A 60-year old, markedly emaciated man was found in a state of disorientation. He had lived alone, eating poorly and drinking large amounts of hard liquor.

Physical examination findings:
• Emaciated.
• Distended, protruding abdomen filled with fluid.
• Skin and mucosae - yellow.
• Mentally slow and drowsy.
• Slurred speech.
• Agitated.
• Tremor of hands.
• Palmar erythema, gynecomastia, teleangiectasis.
• Liver slightly enlarged.
• Spleen enlarged.
Hospital course:
• Shortly after admission the patient vomited large amounts of blood (hematemesis), which could not be controlled, and died.

Ascites and dilated abdominal veins. Note the enlarged breasts. This is referred to as gynecomastia.

Gross appearance of the liver. Note the nodularity of the external surface.

Close-up detail of the cross section showing fine nodularity of the parenchyma.

Loss of normal architecture of the liver. Strands of connective tissue divide the parenchyma into regenerative nodules. Note the fatty change of liver cells.

Histologic section stained with a trichrome stain. Note the prominent fibrous septa.

Detail illustrating fatty change of liver cells and Mallory bodies. What are Mallory bodies?

Only 10% of all heavy alcoholics have cirrhosis of the liver. However, almost all show fatty change of the liver. This slide illustrates the gross appearance of a fatty liver. Note its color.

Alcoholic hepatitis.

The cause of death was exsanguination from the esophageal varices. In this image, the esophagus has been everted (turned inside out).

Question for Class Discussion