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Importance of Gross Examination of Liver During

ORIGINAL ARTICLE Importance of Gross Examination of Liver During Autopsy

Kajal M. Suvera1, Seema Baxi2*

1Third year Resident, 2Additional Professor in Department of , Govt. Medical College, Bhavnagar

ABSTRACT BACKGROUND: of liver at autopsy is an important extended method to assess the liver prevalent in any region. Noting gross appearance of liver at the time of autopsy can give a clue to many of the underlying conditions. AIMS AND OBJECTIVE: This study was carried out to note the importance of gross examination of liver and correlate it with underlying condition of liver. MATERIAL & METHODOLOGY: A prospective study was conducted during the period from 1st September 2015 to 30th June 2016, liver was weighed and photographed. RESULT & OBSERVATION: 54% livers appeared normal, 21% had , 13% had fibrosis/cirrhosis and 11% had congestion. 4 livers weighed more than >2000 gm. Three were due to fatty changes and One case had of abundant pigment in kupffer cells Overall 59 % of livers had normal colour, 22 were yellowish, 12 were greenish & 11 bright . CONCLUSION: Gross appearance matched with microscopic finding in majority of the cases. Sub microscopic fatty changes or fibrosis could be the reasons of differences where gross appearance did not match with microscopy.

Keyword: Autopsy, Gross appearance, Hepatic lesions, colour of liver, steatosis , weight of liver

INTRODUCTION MATERIAL & METHODOLOGY The liver is vulnerable to a variety of A prospective study was conducted in the metabolic, toxic, microbial and circulatory Department of Pathology, Government insults. In some instances, the insult is Medical College, Bhavnagar, during the primary while in others the hepatic period from 1st September 2015 to 30th involvement is secondary, which can be June 2016 on all non decomposed due to cardiac de-compensation, . Liver was examined grossly, alcoholism or extra hepatic .1 weighed and photographed. Then it was Though many of these conditions become bisected to see for any lesions inside the symptomatic during life , some are liver. Sections were fixed in 10% formalin, diagnosed only on autopsy. Processed and stained with Haematoxylin Histopathology of liver at autopsy thus and Eosin according to standard becomes an important extended method to procedures. assess the liver diseases prevalent in the RESULT & OBSERVATION region. Noting gross appearance of liver at During gross examination, 54% livers the time of autopsy can give a clue to appeared normal, 21% had steatosis, 13% many of the underlying conditions. Hence had fibrosis/cirrhosis and 11% had a study was carried out on the autopsies congestion. One liver had a single well conducted at a tertiary hospital in defined cyst with thick fluid inside Bhavnagar district to note the importance and yellow membrane covering[Table No. of gross examination of liver and correlate 1]. Those livers which showed no it with underlyimg condition of liver. histological abnormality weighed between 1001-1500gm. Hence it may be considered *Corresponding Author: as the rough mean weight of liver in the Dr. Seema Baxi population of this study. Only 4 livers Additional Professor weighed more than >2000 gm. Three were Dept of Pathology. due to fatty changes and One case had of Govt. Medical College, abundant pigment in kupffer cells Bhavnagar. (possibility of past malaria) [Table no 2]. Contact No: 8140387097 Overall 59 % of livers had normal colour, Email: [email protected] 22 were yellowish, 12 were greenish & 11

53 Int J Res Med. 2017; 5(4); 53-55 e ISSN:2320-2742 p ISSN: 2320-2734

Importance of Gross Examination of Liver During Autopsy bright red. Five out of ten normal liver Table 1: Showing percentage of gross showed normal colour, one was bright red findings. & two had colour (due to bile Colour Consistency Cut surface % discolouration). Cirrhotic livers were Normal Normal 54 Brown Cystic Fluid 1 either yellowish on green. Majority of Yellow Soft Greasy 21 steatosis were normal coloured, five were Red Firm Nutmeg 11 bright red, six were yellow & four were Yellow Green Hard Nodular 13 greenish. Five cases of hepatic injury Table 2: Histopathology findings in showed yellow colour and two were green. different weight of liver. Histology finding <1000 1001-1500 1501-2000 2001-2500 13 livers which had sinusoidal dilatation (gm) (gm) (gm) (gm) were normal in colour, four had bright red, Normal 1 6 2 - four yellowish and 2 green. [Table 3] Cirrhosis 1 2 2 - DISCUSSION Steatosis 3 19 5 3 HepaticInjury 4 8 7 - Colour: It can be seen in Table 4 that the Pigment in kupffer 2 4 - 1 percentage of yellow liver was Post mortem 1 - changes 2 5 comparative to all other studies except Bal Sinusoidal 5 - MS4 where it was highest. Percentage of Dilatation 6 10 Sickle Cells in - - 1 - Green liver indicating cirrhosis was almost sinusoid half in our study compared to Bal MS4 and Total 19 54 23 4 Thamil R2. Babu U6 reported the least Table 3: Histopathology finding according to colour. green livers. Histopathology Brown Red Yellowish Greenish Consistency: Liver of Bal MS4 study Normal 5 1 1 2 showed more number of soft and hard liver Cirrhosis - - 3 2 consistency with steatosis and fibrosis Steatosis 16 5 6 4 respectively. Babu U6 have reported least Hepatic Injury 12 1 5 2 Pigment in kupffer 7 - - - 2 cases with hard liver. Thamil R and Post Mortem Alagarsamy J5 have not mentioned about Changes 5 - 3 - Sinusoidal consistency on their study. None of the Dilatation 13 4 4 2 studies including this study have noted the Sickle Cells in sinusoid 1 - - - weight of the deceased. So, a comparison Table 4: Comparison of colour, weight of the abnormal v/s average weight consistency and cut surface of liver in of liver could not be made. However the different studies .

5

following impressions appear from

2

6

4 comparison with other studies[Table 5].

 Studies from all centres (except Punjab) Colour

Bal MS

Babu U

Thamil R

Cut surface has maximum number of cases of liver Consistency

Alagarsamy J

Present StudyPresent % weight in range of 1000-1500gm. Brown Normal Normal 54 31 65 23 32 4  Study from Bal MS has reported Yellowish Soft Greasy 21 34 23 43 20 maximum number of cases with Red Firm Nutmeg 11 7 10 18 26 hepatomegaly (1501- 2000 gm). Greenish Hard Nodular 13 27 3 6 16 Brown Soft cystic Fluid 1 1 - 5 6 CONCLUSION Total Total Total 100 100 100 100 100 Though gross appearance matched with Table 5: Comparison of weight in microscopic finding in majority of the various studies in percentage. Liver Present Bal MS4et Babu U13 Alagarsamy cases, it did not in a few of them. Sub weight.(gm) Study % al et al J5et al microscopic fatty changes or fibrosis could < 1000 16 5 25 16 be the reasons of these differences. Overall 1000-1500 59 26 52 32 59 % of livers had normal colour, 22 were 1501- 2000 21 58 15 52 yellowish, 12 were greenish & 11 bright 2001- 2500 4 10 4 - >2500 - 1 4 - red. Total 100 100 100 100 54 Int J Res Med. 2017; 5(4); 53-55 e ISSN:2320-2742 p ISSN: 2320-2734

Importance of Gross Examination of Liver During Autopsy REFERENCE 4. Bal MS, Singh SP, Bodal VK, Oberoi 1. Rezek R, Millard M, Autopsy SS, Surinder K. Pathological findings pathology, Springfield, Thomas.1june in Liver autopsy. J Indian Acad 1963: 464- 467. Forensic Med. 2004; 26(2): 55-57. 2. Thamil R, Selvam V, Subramanium 5. Alagarsamy J, Muthureddy Y, Yadav PM. Common Silent liver Diseases in NS. Incidentally Discovered Liver and Around of Salem Population: An Diseases- An Autopsy Study of Fifty Autopsy study. Journal of Clinical and Cases. International Journal of Science Diagnostic Research 2012 Apr; and Research (IJSR). May 2014 6(2):207-10. ;3(5):1330-1332. 3. Devi M, Myrthong BG, Th Meera, H 6. Umesh BR, Gayathri BN, Harendra Nabachandra. Pathological Findings of kumar ML. Spectrum of Liver Liver in Autopsy Cases A Study at Pathology at Autopsy Int J Res & Imphal, J Indian Acad Forensic Med. Rev.2015;2(3):79-86. July-September 2013;35 (3): 206-210.

55 Int J Res Med. 2017; 5(4); 53-55 e ISSN:2320-2742 p ISSN: 2320-2734