Morphological peculiarities of the liver in alcoholic hepatitis in combination with arterial hypertension

Abstract

The purpose of the study is to investigate the morphological features of the liver with alcoholic hepatitis in combination with arterial hypertension. Material and methods. Autopsy material (34 cases) of the liver of the deceased with the clinical diagnosis of alcoholic liver disease was investigated. The definitive diagnosis of the form of alcoholic liver damage was revealed by microscopic examination of histological sections of the liver using the method of inspection staining (hematoxylin and eosin) and three histochemical methods: staining with chromotropic-aqueous blue by N. Z. Slinchenko, bromphenol blue according to Mikel Calvo (to evaluate the processes of oxidative modification of proteins and to estimate the total protein concentration), staining free amino groups of proteins in ninghydrin-Schiff and reaction Yasuma Ichikawa and evaluation processes for limited proteolysis. Results. Histological examination of liver preparations of patients with alcoholic hepatitis showed a typical picture of the inflammatory process in combination with steatosis. The inflammation was localized mainly in the connective tissue of the portal tracts in the form of lymphocytic infiltrates with impurities of polymorphonuclear leukocytes. The proportion of infiltrates in patients with hypertension did not differ, on average, from patients without hypertension. The density of infiltration by lymphocytes and polymorphonuclear leukocytes was very uneven, even within one liver. But it can be noted that the infiltration of the portal tracts was generally more dense than the periportal areas of the liver lobules. The portal tract stroma in some patients was slightly swollen. The sinusoids of the liver lobules are somewhat enlarged, with plethora. There are hemorrhages in the stroma of the portal tracts and around them. In hypertension, the specific volume of hemorrhage is more than twice the rate of patients with alcoholic hepatitis without arterial hypertension. In arterial hypertension, the percentage of hepatocytes in the state of fatty dystrophy and in the state of necrosis is much higher. Fatty dystrophy was predominantly a large droplet in both groups of the study, some of the hepatocytes were with signs of medium-sized fatty dystrophy. The nature of the fat droplets did not depend on the presence of hypertension. Necrosis was either colliquative (more common), or in other cases, necrosis was fat. In arterial hypertension, the specific connective tissue volume of portal tracts and collagen fibers was higher (p <0.05). For hepatocytes with signs of fatty dystrophy, the R/B coefficient in hypertension exceeded this in observations of alcoholic hepatitis without hypertension. Alcoholic hepatitis on the background of hypertension in all hepatocytes there is also an increase in processes of limited proteolysis. An important fact was the establishment of a higher level of proteolysis in connective tissue fibers. Conclusions. In alcoholic hepatitis in patients with hypertension compared with patients without hypertension, there is an increase in the percentage of hepatocytes in the state of fatty dystrophy and the percentage of hepatocytes in a state of necrosis, increase in the specific volume of hemorrhage, increase in the specific volume of tissue. collagen fibers and the optical color density of collagen fibers. There is also an intensification of the processes of free radical oxidation of proteins and limited proteolysis in hepatocytes and connective tissue fibers.