Page 617 - Robbins Basic Pathology by Vinay Kumar, Abul K. Abbas, Jon C. Aster
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CHAPTER CONTENTS
THE LIVER 603 Drug/Toxin-Mediated Injury with Tumors and Hepatic Nodules 635
Clinical Syndromes 604 Steatosis 625 Benign Tumors 635
Hepatic Failure 604 Cholestatic Liver Diseases 626
Neonatal Cholestasis 626 Precursor Lesions of Hepatocellular
Jaundice and Cholestasis 605 Carcinoma 636
Cholestasis of Sepsis 626
Hepatic Encephalopathy 606 Hepatocellular Carcinomas 637
Primary Biliary Cirrhosis 627 DISORDERS OF THE
Cirrhosis 607 GALLBLADDER AND THE
Primary Sclerosing Cholangitis 628 EXTRAHEPATIC BILIARY
Portal Hypertension 608 TRACT 639
Drug/Toxin-Induced Cholestasis 629 Gallbladder Diseases 639
Portosystemic Shunt 609 Inherited Metabolic Diseases 629 Cholelithiasis (Gallstones) 639
Drug- or Toxin-Induced Liver Hemochromatosis 629
Disease 610 Cholecystitis 641
Acute and Chronic Hepatitis 611 Wilson Disease 630 Disorders of Extrahepatic Bile
Viral Hepatitis 614 Ducts 642
α1-Antitrypsin Deficiency 631 Choledocholithiasis and Cholangitis 642
Other Viral Infections of the Liver 620 Circulatory Disorders 632
Impaired Blood Flow into the Liver 632 Secondary Biliary Cirrhosis 642
Autoimmune Hepatitis 620
Impaired Blood Flow Through the Liver 633 Biliary Atresia 642
Drug/Toxin-Mediated Injury Mimicking Tumors 643
Hepatitis 621 Hepatic Vein Outflow Obstruction 634 Carcinoma of the Gallbladder 643
Alcoholic and Nonalcoholic Fatty Liver Other Inflammatory and Infectious
Disease 621 Diseases 635 Cholangiocarcinomas 643
Alcoholic Liver Disease 623 Liver Abscesses 635
Nonalcoholic Fatty Liver Disease Granulomatous Disease 635
(NAFLD) 625
THE LIVER of metabolic, toxic, microbial, and circulatory insults. In
some instances the disease process is primary to the
The liver and its companion biliary tree and gallbladder liver. In others the hepatic involvement is secondary, often
are considered together because of their anatomic proxim- to some of the most common diseases in humans, such
ity and interrelated functions and the overlapping features as heart failure, diabetes, and extrahepatic infections.
of some diseases that affect these organs. This chapter
focuses primarily on the liver, because it has by far the The liver has enormous functional reserve, and regen-
greater role in normal physiology and is the site of a wide eration occurs in all but the most fulminant of hepatic
variety of diseases. diseases. Surgical removal of 60% of the liver in a normal
person is followed by minimal and transient hepatic
Residing at the crossroads between the digestive tract impairment, with restoration of most of its mass by regen-
and the rest of the body, the liver has the enormous task eration within 4 to 6 weeks. In persons who have sustained
of maintaining the body’s metabolic homeostasis. This massive hepatic necrosis, almost perfect restoration may
task includes the processing of dietary amino acids, car occur if the patient can survive the metabolic insult of liver
bohydrates, lipids, and vitamins; synthesis of serum failure. The functional reserve and the regenerative capac-
proteins; and detoxification and excretion into bile of ity of the liver mask to some extent the clinical impact of
endogenous waste products and xenobiotics. Thus, it is early liver damage. However, with progression of diffuse
not surprising that the liver is vulnerable to a wide variety disease or disruption of the circulation or bile flow, the
consequences of deranged liver function become severe
Contributions of Drs. Jim Crawford and Nelson Fausto to this chapter and even life-threatening.
in earlier editions are gratefully acknowledged.
