Post Mortem Study of Alcoholic and Non-Alcoholic Liver Diseases in Ajmer Region
Keywords:
autopsy, liver disease, steatosis, chronic hepatitis
Abstract
Background: Most of the chronic liver diseases even in advanced stage may cause no prominent clinical signs or symptoms. They either go undiagnosed or are found incidentally during general health check-ups, investigations for other diseases, surgery, or autopsy. The underlying causes of chronic liver diseases vary in different geographic areas and are based on various factors such as socioeconomic status, life style, diet, local or regional infections, and other endemic diseases. The aim of our study is to establish prevalence of silent liver diseases like NASH and alcoholic liver disease and its correlation with age, sex, lifestyle and other factors in local population. Methods: 146 Post-mortem specimens of liver were received in Department of Pathology, J.L.N. Medical College, Ajmer from January 2018 to August 2018. 27 cases were excluded due to autolysis. Information regarding age, sex, marital status, place, food habit, alcoholic usage and previous history of any disease were collected in whenever cases possible. Processed tissue sections were stained and were analysed by descriptive statistics. Result: Total 119 cases of liver were included. The age ranged from 11-90 years with mean age 42.14 ±13.12 years. Majority of patients belonged to the 4th decade of life, followed by 5th decade with male preponderance (M:F ratio 5:1). Maximum number of cases was of steatosis with grade I and IV. Important findings included steatosis in 58 (48.74%), steatohepatitis in 12 (10.08%), chronic hepatitis in 36 (30.25%), confluent necrosis in 8 (6.72%), cirrhosis in 5 (4.2%) cases. Conclusion: Silent diseases of the liver like NASH are not uncommon. Steatosis and chronic hepatitis comprise a significant finding in our locality.References
1. Sotoudehmanesh R, Sotoudeh M, Ali-Asgari A, Abedi- Ardakani B, Seyed-Mohammad T, Ali Khakinejad, et al. Silent Liver Diseases in Autopsies from Forensic Medicine of Tehran. Arch Iranian Med. 2006;9(4):324-8
2. Carithers RL Jr. Alcoholic hepatitis and cirrhosis. In Kaplowitz N(ed): Liver and Biliary diseases. Baltimore, Williams & Wilkins, 1992, pp. 334-46.
3. Voinova LV. Aetiological and nosological structure of liver diseases (on autopsy data of clinics of I.M.Sechenov Moscow Medical Academy in 1988-1997). Arkh patol. 2000; 62: 45-47.
4. John T Galambos: liver in 4th Ed., Gastroenterology, WB Saunders Company, Pliladelphia, 1985; 2985-3048.
5. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL; Asia-Pacific Working Party on NAFLD. How common is non-alcoholic fatty liver disease in the Asia–Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22: 788–793.
6. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34: 274–285.
7. Melato M, Sasso F, Zanconati F. Liver cirrhosis and liver cancer. A study of their relationship in 2563 autopsies. Zentralbl Pathol 1993; 139: 25–30.
8. Graudal N, Leth P, Marbjerg L, Galloe AM. Characteristics of cirrhosis undiagnosed during life: a comparative analysis of 73 undiagnosed cases and 149 diagnosed cases of cirrhosis, detected in 4929 consecutive autopsies. J Intern Med 1991; 230:165–171.
9. Lim YS, Kim WR. The global impact of hepatic fibrosis and end-stage liver disease. Clin Liver Dis 2008; 12: 733–746.
10. Mathers C, Lopez A, Murray C. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez A, Mathers C, Ezzati M, et al, editors. Global burden of disease and risk factors. Washington (DC): Oxford University Press and the World Bank; 2006. p. 45–93.
11. Umesh Babu R, Gayathri B.N, Harendra Kumar M.L Spectrum of liver pathology at autopsy. International Journal of Research and Review 2015;2(3):79-86.
12. Bal MS, Singh SP, Bodal VK, Oberoi SS, Surinder K. Pathological findings in liver autopsy. Journal of Indian Academy of Forensic Medicine 2004; 26(2):971-73
13. Fubara DS, Jebbin NJ. Hepatocellular carcinoma in Port Harcourt, Nigeria: Clinicopathologic Study of 75 Cases. Annals of African Medicine 2007; 6(2):54- 7
14. Akhilesh Pathak, Mangal H.M. Original research paper Histo-Pathology Examination in Medico-legal Autopsy Pros & Cons. J Indian Acad Forensic Med, 2010; 32(2):128.
15. Saphir O. Liver 4th ed. Autopsy diagnosis and techniques by Paul B, Hobber, New York. 1958:354-65.
16. Copeland AR. Sudden death in the alcoholics. Jr. Forens. Sci. Inter. 1985;29:159-159
17. Hultcrantz R, Glaumann H, Lindberg G, Nilsson LH. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases.
18. Selvi RT, Selvam V, Subramanium PM. Common Silent liver Diseases In and Around of Salem Population: An Autopsy study. Journal of Clinical and Diagnostic Research 2010 Apr; 6(2):207-10.
19. Merat S, Sotoudehmanesh R, Nouraie M, Peikan-Heirati M, Sepanlou SG, Malekzadeh R et al. Sampling Error in Histopathology Findings of Nonalcoholic Fatty Liver Diseases: A Postmortem Liver Histology Study. Archives of Iranian Medicine 2012 July; 7:418-20.
20. Kringsholm B, Christoffersen P. Liver pathology in fatal drug addiction. Forensic Science International 1982 Sep-Oct; 20(2): 14151.
21. Elayassi H. Fatty Liver, a postmortem study. Medical Journal of Iran Hospital 2000 Jul; 5(1):28-29.
22. Kringsholm B, Christoffersen P. Liver pathology in fatal drug addiction. Forensic Science International 1982 Sep-Oct; 20(2): 14151.
23. Passarino G, Ciccone G, Siragusa R, Tappero P, Mollo F. Histopathological Findings in 851 Autopsies, with Toxicological and Virological Correlations. American Journal of Forensic Medicine and Pathology 2005 June; 26(2):106-16.
24. Kochar N, Lowes J, Teague RH. Nonalcoholic fatty liver disease in South West England. Gasteroenterology. 2002; 122:667-670.
25. Tsokos M, Turk EE. Esophageal variceal haemorrhage presenting as sudden death in outpatients. Archives Pathol Lab Med 2000 Oct; 126:1197-00.
26. Iwamura K, Inaba R. Clinical study on latent cirrhosis of the liver. Tokai Journal Exp Clin Med 1983 Jul; 8(3):281-91.
2. Carithers RL Jr. Alcoholic hepatitis and cirrhosis. In Kaplowitz N(ed): Liver and Biliary diseases. Baltimore, Williams & Wilkins, 1992, pp. 334-46.
3. Voinova LV. Aetiological and nosological structure of liver diseases (on autopsy data of clinics of I.M.Sechenov Moscow Medical Academy in 1988-1997). Arkh patol. 2000; 62: 45-47.
4. John T Galambos: liver in 4th Ed., Gastroenterology, WB Saunders Company, Pliladelphia, 1985; 2985-3048.
5. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL; Asia-Pacific Working Party on NAFLD. How common is non-alcoholic fatty liver disease in the Asia–Pacific region and are there local differences? J Gastroenterol Hepatol 2007; 22: 788–793.
6. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34: 274–285.
7. Melato M, Sasso F, Zanconati F. Liver cirrhosis and liver cancer. A study of their relationship in 2563 autopsies. Zentralbl Pathol 1993; 139: 25–30.
8. Graudal N, Leth P, Marbjerg L, Galloe AM. Characteristics of cirrhosis undiagnosed during life: a comparative analysis of 73 undiagnosed cases and 149 diagnosed cases of cirrhosis, detected in 4929 consecutive autopsies. J Intern Med 1991; 230:165–171.
9. Lim YS, Kim WR. The global impact of hepatic fibrosis and end-stage liver disease. Clin Liver Dis 2008; 12: 733–746.
10. Mathers C, Lopez A, Murray C. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez A, Mathers C, Ezzati M, et al, editors. Global burden of disease and risk factors. Washington (DC): Oxford University Press and the World Bank; 2006. p. 45–93.
11. Umesh Babu R, Gayathri B.N, Harendra Kumar M.L Spectrum of liver pathology at autopsy. International Journal of Research and Review 2015;2(3):79-86.
12. Bal MS, Singh SP, Bodal VK, Oberoi SS, Surinder K. Pathological findings in liver autopsy. Journal of Indian Academy of Forensic Medicine 2004; 26(2):971-73
13. Fubara DS, Jebbin NJ. Hepatocellular carcinoma in Port Harcourt, Nigeria: Clinicopathologic Study of 75 Cases. Annals of African Medicine 2007; 6(2):54- 7
14. Akhilesh Pathak, Mangal H.M. Original research paper Histo-Pathology Examination in Medico-legal Autopsy Pros & Cons. J Indian Acad Forensic Med, 2010; 32(2):128.
15. Saphir O. Liver 4th ed. Autopsy diagnosis and techniques by Paul B, Hobber, New York. 1958:354-65.
16. Copeland AR. Sudden death in the alcoholics. Jr. Forens. Sci. Inter. 1985;29:159-159
17. Hultcrantz R, Glaumann H, Lindberg G, Nilsson LH. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases.
18. Selvi RT, Selvam V, Subramanium PM. Common Silent liver Diseases In and Around of Salem Population: An Autopsy study. Journal of Clinical and Diagnostic Research 2010 Apr; 6(2):207-10.
19. Merat S, Sotoudehmanesh R, Nouraie M, Peikan-Heirati M, Sepanlou SG, Malekzadeh R et al. Sampling Error in Histopathology Findings of Nonalcoholic Fatty Liver Diseases: A Postmortem Liver Histology Study. Archives of Iranian Medicine 2012 July; 7:418-20.
20. Kringsholm B, Christoffersen P. Liver pathology in fatal drug addiction. Forensic Science International 1982 Sep-Oct; 20(2): 14151.
21. Elayassi H. Fatty Liver, a postmortem study. Medical Journal of Iran Hospital 2000 Jul; 5(1):28-29.
22. Kringsholm B, Christoffersen P. Liver pathology in fatal drug addiction. Forensic Science International 1982 Sep-Oct; 20(2): 14151.
23. Passarino G, Ciccone G, Siragusa R, Tappero P, Mollo F. Histopathological Findings in 851 Autopsies, with Toxicological and Virological Correlations. American Journal of Forensic Medicine and Pathology 2005 June; 26(2):106-16.
24. Kochar N, Lowes J, Teague RH. Nonalcoholic fatty liver disease in South West England. Gasteroenterology. 2002; 122:667-670.
25. Tsokos M, Turk EE. Esophageal variceal haemorrhage presenting as sudden death in outpatients. Archives Pathol Lab Med 2000 Oct; 126:1197-00.
26. Iwamura K, Inaba R. Clinical study on latent cirrhosis of the liver. Tokai Journal Exp Clin Med 1983 Jul; 8(3):281-91.
Published
2020-06-06
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
