SDL 22. Metabolic Liver Disease
non-alcoholic steatohepatitis (NASH)
NAFLD; showing predominately macrovesicular steatosis + inflammatory foci (composed of lymphocytes and macs/Kupffer cells)
2 hrs s/p acetaminophen toxicity
centrilobular hepatocytes are vacuolated, shrunken, necrotic (arrows)
non-alcoholic fatty liver disease
chicken wire fibrosis (perivenular/pericellular)
1 hr s/p acetaminophen toxicity
adduct throughout centrilobular + midzonal regions
non-alcoholic fatty liver disease
ballooned hepatocytes w/surrounding inflammatory cells
alcoholic liver disease
hepatis steatosis of mod. degree composed of small + large-droplet fat (steatosis most prominent near central v. (*), extends outward toward portal tract w/increasing severity)
alcoholic steatohepatitis
hepatocyte ballooning degeneration (note swelling + rare-fraction of cytoplasm)
drug-induced acute hepatitis
hepatocyte swelling infiltration of inflammatory cells (black arrow) hepatocellular necrosis (white arrow)
acetaminophen intoxication
massive centrilobular necrosis w/relative preservation of the portal tracts
drug-induced microvesicular steatosis
numerous small lipid droplets throughout cytoplasm of hepatocytes
alcoholic steatohepatitis
portal tract fibrosis in center, associated w/lymphocytic/monocytic inflammatory infiltrate + macrovascular steatosis
drug-induced pure cholestasis
prominent bile plugs present in hepatocytes and canaliculi w/o inflammation or hepatocellular damage
alpha1 antitrypsin deficiency
red cytoplasmic granules
Mallory bodies
red, globular material accumulated in hepatocyte cytoplasm; composed of cytoskeletal intermediate filaments in complex w/ubiquitin (ropy/clumpy eosinophilic inclusions)
drug-induced macrovesicular steatosis
toxic hepatitis; fat vacuoles distending the hepatocyte + pushing the nucleus/cytoplasm to the side