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21. Central haemorrhagic necrosis: Difference between revisions

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(Created page with "'''Staining''': HE '''Organ''': Liver '''Description''': Many things can be seen here. Inside the sinusoidal spaces can RBCs be seen. Some hepatocytes have smaller, denser nuclei with vacuoles in their cytoplasm. Inside the portal triad can fibrosis be seen. In a few places can “fat bubbles” be seen. Lastly, around the central veins can necrosis be seen. Fewer nuclei are present and loss of structure can be seen. '''Diagnosis''': Central haemorrhagic liver necr...")
 
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'''Staining''': HE
[[File:Central haemorrhagic necrosis of the liver - overview.png|thumb|Overview of the slide]]'''Staining''': HE


'''Organ''': Liver
'''Organ''': Liver


'''Description''':
'''Description''': Many things can be seen here. Inside the sinusoidal spaces can RBCs be seen. Some hepatocytes have smaller, denser nuclei with vacuoles in their cytoplasm. Inside the portal triad can fibrosis be seen. In a few places can “fat bubbles” be seen. Lastly, around the central veins can necrosis be seen. Fewer nuclei are present and loss of structure can be seen.
 
Many things can be seen here.
 
Inside the sinusoidal spaces can RBCs be seen. Some hepatocytes have smaller, denser nuclei with vacuoles in their cytoplasm. Inside the portal triad can fibrosis be seen. In a few places can “fat bubbles” be seen.
 
Lastly, around the central veins can necrosis be seen. Fewer nuclei are present and loss of structure can be seen.


'''Diagnosis''': Central haemorrhagic liver necrosis
'''Diagnosis''': Central haemorrhagic liver necrosis
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* Chronic right ventricular failure + acute left ventricular failure
* Chronic right ventricular failure + acute left ventricular failure


'''Theory''':
'''Theory''':[[File:Central haemorrhagic necrosis of the liver - nutmeg liver slide.png|thumb|Overview of a different slide with nutmeg liver but without central haemorrhagic liver necrosis]]Chronic right ventricular failure has a backward failure symptom called ''nutmeg liver'' or ''hepar moschatum''. You can read about the mechanisms of backward failure in pathophysiology. The right-sided heart failure causes congestion of the venous system, which affects the liver. Recall from anatomy that the central vein is the vein that drains into the hepatic vein and eventually the inferior vena cava, while the veins in the portal triad originate from the portal vein. When the right ventricle fails will congestion occur in the inferior vena cava and therefore the central veins, but not the portal vein. The signs of congestion are therefore most prominent around the central vein.
 
Chronic right ventricular failure has a backward failure symptom called ''nutmeg liver'' or ''hepar moschatum''. You can read about the mechanisms of backward failure in pathophysiology. The right-sided heart failure causes congestion of the venous system, which affects the liver. Recall from anatomy that the central vein is the vein that drains into the hepatic vein and eventually the inferior vena cava, while the veins in the portal triad originate from the portal vein. When the right ventricle fails will congestion occur in the inferior vena cava and therefore the central veins, but not the portal vein. The signs of congestion are therefore most prominent around the central vein.
 
The congestion in the liver causes RBCs to filter out from the vessels into the sinusoidal spaces. Fibrosis occurs around the portal triad, a process called ''incipient periportal fibrosis''. Atrophy of hepatocytes occurs. Some fatty degeneration of the hepatocyte is also visible.


That was the case of nutmeg liver. Despite it not being in the topic list is it still possible to draw nutmeg liver as a slide on the exam! It’s similar to this slide in all ways except there is no necrosis around the central veins.
The congestion in the liver causes RBCs to filter out from the vessels into the sinusoidal spaces. Fibrosis occurs around the portal triad, a process called ''incipient periportal fibrosis''. Atrophy of hepatocytes occurs. Some fatty degeneration of the hepatocyte is also visible.[[File:Central haemorrhagic necrosis of the liver - atrophic cells.png|thumb|Atrophied cells. Sinusoidal congestion is also visible]]That was the case of nutmeg liver. Despite it not being in the topic list is it still possible to draw nutmeg liver as a slide on the exam! It’s similar to this slide in all ways except there is no necrosis around the central veins.


If a patient already has nutmeg liver ''and'' develops acute left ventricular failure will there be a haemorrhagic necrosis around the central veins, called ''central haemorrhagic liver necrosis''. The necrosis occurs because of the hypoxia from the left ventricular failure, while the haemorrhage comes from the congestion from the right ventricular failure.
If a patient already has nutmeg liver ''and'' develops acute left ventricular failure will there be a haemorrhagic necrosis around the central veins, called ''central haemorrhagic liver necrosis''. The necrosis occurs because of the hypoxia from the left ventricular failure, while the haemorrhage comes from the congestion from the right ventricular failure.
[[File:Central haemorrhagic necrosis of the liver - overview.png|center|thumb|Overview of the slide]]
[[File:Central haemorrhagic necrosis of the liver - incipient periportal fibrosis.png|thumb|Incipient periportal fibrosis. The wavy stuff is the fibrosis.|left]]
[[File:Central haemorrhagic necrosis of the liver - nutmeg liver slide.png|center|thumb|Overview of a different slide with nutmeg liver but without central haemorrhagic liver necrosis]]
[[File:Central haemorrhagic necrosis of the liver - fatty degeneration.png|thumb|Fatty degeneration]]
[[File:Central haemorrhagic necrosis of the liver - atrophic cells.png|center|thumb|Atrophied cells. Sinusoidal congestion is also visible]]
[[File:Central haemorrhagic necrosis of the liver - necrotic area.png|thumb|Central haemorrhagic necrosis.|left]]
[[File:Central haemorrhagic necrosis of the liver - incipient periportal fibrosis.png|center|thumb|Incipient periportal fibrosis. The wavy stuff is the fibrosis.]]
[[File:Central haemorrhagic necrosis of the liver - necrotic hepatocytes.png|thumb|If you are having problems seeing the necrosis around the central veins (like many have), keep in mind what hepatocytes look like. They have large, round nuclei. The small nuclei around the central veins do not belong to hepatocytes, but to white blood cells. If you keep this in mind can you see that many hepatocytes here actually don’t have a nucleus, and are therefore necrotic.]]
[[File:Central haemorrhagic necrosis of the liver - fatty degeneration.png|center|thumb|Fatty degeneration]]
[[File:Central haemorrhagic necrosis of the liver - necrotic area.png|center|thumb|Central haemorrhagic necrosis.]]
[[File:Central haemorrhagic necrosis of the liver - necrotic hepatocytes.png|center|thumb|If you are having problems seeing the necrosis around the central veins (like many have), keep in mind what hepatocytes look like. They have large, round nuclei. The small nuclei around the central veins do not belong to hepatocytes, but to white blood cells. If you keep this in mind can you see that many hepatocytes here actually don’t have a nucleus, and are therefore necrotic.]]
[[Category:Pathology 1 - Histopathology slides]]
[[Category:Pathology 1 - Histopathology slides]]