done. Discuss the expected morphologic findings.

Micronodular cirrhotic liver caused by alcohol abuse

Macrovesicular steatosis

Alcoholic liver disease with Mallory bodies

Cirrhosis

Esophageal varices

Case III A 35 y/o homosexual consulted because of 1 yr history of on & off right upper quadrant abdominal pain, difficulty of breathing, yellow discoloration of sclerae, ascites and progressive weight loss. 3 yrs prior to consult, he was diagnosed as a case HBV. 1. Liver biopsy was done. Discuss the findings. 2. Give the differential diagnosis. 3. Discuss pertinent laboratory results. 4. Give the prognosis of the patient.

Hepatoma

Case IV A 50 y/o female complained of fat intolerance and upper quadrant abdominal pain for he past 4 yrs. 2 months ago, she developed shooting pains at the right upper quadrant. 1. Correlate the clinical course with the gross and microscopic findings of the lesion. 2. Discuss the malignant potential of the disease process.

Chronic cholecytitis

Chronic cholecystitis with cholesterolosis:

Cholesterol & pigment stones

Case V A 21 y/o actor was rushed to the ER in coma. He had bouts of drinks the previous night in celebration of his birthday. 1. What laboratory tests must be requested to arrive at the diagnosis? 2. The patient died and autopsy was done. Discuss the morphology o the pancreas. 3. Correlate the signs and symptoms of the patient with morphoogic changes in the pancreas. 4. What is the prognosis of this patient?

Acute hemorrhagic pancreatitis

Edematous hemorrhagic pancreas (H), followed by necrosis and liquefaction. Focal fat necrosis, due to release of lipase, are seen as white spots (F) in mesenteric and peritoneal fat.

Acute hemorrhagic pancreatitis

Focal necrosis of adipose tissue (F) with adjacent reactive inflammatory infiltrates (I).