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Liver, gall bladder and bile ducts
The liver of the newborn is relatively large, especially its left lobe, to which the spleen is adjacent.
Cases of agenesis of the liver are rare, they are more often found to be underdeveloped. On the back or on the lower surface of the liver, you can sometimes see congenital notches, often located in the sagittal direction. If these depressions are significant, the liver is divided into additional lobes. Less commonly, such recesses are found on a convex surface.
Additional liver in rare cases is found in the crescent ligament and in the greater omentum. We have already mentioned the changes in the position of the liver when describing an indicative examination of the abdominal organs.
On the surface of the incision of the unchanged liver of the newborn, the boundaries of the lobules are not so pronounced as in an adult. This physiological staining of the pattern is explained by the insufficient development of the network of blood capillaries around the lobules. With circulatory disorders, with asphyxia and some other pathological conditions, the liver is enlarged, dense, dark red in color, with a large amount of blood in the venous vessels, which indicates its sharp plethora.
In newborns born in asphyxia, quite often under the capsule of the liver there are small hemorrhages in the form of an accumulation of liquid blood. Microscopic examination in these cases does not reveal damage to the hepatic parenchyma.
In cases of congenital overgrowth of the bile duct, an autopsy reveals an enlarged dense liver with a smooth or fine-grained surface, dark green in size, with pronounced connective tissue cords between the liver lobules. With a significant growth of connective tissue, the liver looks like the so-called beat paired cirrhosis.
Parenchymal dystrophies are quite common. In this case, the liver is enlarged, its edges are rounded, and the edges of the incisions bulge over the capsule. The parenchyma is pale, friable, without the usual luster, the pattern of the structure is poorly distinguishable. Parenchymal dystrophy along with fatty degeneration may be the only morphological sign of a common infection in a newborn.
With fatty degeneration of the liver, in addition to an enlargement of the organ, a yellowish color of the parenchyma with staining of the contours of the lobules is found.
An increase in the liver, sometimes very significant, especially in combination with parenchymal dystrophy, is one of the characteristic, although not always detectable signs of hemolytic disease of the newborn, developing as a result of a serological conflict. More typical changes that make it possible to establish an ego disease are revealed in the study of microscopic preparations.
As we can judge from our observations, in microscopic studies of the liver of fetuses and newborns who died from hemolytic disease due to a serological conflict, the fading of the tissue pattern, the divergence of the liver beams, the expansion of venous vessels and capillaries and filling them with pale-colored erythrocytes come to the fore. among which single nuclear red blood cells are visible. In many places in the vessels are fresh blood clots. Hepatic cells are swollen, spherically swollen, their nuclei are weakly colored, the contours of the cells are unclear. Around the numerous dilated capillaries are small islands of hematopoiesis. In the cells of the liver beams, in the lumen of the vessels, as well as in their walls, abundant deposits of derivatives of the blood pigment are visible. Some of them give characteristic reactions to iron (hemosiderin). The bile ducts, especially intralobular ones, are filled with bile and greatly dilated. In children of the late neonatal period, fibrous tissue sometimes grows around the lobules or around the central vessels with its ingrowth between individual hepatic beams.
Less pronounced liver changes occurring in hemolytic disease are sometimes difficult to distinguish from manifestations of physiological jaundice, especially in premature babies who died soon after birth. Microscopic examination is of great importance. A significant expansion of the small bile ducts, stagnation of bile, foci of necrosis, and especially hemosiderosis, along with a large number of hematopoietic islands, the presence of erythroblasts in the peripheral blood indicate hemolytic jaundice. In cases difficult to diagnose, this disease can be finally established by serological blood tests, especially with the help of the Coombs reaction.
An enlarged heavy liver of dense elastic consistency, on a brownish-red incision with an erased pattern of the structure - the so-called flint liver - is found in congenital syphilis of the fetus and newborn.
In such cases, the densification of the liver is caused by abundant proliferation of connective tissue, which in the form of whitish or grayish-pink spots and strands penetrates the entire organ parenchyma (hepatitis interstitialis syphilitica diffusa). The growth of connective tissue can be expressed mainly along the branches of the portal vein and branching of the bile ducts (periphlebitis et pericholangitis fibrosa syphilitica).
In some cases, the so-called glycogenic degeneration of the liver (Girke's disease) may occur. The liver is enlarged, macroscopically without characteristic features, the spleen of normal size. The disease can only be established by microscopic examination, and then only immediately after death.
With congenital tuberculosis of the liver, scattered limited foci of gray or gray-pink color of various sizes are found in its tissue. Morphologically, in these foci, specific changes characteristic of tuberculosis are detected. Congenital tuberculosis (tuberculosis congenita) is extremely rare, and usually in newborns whose mothers have miliary tuberculosis or have caverns. Infection of the fetus occurs through the placenta. Foci of specific inflammation can be scattered throughout the body, but the greatest changes are observed in the liver (A.I. Abrikosov, Baar, Potter, Pashkevich).
With early congenital syphilis of the fetus (syphilis congenita recens), prosovidny gum scattered throughout the liver are most often found. These gummas are so small that they are detected only by histological examination. Large liver gums in early congenital syphilis are rare.
In the liver tissue, you can also find small necrotic prosovidny foci not syphilitic etiology. These are numerous nodules of necrosis of a grayish-yellow color, on average 1.5-2 mm in diameter, located mainly under the capsule and in the peripheral parts of the liver. In the middle part of the liver, they are much smaller. The pathogenesis of these nodules has not yet been established; they are usually found in infections of the umbilical vessels, as well as in severely occurring enteritis (Baar). Similar foci of necrosis in the liver parenchyma, as already noted, are found in toxoplasmosis.
Post-mortem changes in liver tissue in the early period are manifested in the form of its swelling, loss of gloss, and fuzzy pattern of the structure (pseudodegenratio parenchytnatosa). Pale areas, often found under the capsule and resemble heart attacks, can occur as a result of hypoxia of the liver tissue in the agonal period. On the surface of the liver there may also be grayish-yellow spots and streaks formed due to pressure on the liver of the swollen bowel loops.
With putrefactive processes, the liver tissue becomes greenish or dirty bluish, especially in the region of large vessels and under the capsule, mainly on the back surface; this color is due to the deposition of sulphurous iron (pseudomelanosis). After death, bile pigments quickly penetrate the hepatic parenchyma, so the tissue around the bladder is dark green in color. With far-reaching putrefactive processes, putrefactive gases are formed in the liver, destroying its parenchyma, and cavities filled with gas arise, giving the body the consistency and structure of a sponge.
In the newborn, a spindle-shaped bile. Often it is shrouded in connective tissue growths. The bladder usually contains more or less bile, the color of which can be different - from light yellow to dark brown. Underdevelopment of the bladder occurs with congenital obstruction of the common hepatic duct or duct of the bladder. Sometimes there is no bile in the bladder at all, and there is only a little mucus. Patency of the bile ducts is checked by lightly compressing the gallbladder with your hand (bile secretion in the duodenum is observed) or using a probe inserted into the biliary tract from the side of the Vater papilla.
The study can be detected as obstruction of the duct of the gallbladder or common hepatic duct, and the fusion of both of these ducts. The latter is usually observed in connection with cirrhosis. Due to obstruction of the biliary tract, icteric staining of his skin occurs shortly after the birth of the baby. The bile ducts or their sections in such cases look like a continuous strand, or their lumen is significantly narrowed, sometimes clogged by thickened, densified bile masses.
Congenital saccular expansion of the common hepatic duct is extremely rare. In this case, the skin of the newborn can also have icteric color.
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Liver, gall bladder and bile ducts
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