Hepatobiliary System and Exocrine Pancreas

The interrelationships among hepatic steatosis, hepatitis, and cirrhosis are shown, along with a depiction of key morphologic features at the microscopic level.
Alcoholic liver disease

Severe fatty change liver

The liver is enlarged, soft, greasy and diffusely yellow in color.

Fatty change liver

Normal
Fatty change

•Initially small lipid droplets accumulate in hepatocytes Alcoholic Microvesicular Steatosis

Alcoholic steatosis

Hepatic steatosis in patient with alcohol abuse. The picture shows a mixture of macrovesicular and microvesicular steatosis and a lipogranuloma (upper right corner). (H&E)

Alcoholic steatosis

Moderately severe degree of alcoholic macrovesicular steatosis

Alcoholic hepatitis (ASH)

Detail of centrilobular parenchyma, characterized by pericellular fibrosis, steatosis, hydropic swelling of several hepatocytes containing Mallory bodies. (H&E)


This is from a core biopsy of the liver of a patient who denied use of alcohol (despite her family's claims to the contrary). Features of alcoholic liver disease, include steatosis, Mallory hyalin, & ballooning degeneration (arrow).
Alcoholic hepatitis

Alcoholic hepatitis

A, The cluster of inflammatory cells marks the site of a necrotic hepatocyte. A Mallory body is present in a second hepatocyte (arrow). B, Eosinophilic Mallory bodies are seen in hepatocytes. (H&E).

Alcoholic hepatitis

Alcoholic cirrhosis
Alcoholic cirrhosis. A, The characteristic diffuse nodularity of the surface reflects the interplay between nodular regeneration and scarring. The greenish tint of some nodules is due to bile stasis. A hepatocellular carcinoma is present as a budding mass at the lower edge of the right lobe (arrow). B, The microscopic view shows nodules of varying sizes entrapped in blue-staining fibrous tissue. The liver capsule is at the top (Masson trichrome). C, characteristic diffuse nodularity of the surface induced by the underlying fibrous scarring. The average nodule size is 3 mm in this close-up view. The greenish tint is caused by bile stasis.


The disparity between the typical cirrhosis of chronic viral hepatitis (small liver, big nodules) and alcoholic liver diseases (big liver, small nodules) is particularly evident here. The greenish discoloration of the liver with alcoholic cirrhosis is due to bile stasis.
Alcoholic cirrhosis Vs cirrhosis of viral hepatitis



This is an example of a micronodular cirrhosis. The regenerative nodules are quite small, each averaging less than 3 mm in size.
Micronodular cirrhosis
The regenerative nodules of liver in this case of micronodular cirrhosis are 3 mm in size or smaller. The pale tan color is due to fatty change. The most common cause of this form of cirrhosis is chronic alcoholism.