Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Disease of hepatobiliary system > CP 59 - Disease of Hepatobiliary & liver tumours and billary > Flashcards

CP 59 - Disease of Hepatobiliary & liver tumours and billary Flashcards

1
Q

when will jaundice be visible to human eyes

A

when bilirubin >40 umol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is pre-hepatic jaundice?

A

due to too much bilirubin produced - haemolytic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is hepatic jaundice

A

due to too few functioning liver cells - acute diffuse liver cell injury, end stage chronic liver disease, inborn errors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is post-hepatic jaundice

A

bile duct obstruction - stone, stricture, tumours of bile duct, pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is bilirubin?

A

broken down product of haemoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how is bilirubin excreted out of the body

A

by hepatocyst through converting unconjugated bilirubin into conjugated bilirubin which is soluble in water and excreted in bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what happens to conjugated bilirubin if bile duct is blocked

A

reabsorb by hepatocyst and excrete in urine instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what happen to bilirubin once it passes into the intestine

A

it will be converted into by bacteria to faecal urobilinogen and makes up the brown colour of faeces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where is erythrocytes engulf and digested

A

in spleen by splenic macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the explanation of pathogenesis for pre-hepatic jaundice?

A

unconjugated - then bound to albumin which is insoluble and so not excreted - ie yellow colour only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the explanation of pathogenesis for hepatic jaundice?

A

bilirubin mainly conjugated and so soluble - yellow colour and dark urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the explanation of pathogenesis for post- hepatic jaundice?

A

bilirubin is conjugated and so soluble and excreted just can not get to the gut - yellow eyes, pale stool and dark urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are some examples of liver enzymes which can be used for testing for liver disease

A

liver enzymes -

Leak from hepatocytes – ALT, AST, (mild increase - chronic liver disease, v. high acute liver disease)

Leak from bile ducts – Alk phos (high in obstructive jaundice and chronic biliary disease)

bilirubin, albumin, clotting factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the most important pathological features in liver with obstructive jaundice

A

bile in liver parenchyma

increase in time - portal tract expansion, oedema of the liver, accumulation of bile salts and copper (bile salts in skin - patients itchy)parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the most important histopathological features in liver with obstructive jaundice

A

bile plug in canaliculae between hepatocytes

Ductular reaction –
Portal tract enlarged by increase
In ductules and
oedematous fibrous tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how can suspected jaundice be investigated

A

USS for dilated ducts in obstruction - biopsy if nto dilated duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the commonest cause to non-obstructive jaundice?

A

acute hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how long does chronic hepatitis has to be in order for it to be chronic?

A

over 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

causes of acute hepatitis

A

acute

  • inflammatory - viral, drugs, autoimmune
  • toxic/metabolic injury - alcohol, drugs etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are some of the presentation of acute hepatitis?

A

vary within a spectrum - Asymptomatic, malaise, jaundice, coagulopathy, encephalopathy, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are some of the histological changes i acute hepatitis?

A

Mild

apoptotic hepatocytes - acidophil body - spotty necrosis

presence of inflammatory cells

overall - lobular disarray

Severe

all hepatocytes have died - confluent panacinar necrosis

intermediate severe

bridging necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the causes of chronic hepatitis

A

-Immunological injury –

virus, autoimmune, drugs

Toxic/metabolic injury – fatty liver disease, alcohol, non-alcoholic fatty liver disease (NAFLD), drugs

Genetic inborn errors – iron, copper, alpha1antitrypsin

Biliary disease – autoimmune, duct obstruction, drugs,

Vascular disease – clotting disorders, drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how does chronic liver disease process?

A

During any chronic liver disease,
scarring gradually increases and starts to link vascular structures (bridging)
eventually transforming the liver tissue into separate nodules – end stage = cirrhosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what cause Hep A?

A

Picorna RNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what cause Hep B?

A

Hepadna DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Wha cause Hep C

A

Flavivirus RNA

27
Q

what other virus can also cause hepatitis?

A

EBV, CMV, HSV - usually in immunocompromised host

28
Q

what are the different degrees of changes in the liver due to alcohol consumption?

A

fatty changes, alcoholic steatohepatitis, cirrhosis

29
Q

what is the fatty changes due to alcohol consumption in the liver?

A

steatosis

30
Q

what is the histological features of alcoholic steatohepatitis?

A

steatosis, Ballooned hepatocyte with Mallory Body, inflammatory cells

progress to

fibrosis in portal tracts and around hepatocytes (pericellular fibrosis)

31
Q

what does NAFLD stands for?

A

non-alcoholic fatty liver disease

32
Q

what can NAFLD leads to

A

Steatosis, steatohepatitis, cirrhosis, HepatoCellular Carcinoma

33
Q

what is associated with NAFLD?

A

Metabolic syndrome – obesity, type 2 diabetes, hyperlipidaemia, also some drugs

34
Q

what are some examples of drug induced liver injury

A

paracetamol

35
Q

what does DILI stands for?

A

drug induced liver injury

36
Q

what can paracetamol do to the liver?

A

acute liver failure as paracetamol is toxic and cause intrinsic hepatotoxicity

37
Q

what does paracetamol cause in the liver histologically

A

uniform zonal necrosis - high proportion of hepatocytes in a predictable, zonal distribution, without any inflammation.

38
Q

what is the mechanism of paracetamol toxicity

A

if safe dosage - then metabolism by 2 safe pathways

excess - metabolise by P45o to a toxic metabolite and bind to the membrane of hepatocytes and cause necrosis

39
Q

what is the treatment for paracetamol

A

N-acetyl cystein (restore Glutathione)

40
Q

Definition of cirrhosis?

A

defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.

41
Q

what can cause cirrhosis?

A

end point for chronic liver disease

prolonged

alcohol
Non-alcoholic steatohepatitis 
Chronic viral hepatitis – B, C
Autoimmune liver disease 
Metabolic - alpha 1 antitrypsin, iron, copper
42
Q

macroscopically what is the liver turned into in cirrhosis?

A

a mass of regenerating nodules wrapped by fibrosis scar tissue

43
Q

what are some complication of cirrhosis?

A

structural changes - fibrosis - Portal hypertension, portal vein hypertension, increased blood flow, oesophageal varices

Liver cell failure – unable to maintain homeostasis
- Synthetic - oedema, bruising, muscle wasting
Detoxifying – drugs, hormones, encephalopathy,
Ascites – low albumin, portal hypertension, hormone fluid retention (aldosterone)

excretion - jaundice, itchy

hepatocellular carcinoma

44
Q

what is Alpha 1 antitrypsin deficiency

A

Alpha 1 antitrypsin is a protein made in the liver excreted into blood where it functions to neutralise proteolytic enzymes, particularly from active polymorphs - inborn error

Abnormal anti-protease which cannot be exported from hepatocyte

Accumulates in liver cells and injures them – cirrhosis

Insufficient in blood, failure to inactivate neutrophil enzymes

45
Q

what is haemochromatosis

A

Inborn error of iron metabolism - ‘bronzed diabetes’

iron accumulate in 
Liver - cirrhosis 
Pancreas - diabetes
Skin - pigmented
Joints – arthritis
heart - cardiomyopathy
46
Q

what is wilson’s disease

A

inborn error of copper metabolism

copper accumulate in
liver – cirrhosis
Eyes – Kayser-Fleischer rings – brown ring around the eye
Brain – ataxia, etc.

47
Q

what are the systemic effects of liver failure

A 
Ascites
Muscle wasting
Bruising
Gynaecomastia
Spider naevi
48
Q

definition of portal hypertension

A

Increased pressure of blood in the portal veins (

49
Q

what is the major risk factor for hepatocellular carcinoma?

A

cirrhosis

50
Q

what are the 4 reasons why you would die from cirrhosis?

A

ascite (an accumulation of fluid in the peritoneal cavity that exceeds 25 mL) , liver cell failure, infections and cancer

51
Q

what are the risk factors for HCC?

A

male, obesity, alcohol, viral hepatitis (Hep B & C)

52
Q

what are the macroscopic features of HCC?

A

Expansile soft nodules, often green (bile)

53
Q

what are the microscopic features for HCC?

A

hepatocytes like, may produce bile - diagnostic (confirm with immunohistochemistry)

54
Q

what are the treatment for HCC?

A

surgery - if non-cirrhotic
transplant
embolisation
chemo & radio

55
Q

what are some of the cancer which will metastasis to liver?

A

large bowel, lung, pancreas, breast, stomach, melanoma

56
Q

what are cholangiocarcinoma?

A

Adenocarcinoma arising in the bile ducts

57
Q

what does bile contain?

A

bile salts, phospholipids, cholesterol, bilirubin and calcium salts, + mucin from peribiliary gland

58
Q

what is gallstones

A

concentration of bile precipates

59
Q

what are the different types of gallstones

A

cholesterol stones - yellow, opalescent,

pigment stones - small black in haemolytic anaemia

mixed stones (most common)

contain calcium

60
Q

what are some of the complication of gallstones ?

A

inflammation of the gallbladder (cholecystitis)

predisposition to carcinoma of the gallbladder

obstruction of the biliary system resulting in biliary colic (pain when gall stone block the bile duct) and jaundice

infection of static bile, causing cholangitis and liver abscesses

pancreatitis

61
Q

what can cause acute cholecystitis?

A

duct blocked by stone,
Initially sterile, later infected.
Large, swollen, congested, ulcerated.

62
Q

what are some complications for acute cholecystitis?

A

empyema (pus in peritoneal space), rupture

63
Q

what can cause chronic cholecystitis?

A

usually gallstone

64
Q

what can chronic cholecystitis cause?

A

fibrosis and inflammation and can cause Rokitansky-Aschoff sinus

Disease of hepatobiliary system (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions