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8 - Pathology of acute liver failure
- from Part Two - Mechanisms of Disease and Multisystem Involvement
- Edited by William M. Lee, University of Texas Southwestern Medical Center, Dallas, Roger Williams, University College London
- Foreword by Jean-Pierre Benhamou, Jacques Bernuau
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- Book:
- Acute Liver Failure
- Published online:
- 20 May 2010
- Print publication:
- 28 December 1996, pp 79-92
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- Chapter
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Summary
INTRODUCTION
Confluent necrosis and loss of liver parenchyma in either zonal or nonzonal distribution is the commonest pathology underlying acute liver failure. More rarely microvesicular fatty change in the absence of significant parenchymal loss, or another pathology may dominate the histologic picture and indicate the likely etiology. When confluent necrosis does occur, there is usually a lack of specificity of pathologic features. However, different patterns of damage may reflect different etiology and/or disease duration and prognosis and at times influence management and likelihood of recovery.
In this chapter, the terminology and main patterns of liver necrosis are reviewed and then related to the various causes of liver failure. The morphologic changes associated with some rarer causes, in particular Wilson's disease, Budd–Chiari syndrome, malignant infiltration, as well as those of liver failure following orthotopic liver transplantation and in the immunocompromised host are discussed separately. The section ends with some considerations on liver regeneration as observed in human liver after severe necrosis, with the experimental aspects of regeneration being treated in the next chapter.
CONFLUENT PARENCHYMAL NECROSIS
Forms of confluent liver necrosis
Necrosis and/or loss of confluent areas of parenchyma show a variety of patterns which depend on: their distribution in relation to both the acinar architecture and the liver as a whole; whether or not cell dropout has taken place; and the degree and distribution of the regeneration process.
Macroscopic examination
Previously, information about the gross appearances of the liver in acute hepatitis were obtained from laparoscopic views in nonfatal cases and at autopsy in cases of fulminant failure.