FIGURE 10.1

Comparison of normal liver (A) with biopsy from child with Alagille syndrome (B). In normal liver the portal tracts contain a bile duct (arrow), portal vein and hepatic artery but in Alagille the bile duct is missing.

FIGURE 10.2

Comparison of lobular and acinar models of liver microarchitecture: (A) Hepatic lobule arranged round a single central (hepatic) vein into which blood flows. (B) Simple acinus arranged around a hepatic artery branch. (C) Relationship between adjacent acini in liver.

FIGURE 10.3

Schematic diagram of liver parenchyma and sinusoids.

FIGURE 10.4

Features of hepatic failure.

FIGURE 10.5

Liver cell necrosis in hepatitis. (A) An acidophil (apoptotic) body (arrow) – the dead hepatocyte – is surrounded by lymphocytes. (B) Massive necrosis where there are few remaining hepatocytes. The ductular structures seen here represent an attempt at regeneration.

FIGURE 10.6

Chronic hepatitis: so-called interface hepatitis where there is inflammation and death of hepatocytes at the limiting plate between the parenchyma and the portal tract.

FIGURE 10.7

Primary biliary cirrhosis. An injured bile duct (BD) is surrounded by a granulomatous and lymphocytic infiltrate.

FIGURE 10.8

Sclerosing bile duct lesion in primary sclerosing cholangitis. A cuff of collagen is seen around a degenerate bile duct (arrows).

FIGURE 10.9

Massive fatty liver. This was the appearance at autopsy of a middle-aged woman with an 11-year history of alcohol misuse. The liver weighed 2890 g, over twice the normal weight.

FIGURE 10.10

Alcoholic hepatitis. This shows a ballooned hepatocyte (arrow) containing a large Mallory body and surrounded by polymorphs.

FIGURE 10.11

End-stage cirrhosis in a patient with fatty liver disease.

FIGURE 10.12

Histological changes in liver, removed at time of transplantation from patient in the case study. This shows zonal necrosis with coagulative necrosis involving all hepatocytes in the regions around hepatic veins and so-called midzones. There is some preservation of cells around the portal tracts.

FIGURE 10.13

Genetic haemochromatosis. This shows staining of iron in hepatocytes using Perl’s stain. The blue granules represent abnormal accumulation of haemosiderin; normal hepatocytes should be negative.

FIGURE 10.14

Histological appearances of a hepatic adenoma. This resembles non-tumorous liver and is composed of hepatocytes, but there are no portal tracts. Large atypical arteries are present (arrows).

FIGURE 10.15

(A) Cirrhotic liver removed at time of transplantation. Several nodules (arrows) are larger and are either white or bile-stained; these are small hepatocellular carcinomas. (B) Biopsy appearances in hepatocellular carcinoma. The tumour has a trabecular arrangement and there is evidence of vascular invasion (arrow).

FIGURE 10.16

Mechanisms of gallstone development.

FIGURE 10.17

Macroscopic picture of gallbladder containing mixed stones.

FIGURE 10.18

Islet blood supply. The vasculature in this pancreas has been injected with India Ink. The islets have been immunostained to show insulin-containing B cells. An arteriole (arrowed) enters the islet (I) and divides into intra-islet sinusoids which leave the islet and supply the surrounding exocrine tissue.

FIGURE 10.19

Duct inflammation and perilobular necrosis. An inflamed interlobular duct is present which contains proteinaceous concretions and polymorphs. An acute inflammatory infiltrate extends into the surrounding exocrine parenchyma.

FIGURE 10.20

Acute haemorrhagic pancreatitis. In this autopsy the pancreas (P) and gallbladder (GB) have been exposed. The pancreas is haemorrhagic and necrotic.

FIGURE 10.21

Fat necrosis of the omentum. Dark yellow flecks of fat necrosis can readily be seen.

FIGURE 10.22

Chronic pancreatitis. The main pancreatic duct (D) is ulcerated and contains concretions. Scar tissue surrounds the duct and pancreatic lobules.

FIGURE 10.23

Periampullary tumour. This is a moderately differentiated adenocarcinoma which is invading through smooth muscle (M).

FIGURE 10.24

Periampullary tumour in the duodenum. It is forming a raised ulcer, 15 mm in diameter.