- repeated regeneration of hepatocytes - point mutations in KRAS, p53, increased expression of c-MYC, c-MET TGF-a and insulin-like growth factor 2 leads to carcinogenesis

- Point mutation in KRAS and p53, and expression of c-MYC, c-MET (the receptor for hepatocyte growth factor), inhibition of TGF-a, and activated insulin like growth factor 2 leads to carcinogenesis

- HBV DNA integration into host genome during regeneration of hepatocytes may activate proto-oncogenes - leads to tumorigenicity / carcinogenicity

- HCV is a positive-strand RNA virus that replicates in cytoplasm and no integration into host DNA - Repeated cycles of cell death and regeneration cause accumulations of mutations and may damage DNA repair mechanisms, eventually leads to carcinogenesis

Acute Hep B

Chronic Hep B

Acute Hep C

Chronic Hep C

I : Triaditis

C : Limiting plate eroded

D : Bridging fibrosis

E : Necrosed hepatocytes

F : Proliferated bile duct

G : Portal tract expand

H : Focal necrosis

I : Focal necrosis

C : Limiting plate eroded

D : Proliferated bile duct

E : Necrosed hepatocytes

F : Bridging fibrosis

G : Portal tract expand

H : Triaditis

I : Portal tract expand

C : Triaditis

D : Proliferated bile duct

E : Necrosed hepatocytes

F : Bridging fibrosis

G : Focal necrosis

H : Limiting plate eroded

I : Portal tract expand

C : Focal necrosis

D : Proliferated bile duct

E : Limiting plate eroded

F : Bridging fibrosis

G : Triaditis

H : Necrosed hepatocytes

Chronic hepatitis

Cirrhosis

Hepatocellular ca

Liver failure

Esophageal mucosa is smooth and tan white appearance, gastric mucosa has reddish pink rugosities.

Reddish change in mucosal appearance at lower end of esophagus, above the GEJ denoting some epithelial changes.

Squamous cell mucin secreting glandular epithelium with goblet cells at lower end of oesophagus instead of normal tall columnar epithelium. Also metaplastic mucosa containing goblet cells.

Tall columnar mucin secreting glandular epithelium with goblet cells at lower end of oesophagus instead of normal squamous epithelium. Also metaplastic mucosa containing goblet cells.

• Reflux of gastric juices – resulting in esophagitis through mucosal injury and leading to GERD

• The stratified squamous epithelium of the esophagus is resistant to abrasion from foods but is sensitive to acid.

• Decrease in lower esophageal sphincter LES tone or increase abdominal pressure contribute to GERD

• In severe cases - duodenal bile reflux exacerbate the damage.

• Decrease in lower esophageal sphincter LES tone or increase abdominal pressure contribute to GERD

• The stratified squamous epithelium of the esophagus is resistant to abrasion from foods but is sensitive to acid.

• Reflux of gastric juices – resulting in esophagitis through mucosal injury and leading to GERD

• In severe cases - duodenal bile reflux exacerbate the damage.

• The stratified squamous epithelium of the esophagus is resistant to abrasion from foods but is sensitive to acid.

• Reflux of gastric juices – resulting in esophagitis through mucosal injury and leading to GERD

• In severe cases - duodenal bile reflux exacerbate the damage.

• Decrease in lower esophageal sphincter LES tone or increase abdominal pressure contribute to GERD

• The stratified squamous epithelium of the esophagus is resistant to abrasion from foods but is sensitive to acid.

• Reflux of gastric juices – resulting in esophagitis through mucosal injury and leading to GERD

• Decrease in lower esophageal sphincter LES tone or increase abdominal pressure contribute to GERD

• In severe cases - duodenal bile reflux exacerbate the damage.

HbsAg

HbeAg

serum alpha

serum beta

Transmural lymphoid aggregate

Crypt abcess

Ulcerative collitis

Crohn disease

X : Extensive inflammation in lamina propia

Y : Crypt abscess

X : Crypt abscess

Y : Extensive inflammation in lamina propria

Ulcerative collitis

Ischemic enterocollitis

Ischemic enterocollitis

Crohn disease

IBD

Acute infectious enterocollitis

A rare thyroid disorder of unknown etiology, characterized by chronic inflammation and extensive fibrosis causing hypothyroidism with stone -like.

A rare thyroid disorder of unknown etiology, characterized by acute inflammation and extensive fibrosis causing hypothyroidism with stone -like.

A rare thyroid disorder of unknown etiology, characterized by chronic inflammation and extensive fibrosis causing hyperthyroidism with stone -like.

A common thyroid disorder of unknown etiology, characterized by chronic inflammation and extensive fibrosis causing hypothyroidism with stone -like.

Bilateral adrenal hyperplasia

Bilateral adrenal atrophy

Bilateral adrenal hypertrophy

High cortisol, low ACTH with atrophied adrenal cortex

Low cortisol, high ACTH with atrophied adrenal cortex

High cortisol, low ACTH with hypertrophied adrenal cortex

Low cortisol, high ACTH with hypertrophied adrenal cortex

Type 1

Type 2

DKA

Hyperosmolar hyperglycemic state

Hyperglycemia

Lactic acidosis

1. Random plasma glucose

2. Fasting plasma glucose

3. 2H plasma glucose OGTT

4. HbA1c (%)

1. Fasting plasma glucose

2. Random plasma glucose

3. 2H plasma glucose OGTT

4. HbA1c (%)

1. HbA1c (%)

2. 2H plasma glucose OGTT

3. Random plasma glucose

4. Fasting plasma glucose

1. 2H plasma glucose OGTT

2. Fasting plasma glucose

3. Random plasma glucose

4. HbA1c (%)