<prompt> Centrilobular necrosis of liver may be seen with -PhosphorusArsenicCCI4Ethanol  <response>: Ans. is c i.e., CC14 Hepatocellular necrosis: - o Liver necrosis is a common manifestation of many liver diseases and it can present in various ways, o If severe it can cause liver failure. o In some cases however the necrosis is subclinical, revealed only by elevations of liver enzymes in serum, o Various diseases can cause different patterns of necrosis. These are - Focal Necrosis - Randomly occurring necrosis of single cells or small clusters of cells. It can involve any area of the lobule All lobules are not involved. Characteristic features on biopsy are - Councilman bodies Areas of lysed liver cells surrounded by collection of kupffer cells and inflammatory cells. Causes of Focal necrosis - Viral hepatitis, Bacterial infections, Toxic damage Zonal necrosis - The characteristic of zonal necrosis is that identical regions of liver lobules are involved. All liver lobules are involved. The necrosis is divided according to the zone involved Note: In focal necrosis any area of lobule and some lobules are involved. Types of zonal necrosis Centrizonal necrosis centrilobular - Necrosis in the cells surrounding central hepatic vein, seen in - i Cardiac failure or shock iii Chloroform toxicity ii Carbon tetrachloride toxicity CC14 iv Viral hepatitis Peripheral zonal necrosis periportal - Necrosis is seen in areas around the portal tracts, Seen in i Eclampsia ii Phosphorus poisoning Midzonal necrosis - Rare, seen in yellow fever Also know - o Submassive necrosis - Occurrence of liver cell necrosis that is not limited by lobular boundaries i.e., the necrosis extends beyond lobular boundaries. o Massive liver necrosis - In this large areas of liver cell undergo necrosis. Only small areas are left intact, o Massive and submassive fiver necrosis are clinically manifested as. Acute fiver failure of variable severity Serum enzyme levels are very high 