Structural changes in Liver Disease

Liver is a delicately structured organ which will perform several vital tasks in order to keep the person healthy. Among its tasks, metabolism of harmful elements, detoxification, storage of excess nutrients, producing protein elements to perform certain functions, conversion of nutrient elements in to active metabolic substances can be recognized as the most important.

With liver disease, these tasks would be disrupted and more often than not the delicate structure of the liver will also get disrupted. Thus, the clinicians will be able to observe these changes through biopsies and arrive at definitive diagnosis as well as predict the potential outcome or the prognosis of certain disease entities.

In this article we will look at certain changes that take place in some of the common disease entities which can be identified as microscopic as well as macroscopic features of the disease.

1. Fatty liver

The condition will not alter the hepatic structure to that extent up to being symptomatic but there will be ‘fat globules’ in the cytoplasm of the liver cells. These fat globules, if wide spread, can lead to disruption of function in these cells and thus could damage the containing liver cells.

2. Cirrhosis of the liver

Many alterations can be seen in this condition and it’s the presence of widespread fibrosis that identifies the initial phases of a cirrhotic condition. The appearance of the liver will change into nodules of hepatocytes that are being surrounded by bands or septa of fibrous tissues. These tissues will obstruct the flow of bile as well as the portal blood and dilatation of these vessels could also be visible.

In cirrhotic liver, the smooth and perfect arrangement of liver cells around the sinusoidal spaces would be absent in most areas and this leads to ineffective functioning of these systems. Blood pooling is another phenomena that can be identified which would be the result of obstructed flow in the portal system.

In alcoholic cirrhosis, the nodular appearance may be macroscopic and is also known as macro nodular cirrhosis.

3. Hepatitis

In hepatitis, the liver parenchyma will see large number of inflammatory infiltrates and would show increased vascularity as well. There might not be a structural derangement as in most instances the structure of the liver cells will be preserved.

4. Liver cancer

Most often there will be a nodular appearance that can be seen macroscopically and these can be one large mass or else multiple or diffuse in appearance. The liver cells will also show certain changes including cytoplasmic bile pigments and can form different patters such as trabeculae, nests or even cords. In certain types, the differentiation would not be obvious and the malignant cells will be haphazardly placed.