9. 1 .High-power view of hepatic macrosteatosis and microsteatosis. The small intracellular fat
vacuoles give the hepatocytes a foamy appearance. Note megamitochondria (arrowhead)
(hematoxylin-eosin).
2. High-power view of hepatocytes containing Mallory bodies. The chemotaxis of the denatured
cytokeratin filaments attracts neutrophils (hematoxylin-eosin).
3. Immunoperoxidase reactivity of Mallory bodies with antibody to low–molecular weight
cytokeratin.
4. Immunoperoxidase reactivity of Mallory bodies with antibody to ubiquitin.
10. Fibrosis
• Brisk sinusoidal & perivenular fibrosis.
• “Creeping collagenosis”
• Periportal fibrosis – repeated bouts of heavy alcohol intake.
• Cholestasis, iron deposits.
• Macroscopic – liver mottled red with bile stained areas.
14. Alcoholic Cirrhosis
• First – yellow tan, fatty, enlarged, over 2kg.
• Brown shrunken non fatty organ.
• Initial- fibrous septa delicate, extend through sinusoids from
C.V to portal regions as well as from portal tract to portal tract.
• Micronodules - < 3cm
• Regenerative activity of entrapped parenchymal hepatocytes.
15. • Scattered larger nodules – “Hobnail Appearance”.
• More fibrotic, loses fat, shrinks progressively.
• Last - Mixed micronodular & macronodular pattern.
• Pale scar tissue – ischemic necrosis, fibrous obliteration of
nodules → Laennec cirrhosis.
• Bile stasis often.
• Mallory bodies rare
20. PATHOGENESIS
• 50-60g/day
• Women > men
• Alcohol pharmacokinetics
• Estrogen dependent liver response to gut endotoxin.
• Genetic
• Co morbid conditions – iron overload, infections.
21. Hepatocellular steatosis
1. Shunting of normal substrates away from catabolism and
toward lipid biosynthesis
• Excess NADH
2. Impaired assembly & secretion of lipoproteins
3. Increased peripheral catabolism of fat.