Liver surface

Direct laparoscopic visualization of the peritoneum, omentum, and liver surface can spare patients unnecessary surgery. Once a pancreatic mass is considered to be unresectable or if metastasis occurs, then a histologic diagnosis should be established by using direct fine-needle aspiration. 

Fig. 1.15 Illustration of the human visceral liver surface by A. Vesalius, 1543 (19)...

Fig. 2.3 Reticular fibrosis of the liver surface in chronic persistent hepatitis B with a so-called simian cleft (s. fig. 31.20)...

During palpation, the liver surface proves to be smooth, humped or roughly noduled. The consistency of the liver is perceptible as soft, firm or hard. It is important to point out that the firmer the liver, the larger it appears to the palpating hand. 

Ferral, H., Male, R., Cardiel, M., Munoz, L., Quiroz y Ferrari, F. Cirrhosis diagnosis by liver surface analysis with high-frequency ultrasound. Gastrointest. Radiol. 1992 17 74-78... 

Simonovsky, V. The diagnosis of cirrhosis by high resolution ultrasound of the liver surface. Brit. X Radiol. 1999 72 29, 34... 

It would be of great benefit to the pathologist if a colour Polaroid shot was enclosed with each sample of laparoscopic material obtained by liver biopsy -in addition to laboratory values, diagnostic issue in question and description of the liver surface. In evaluating the liver biopsy, the pathologist should be aware of the traditional dual assessment of an organ macroscopy + histology. 

Solis-Herruzo, JA., Colina, F., Munoz-Yagiie, Castellano, G., Morillas, J.D. Reddish-purple areas on the liver surface the laparoscopic picture of peliosis hepatis. Endoscopy 1983 15 95-100... 

Hepatic infarct generally leads to a sharply delineated, in most cases triangular, hypodense area, possibly extending up to the liver surface. 

Laparoscopy In laparoscopy, cholestasis is usually presented as greenish to brownish green spotting or as diffuse greyish green colouration of the liver surface. 

Fig. 13.6 Smooth, brownish-green sprinkled liver surface (due to...

Vitamin A intoxication Prolonged and marked vitamin A intoxication leads to a substantial increase in individual Ito cells. This in turn causes constriction of the sinusoids the accompanying fatty degeneration of the hepatic cells supports this obstructive effect. The Ito cells are responsible for perisinusoidal fibrosis. The liver surface is strikingly smooth despite marked portal hypertension (often with considerable oesophageal varices). (119) (s. figs. 14.2, 14.3)... 

Fig. 16.5 Numerous, partially ruptured lymphcysts (light red, dot-like ruptured openings) on the liver surface with extravasation of protein-rich lymph (so-called liver weeping ) in alcoholic cirrhosis...

Fig. 21.9 Sarcoid granulomas (miliary type, up to the size of a lentil) on the liver surface (right liver lobe)...

After severe viral hepatitis had been overcome, we were able to use photolaparoscopy in many cases to document extensive parenchymal losses, particularly in the area of the left liver lobe. We found not only (1.) diffusely distributed scarred retractions and defects in the connective tissue on the liver surface, but also (2.) circumscribed, relatively clearly defined grey-white and sunken scar plates, and even (i.) a largely dystrophic loss of the left liver lobe. (s. figs. 21.10 22.15, 22.16)... 

Laparoscopically, (134), the cyst appears on the liver surface with an irregularly thickened capsule and moderately diffuse vascular irritation (no vascular breaks). Slight fibrinous exudates may be seen at the adjacent peritoneum, (s. fig. 25.19) Palpation with the palpatory rod reveals a distended elastic consistency. Although puncture is considered to be dangerous, it is nonetheless... 

Laparoscopy shows a brick-red liver surface, reticulated fibrosis, enhanced vascularization of the capsule with perivascular fibrosis, reddish speckles as well as an irregular liver surface with scattered light reflection, (s. fig. 28.10) The clinical spectrum of alcoholic hepatitis covers various forms (1.) asymptomatic, (2.) chronic... 

Fig. 30.2 Thorotrast liver dark brown colouring of the liver surface with reticular bright white fibrosis...

Fig. 32.8 Primary biliary cholangitis Map-like marking of the liver surface (stage I) still largely smooth surface (see light reflex), dark red/livid blue colouring tiger skin-like pattern in the irregular reddish areas...

Fig. 33.4 Liver cirrhosis due to AIH flat-nodular liver surface, highly cicatrized furrows, local neovascularization, signs of mild inflammation...

Fig. 34.1 Chronic persistent hepatitis smooth liver surface with spotted, brick-red coloured pattern. Clearly pronounced blood vessels with perivascular connective tissue, fine perilobular fibrosis...

Fig. 34.3 Chronic active hepatitis flat, undulatory liver surface ( scattered light reflection ) with pronounced fibrosis, scarring and a marked rim of connective tissue in the left lobe of liver. Red spots due to highly inflammatory parenchymal areas. Isolated fine blood vessels and distinct lymphatic congestion...

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