PATHOLOGY

OF THE
HEPATOBILIARY SYSTEM
AND PANCREAS

SITUATIONAL ANALYSIS

Mennen A. Alsol, MD
Normando C. Gonzaga, MD
Lorna B. Lioanag, MD
Instructions:
1. Give the differential diagnosis and discuss
pathophysiology of the disease process.
2. Correlate the signs and symptoms of the
patient with the morphologic changes in the
organ(s) involved.
3. Discuss the morphologic features of each
condition.
4. Enumerate laboratory tests that may help in
prognostication of the condition(s).
 Case I
A 40 y/o chronic renal patient complained of
anorexia, upper abdominal quadrant, fullness, and
tea-colored urine which he noted since 2 yrs after he
was started on dialysis.

1. Give your clinical differential diagnosis.

2. Liver biopsy is contemplated. Give the indications
and contraindications for the procedure.
3. Discuss the serologic markers associated with the
condition.
4. What is prognosis of the patient?
Chronic HBV
infection
Hepatitis B: homogenous, pale, glassy cytoplasm due to
accumulation of HBsAg
A. Acute hepatitis with resolution B. Progression to chronic hepatitis.
 Case II
A 66 y/o bus driver was rushed to the
emergency room because of hematemesis. He has
20 yr history of intake of gin PE findings include
pallor, spider angiomas, gynecomastia, impotence,
ascites and bipedal edema.
1. Explain the etiopathogenesis of the signs and
symptoms.
2. Give the laboratory tests required for the diagnosis.
3. Liver biopsy was done. Discuss the expected
morphologic findings.
 Micronodular cirrhotic
liver caused by alcohol
abuse

Macrovesicular
steatosis
Alcoholic liver disease with Mallory bodies
Cirrhosis
Esophageal varices
 Case III
A 35 y/o homosexual consulted because of 1 yr
history of on & off right upper quadrant abdominal
pain, difficulty of breathing, yellow discoloration
of sclerae, ascites and progressive weight loss. 3
yrs prior to consult, he was diagnosed as a case
HBV.

1. Liver biopsy was done. Discuss the findings.

2. Give the differential diagnosis.
3. Discuss pertinent laboratory results.
4. Give the prognosis of the patient.
Hepatoma
 Case IV
A 50 y/o female complained of fat intolerance
and upper quadrant abdominal pain for he past 4
yrs. 2 months ago, she developed shooting pains
at the right upper quadrant.

1. Correlate the clinical course with the gross and

microscopic findings of the lesion.
2. Discuss the malignant potential of the disease
process.
Chronic cholecytitis
Chronic cholecystitis with cholesterolosis:

Cholesterol & pigment stones

 Case V
A 21 y/o actor was rushed to the ER in coma.
He had bouts of drinks the previous night in
celebration of his birthday.

1. What laboratory tests must be requested to arrive at

the diagnosis?
2. The patient died and autopsy was done. Discuss the
morphology o the pancreas.
3. Correlate the signs and symptoms of the patient
with morphoogic changes in the pancreas.
4. What is the prognosis of this patient?
 Acute hemorrhagic pancreatitis

Edematous hemorrhagic pancreas (H), followed by necrosis and

liquefaction. Focal fat necrosis, due to release of lipase, are seen as
white spots (F) in mesenteric and peritoneal fat.
 Acute hemorrhagic pancreatitis

Focal necrosis of adipose tissue (F) with

adjacent reactive inflammatory infiltrates (I).