Atlas of BAS PATHOLOGY SECOND EDITION Gary C Kanel Jacob KorulaContents Preface vii E) General aspects of the liver and liver diseases 1 Viral hepatitis "1 Cholestasis and biliary tract disorders 44 FE Alcoholic liver disease 63 Drug-induced and toxic liver cell injury 78 E Vascular disorders 116 Infectious disorders, non-viral 135 E Developmental, familial, and metabolic disorders 173 E Diseases of hepatic iron and copper metabolism 210 i EE Neoplasms and related lesions 224 EE Transplantation 284 Ee Miscellaneous conditions 315 Index 336General aspects of the liver ‘THE NORMAL LIVER Embryology 1 ‘The hepatic primordium anlage first appears toward the end of the third week of gestation, cealarges. projects cranially into the mesoderm of the septum transyersum, and eventually develops into the hepatic parenchyma and intrahepatic biliary ssestem, The proliferating endoderm: form solid ‘anustomosing cords that form the hepatic sinusoids, while the mesoderm of the sepium transversum, forms the lesser omentum, falciform, coronary and triangular ligaments, und the hepatic (Glisson's) capsule, The hepatoblasts develop into the mature hepa- tocytes, forming cords two cells thick, with those adjacent to the portal mesenchyme becoming the ductal plates By the fifth week, the vascular network, derived from the vitelline and umbilical veins, is identified, the major vessels being the right and left umbilical veins. the transverse portal sinus, the ductus ind the portal vein. ‘The biliary canaliculi are first identified just after the first month, with bile synthesis and secretion seen by 3 months. Hematopoiesis begins in the mesoderm at approxi- mately 6 weeks, is most active during the sixth and seventh months, but then rapidly decreases and is usually absent by 1 month of age. ‘The perisinusoidal (Ito) cells and Kupffer cells appear by 3 months gestation. ‘The individual cell functions occur at different tme periods during fetal development, and include synthesis of (a) e-fetopratein, which is in high (quantities at birth and is initially present by 1 month gestation, (b) glycogen, which is seen by 2 months, and liver diseases with glycogen synthesis by 3 months, (c) fat, ovcur- ring at the same time as glvcogen, and (d) hemo- siderin (iron pigment), which is most evident during uctive hematopoiesis Gross anatomy 1. The liver in the adult measures approximately 15-20 em in width and weighs from 1200-1800 g, depending on the overall boty size, although at bieth the liver is larger compared with the adjacent tho- racic and abdominal viscera, 2. The liver anatomically has four lobes (right, left, calc, and quacrate). with the right lobe accounting for one-half to two-thirds of the total iver volume. 3. There are eight funetional segments, cach demar- cated by the vascular and biliary draina i. Lateral divisions of the right lobe (segments VI and Vil) ii, Medial divisions of the right lobe (segments V and Vil) ili, Medial division of the eft lobe (segment IV) iv, Lateral divisions of the left lobe (segments 11 and Ul) Cauidate lobe (segment 1) (he hepatoduodenal ligament connects the liver to the superior aspect af the duodenum and supports the hilar vessels and ducts, The transverse fissure divides the right lobe from the caudate lobe. The faleiform ligament extends between the liver and the anterior abdominal wall, and separates to form the superior laver of the coronary ligament and the left triangular ligament, while the liga- mentum teres contains the obliterated umbilical veln remnant 6. The portal vein develops from the merger of the superior mesenteric and splenic veins, receives blood from the coronary and cystic veins, and is divided into the right and left branches,