171. Cirrhosis of the liver: classification, pathological anatomy, complications.

Cirrhosis is a chronic disease characterized by increasing liver failure due to scarring and structural restructuring of the liver.

Classification:

By etiology:

1. Infectious (viral hepatitis, biliary tract infections.

2. Toxic and toxic-allergic (Alcohol, poisons, allergens).

3. Biliary (cholangitis, cholestasis).

4. Exchange-alimentary.

5.Circulatory.

6. Cryptogenic.

According to morphological features:

1. Incomplete septal.

2. Small node.

3. Large-node.

4.Mixed.

By microscopic signs:

1.Monolobular.

2.Multilobular.

3.Monomultilobular.

Morphogenetic types of cirrhosis:

1.Post-necrotic

2. Portal

3.Mixed

Pathological anatomy:

Characteristic changes of the liver in cirrhosis: dystrophy and necrosis of hepatocytes, perverted regeneration, diffuse sclerosis, structural restructuring and deformation of the organ. The liver in cirrhosis is dense and lumpy, its size is often reduced, less often enlarged.

With incomplete septal cirrhosis, regenerator nodes are absent, the liver parenchyma is crossed by thin septa, some of which end blindly. In small-nodular cirrhosis, regeneration nodes of the same size, usually no more than 1 cm in diameter, have, as a rule, a monolobular structure; the septa in them are narrow. Large-nodular cirrhosis is characterized by regeneration nodes of different sizes, the diameter of the largest of them is 5 cm. Many nodes are multilobular, with wide septa. With mixed cirrhosis, signs of small- and large-nodular cirrhosis are combined. Histologically, a violation of the lobular structure of the liver with intense fibrosis and the formation of regeneration nodes (false lobules) consisting of proliferating hepatocytes and penetrated by connective tissue layers is determined. In false lobules, the usual radial orientation of the liver beams is absent. The vessels are located incorrectly: the central vein is missing, portal triads are not always detected.

Complications: portal hypertension, hepatic coma, bleeding from varicose veins of the esophagus, ascites, peritonitis, portal vein thrombosis, development of liver cancer.

172. Acute and chronic cholecystitis: definition, etiology, classification, patho- and mophogenesis, complications.

Cholecystitis is an inflammatory disease of the gallbladder.

Etiology: Gallstones and infection (both ascending from the lumen of the intestine and descending through lymphatic or blood vessels) play a role in its development.

Classification:

Downstream:

1.Sharp

2.Chronic

By the presence of complications:

1.Complicated

2.Uncomplicated

Depending on the presence or absence of gallstones in the biliary tract:

1.Stone-free

2.Calculous

Pathogenesis and morphogenesis:

In acute cholecystitis, catarrhal, fibrinous or purulent (phlegmonous) inflammation develops. Acute cholecystitis is complicated by perforation of the bladder wall and biliary peritonitis, in the case of closure of the cystic duct and accumulation of pus in the cavity — empyema of the bladder, purulent cholangitis and cholangiolitis, pericholecystitis with the formation of adhesions.

Chronic cholecystitis develops as a consequence of acute, mucosal atrophy, histiolymphocytic infiltration, sclerosis, and often petrification of the bladder wall occur.

Complications: consist in perforation of the bladder wall and the development of biliary peritonitis, in the case of closure of the cystic duct and accumulation of pus in the bladder cavity, empyema of the bladder, biliary colic, purulent cholangitis and cholangiolitis, jaundice, pericholecystitis with the formation of adhesions.