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The liver develops In the third week of gestation from foregut (primitive duodenum) which develops from endodermal cells. Also, gallbladder and hepatocytes develop from the endodermal cells.
Connective tissue and sinusoids develop from mesenchymal cells.
Intrahepatic bile duct development complete at a 3rd month and bile secretion also start by that time.
The liver is the main organ to store iron and is the site for hematopoiesis. Hematopoiesis stops in two months after birth but may be found in occasional foci in the liver. In premature baby these foci are abundant. The weight of the liver in full term baby is 75 to 180g.Umbilical Vein is the main source of blood supply in fetus after delivery it atrophies and gets round ligament. Liver grows slower than other structures in adult liver weighs 1200 to1500 g (1350G)⅕ of the total body weight (2.5% of total body weight)
The weight of the liver in full term baby is 75 to 180 g. Umbilical Vein is the main source of blood supply in fetus after delivery it atrophies and gets round ligament. Liver grows slower than other structures in adult liver weighs 1200 to1500 g (1350G)⅕ of the total body weight (2.5% of total body weight)
Umbilical Vein is the main source of blood supply in fetus after delivery, it atrophies and transforms into round ligament. Liver grows slower than other structures in adult liver weighs 1200 to1500 g (1350G)⅕ of the total body weight (2.5% of total body weight)
The Liver grows slower than other structures. in adult liver weighs 1200 to1500 g (average 1350G) and is 1/5 Th of the total body weight (2.5% of total body weight).
The liver is divided by a falciform ligament into right and left lobes.The right lobe is divided into quadrate lobe (inferior surface) and caudate lobe ( posterior surface).The upper border extends to the 5th intercostal space.
The liver is covered by thin fibrous capsule called Glisson capsule.The gallbladder is under the right lobe. The Porta hepatis is a deep fissure in the inferior surface of the liver through which all the neurovascular structures( except hepatic veins ) and hepatic ducts enter or leave the liver.It contains the right and left hepatic ducts, right and left branches of the hepatic artery and portal vein. The left lobe is six times smaller than the right lobe.
In the porta hepatis, the hepatic artery is anterior, bile duct also anterior and the portal vein is posterior.
Teres ligament developed from an inferior umbilical vein. Ligamentum venosum developed from posterior ductus venosus. The lower edge of the liver is unusual to be 1 to 3 cm below the costal margin.
The connective tissue surrounds all blood vessels and ducts to finest radicals to join inner aspect of Glisson capsule.
Hepatic artery carries 600 ml of blood per minute while portal vein 900 ml of blood per minutes. Hepatic artery supplies 30 to 40 % of oxygen while portal vein supplies 50 to 60% oxygen. The pressure in the hepatic artery is 90 mm of Hg and in the portal vein is 8 to 10 mm of Hg.
The portal vein has a high level of oxygen content equal to 80% saturation. Mixing of the portal vein and hepatic artery blood leads to drop in the arterial pressure.
These vessels enter into sinusoids and all sinusoids drain blood to central veins. All central veins give rise to right and left hepatic veins Which continue to inferior vena cava.
From the liver left and right duct joins to form the common hepatic duct.The common hepatic duct is joined by the cystic duct from the gallbladder.They give rise to common bile duct the diameter of the duct is .5 to 1.5cm.The common bile duct is joined by the pancreatic duct and they open to the ampulla of water in the duodenum, the ampulla of water is controlled by sphincter of Oddi which is Spiral valve, is a fold of mucosa.
REAL classification is Revised European – American classification of lymphoid neoplasm.
It includes :
REAL classification is into 4 broad categories based on the immunophenotype.
Precursor B – lymphocyte = Precursor B – cell lymphoblastic leukemia/lymphoma.
Precursor T – lymphocyte = Precursor T – cell lymphoblastic leukemia/lymphoma.
Peripheral B – lymphocyte gives rise to:
Peripheral T – cell and NK – neoplasm give rise to:
Non-Hodgkin’s and Hodgkin’s lymphoma can be differentiated and is shown in the tabulated form.
|Sign and Symptom||Non-Hodgkin’s lymphoma||Hodgkin’s lymphoma|
|Age||Common at extreme of age||Peak at 18 to 38 years. rare at puberty|
|General condition||Often effected||Usually excellent|
|Pruritus||usually absent||mostly common|
|Fever||Rare in early stage||May be present in early stage|
|Lesion in respiratory and GIT||Common||Rare|
|Lymph Nodes||Often symmetrical||Often unilateral|
|Cervical lymph nodes||Often bilateral and upper group||Often unilateral and lower group|
|Response to radiation||Immediate||Delayed|
|Epitrochlear lymph nodes||Maybe positive||Practically never|
|Sternal lymph node||Practically never||Sometimes positive|
|Leukemic phase||May be seen||Absent|
Tumors of the spleen may be benign and malignant.
Benign tumors :
Primaries are Non-Hodgkin’ lymphoma (NHL) and Hodgkin’s lymphoma (HD)>.
Secondary involvement is by the NHL and HD.
Hypersplenism is characterized by a triad of :
Mechanism of hypersplenism:
1. Infections: There is enlargement of the spleen in acute pyogenic infection. In septicemia, the spleen is enlarged and called septic spleen.
While non-pyogenic bacteria are Tuberculosis, Typhoid, Brucellosis, and Sarcoidosis.
BEST4 CMH KI
B = Brucellosis E = Echinococcus S = Syphilis and Subacute bacterial endocarditis T 4 = T.B, Typhoid, Toxoplasmosis and Trypanosomiasis
C = CMvirus M = Malaria H = Histoplasmosis K = Kala-azar I = Infectious mononucleosis.
2. Circulatory disturbance: Persistent or chronic venous congestion leads to congestive splenomegaly. This is due to the portal or splenic vein hypertension.
3. Storage diseases: This may be due to :
Hereditary causes are :
4. Neoplasm :
5. Blood disorders :
6. Immunological conditions like Rheumatoid arthritis and systemic lupus erythematosus (SLE).
7. Splenic infarct in early-stage leads enlargement of the spleen. Later on, fibrosis may bring it back to normal size.
Causes are :
Posted Sept. 2, 2016. Pathology
Posted Sept. 2, 2016. Pathology
1. Blood work up includes:
2 Bipedal lymphangiogram. This is done for iliac and para aortic lymph nodes.
3. Staging laparotomy : Laparoscopy can be done for splenectomy, liver biopsy, abdominal lymph nodes and bone marrow biopsy.
4.Clinical Examination : Do careful examination of lymph node, spleen, liver and etc.
5. Biochemical tests are needed are Liver function test (LFT) and lactate dehydrogenase (LDH).
6. Ultrasonography , CT scan and MRI are advised for further work up.
7. Advised liver and spleen scan.
25% positive in nonpalpable spleen by the pathologist.
50% negative in palpable spleen by the pathologist.
9 to 29% may show in the form of aggregates or diffuse infiltrate.