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Liver, gallbladder and biliary tract


The liver of a newborn is relatively large, especially its left lobe, to which the spleen is adjacent.
Cases of liver disease are rare, more often it is found to be underdeveloped. On the back or on the lower surface of the liver, it is sometimes possible to see congenital cavities, often located in the sagittal direction. If these grooves are significant, the liver is divided into additional lobes. Less commonly, such grooves are found on a convex surface.
The added liver in rare instances is found in a crescent sheaf and in a big epiploon. We have already mentioned changes in the position of the liver when describing an approximate examination of the abdominal organs.
On the surface of the incision of the unchanged liver of the newborn, the borders of the lobules are not so clearly expressed as in an adult. This physiological blurring of the pattern is explained by the insufficient development of the network of blood capillaries around the lobules. In case of circulatory disorders, 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 infants born with asphyxia, quite often under the capsule of the liver there are small hemorrhages in the form of accumulation of liquid blood. Microscopic examination in these cases, damage to the hepatic parenchyma is not detected.
In cases of congenital congestion of the bile ducts at necropsy, an enlarged, dense liver with a smooth or fine-grained surface is found, a dark green color in the section, with pronounced connective tissue strands between the hepatic lobes. With a significant increase in connective tissue, the liver has the appearance of the so-called beat-paired cirrhosis.
Parenchymal dystrophies are quite common. At the same time, the liver is enlarged, its edges are rounded, and the edges of the incisions are erupted above the capsule. The parenchyma is pale, friable, without usual gloss, the pattern of the structure is poorly distinguishable. Parenchymal dystrophy along with fatty dystrophy may be the only morphological sign of a common infection in a newborn.
In case of fatty degeneration of the liver, in addition to an increase in the organ, a yellowish color of the parenchyma with staseness of the loops contours is found.
An enlarged liver, sometimes very significant, especially in combination with parenchymal dystrophy, is one of the characteristic, though not always detectable, signs of a hemolytic disease of the newborn that develops as a result of a serological conflict. More typical changes, allowing to establish the ego disease, are revealed when studying microscopic preparations.
As we can judge from our observations, microscopic examination of fetal and newborn liver children dying from hemolytic disease as a result of a serological conflict comes to the fore, the thinning of the tissue pattern, the divergence of the hepatic beams, dilation of the venous vessels and capillaries and filling them with pale colored erythrocytes, among which are seen single nuclear red blood cells. In many places in the vessels are fresh blood clots. Hepatic cells are swollen, spherically swollen, their nuclei are weakly painted, the contours of the cells are indistinct. Around the numerous dilated capillaries are small islands of blood formation. In the cells of the hepatic beams, in the lumen of the vessels, as well as in their walls, abundant deposits of blood pigment derivatives are visible. Some of them give characteristic reactions to iron (hemosiderin). The bile canaliculi, especially the intralobular, are filled with bile and greatly expanded. 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 changes in the liver, occurring in hemolytic disease, are sometimes difficult to distinguish from manifestations of physiological jaundice, especially in premature babies who died soon after their birth. Of great importance is the microscopic examination. A significant expansion of the small bile ducts, stagnation of bile, foci of necrosis, and especially hemosiderosis, along with a large number of blood islets, the presence of erythroblasts in the peripheral blood indicate hemolytic jaundice. In difficult to diagnose cases, this disease can be definitively established by serological blood tests, especially with the help of the Coombs reaction.
An enlarged, heavy liver of a densely elastic consistency, on a brownish-red section with a worn pattern of the structure - the so-called flint liver - occurs in congenital syphilis of the fetus and newborn.
In such cases, the hardening of the liver is caused by abundant proliferation of connective tissue, which in the form of whitish or grayish-pink spots and cords penetrates the entire parenchyma of the organ (hepatitis interstitialis syphilitica diffusa). The proliferation of connective tissue can be expressed mainly along the branches of the portal vein and branches of the bile ducts (periphlebitis et pericholangitis fibrosa syphilitica).
In some cases, the so-called glycogenic degeneration of the liver (Gyrke's disease) can occur. The liver is enlarged, macroscopically without characteristic features, the spleen is of normal size. The disease can be established only by microscopic examination, and then only immediately after death.
In case of congenital tuberculous damage to the liver, scattered limited foci of gray or gray-pink color of various sizes reveal its tissue. Morphologically, these foci show specific changes characteristic of tuberculosis. 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 dispersed throughout the body, but the greatest changes are observed in the liver (A.I. Abrikosov, Baar, Potter, Pashkevich).
In early congenital syphilis of the fetus (syphilis congenita recens), prostate gumma found throughout the liver is most often found. These gumma are so small that they are detected only by histological examination. Large liver gum with early congenital syphilis is rare.
In the liver tissue one can also find small necrotic prosoid foci of non-syphilitic etiology. These are numerous nodules of necrosis of a grayish-yellow color, an average of 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 there are considerably fewer. The pathogenesis of these nodules is not yet established; they are usually found in infection of the umbilical vessels, as well as in hard flowing enteritis (Baar). Similar foci of necrosis in the liver parenchyma, as already noted, are found in toxoplasmosis.
The post-mortem changes in the liver tissue in the early period are manifested in the form of its swelling, loss of luster, and the vagueness of the structure pattern (pseudodegeneratio parenchytnatosa). Pale areas, often found under the capsule and externally resembling heart attacks, may result from hypoxia of the liver tissue in the agonal period. On the surface of the liver may also be grayish-yellow spots and stripes, formed as a result of pressure on the liver loops swollen intestines.
When putrid processes, the liver tissue becomes greenish or dirty-bluish, especially in the area 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. When far-gone putrefactive processes in the liver putrefactive gases are formed, destroying its parenchyma, and there are cavities filled with gas, giving the body the texture and structure of the sponge.
Female in newborns spindle shape. Often it is shrouded in connective tissue growths. The bladder usually contains more or less amount of bile, the color of which may be different - from light yellow to dark brown. Underdevelopment of the bladder occurs in congenital obstruction of the common hepatic duct or duct of the bladder. Sometimes there is no bile in the bladder at all, but there is only a little mucus. The patency of the biliary tract is checked by gently squeezing the gallbladder with the hand (there is a release of bile in the duodenum) or with a probe inserted into the biliary tract from the side of the Vater papilla.
In the study can be detected as obstruction of the duct of the gallbladder or common hepatic duct, and fusion of both of these ducts. The latter is usually observed in connection with cirrhosis of the liver. Due to obstruction of the biliary tract, soon after the birth of the child, the icteric staining of his skin occurs. The bile ducts or their areas in such cases have the form of a continuous cord, or their lumen is significantly narrowed, sometimes blocked by thickened, compacted bile masses.
Congenital sacculate expansion of the common hepatic duct is extremely rare. In this case, the skin of a newborn may also have a jaundiced color.
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Liver, gallbladder and biliary tract

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