医学与人类健康消化系统常见疾病2012.pptVIP

* Microscopically, acute appendicitis is marked by mucosal inflammation and necrosis. * Here, the mucosa shows ulceration and undermining by an extensive neutrophilic exudate. * Neutrophils extend into and through the wall of the appendix in a case of acute appendicitis. Clinically, the patient often presents with right lower quadrant abdominal pain. Rebound tenderness is noted on physical examination. An elevated WBC count is usually present. * This liver is slightly enlarged and has a pale yellow appearance, seen both on the capsule and cut surface. This uniform change is consistent with fatty metamorphosis (fatty change). * This is a larger liver with more pronounced fatty change. Such fatty change is most often nutritional in etiology when diet is poor in protein and/or when fatty acid metabolism is deranged and/or when liver cell function is impaired. * This is the histologic appearance of hepatic fatty change. The lipid accumulates in the hepatocytes as vacuoles. These vacuoles have a clear appearance with HE staining. The most common cause of fatty change in developed nations is alcoholism. In developing nations, kwashiorkor in children is another cause. Diabetes mellitus, obesity, and severe gastrointestinal malabsorption are additional causes. * Here are seen the lipid vacuoles within hepatocytes. The lipid accumulates when lipoprotein transport is disrupted and/or when fatty acids accumulate. Alcohol, the most common cause, is a hepatotoxin that interferes with mitochondrial and microsomal function in hepatocytes, leading to an accumulation of lipid. * Mallorys hyaline is seen here, but there are also neutrophils, necrosis of hepatocytes, collagen deposition, and fatty change. These findings are typical for acute alcoholic hepatitis. Such inflammation can occur in a person with a history of alcoholism who goes on a drinking binge and consumes large quantities of alcohol over a short time. * At high magnification can be seen globular red hyaline mate