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Alimentary System: Pathology SA > Hepatic-Biliary Pathology > Flashcards

Hepatic-Biliary Pathology Flashcards

1
Q

What is an important structural feature of the liver

A

Dual Blood supply - with hepatic artery and portal vein

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2
Q

What is the 5 pathologies of the Liver

A 
Liver failure
Jaundice
Intrahepatic bile duct obstruction
Hepatic Cirrhosis
Hepatic Tumours
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3
Q

What is the cause of Liver failure

A

Acute liver failure which develops into chronic liver injury - cirrhosis

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4
Q

What are the two pathologies that result in acute liver i jury

A

Hepatitis - inflammation of the liver

Bile Duct obstruction

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5
Q

What are the 3 aetiologies resulting in hepatitis of the liver

A

Hepatsis A/B/C/E Viruses

Alcohol

Drugs

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6
Q

What is the normal pathology of hepatitis

A

Inflammation of the liver, liver cells become damaged causing death of individual liver cells

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7
Q

What is the three potential outcomes of hepatitis

A

Resoloution

Liver failure

Progression to chronic hepatitis and cirrhosis

(usually after death of 75% of cells)

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8
Q

Resolution of Hepatitis is likely to occur with what hepatitis viruses

A

Hep A

Hep E

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9
Q

Liver failure due to hepatitis is likely to occur with what hepatitis viruses

A

Hep A
Hep B
Hep E

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10
Q

What hepatitis viruses are likely to result in th progression of cirrhoisis in chronic hepatitis

A

Hep B

Hep C - manifests after primary infection

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11
Q

What is the two pathologies of alcoholic liver disease

A

Excess alcohol in the liver disrupts metabolism of fatty acids in the liver, leaving excess fat in the liver

Causes acute hepatitis/ inflammation resulting in liver cell death

(progresses to liver failure and cirrhosis)

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12
Q

What is the characterised cause of jaundice

A

Increased circulation of bilirubin due to altered metabolism and pathway

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13
Q

What is the three types of Jaundice

A

Pre- Hepatic
Hepatic
Post Hepatic

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14
Q

What is the is the usually cause of Pre-Hepatic

A

heamolysis - increased release of red blood cells

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15
Q

What is the pathology of Pre- Hepatic Jaundice

A

Breakdown of Heamoglobin occurs in the spleen to harm and Globin and the heam part is converted to bilirubin

billirubin is then released into circulation

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16
Q

What is the aetiology of hepatic jaundice

A

Cholestastis - accumulation of bile within the hepatocyte or bile canaliculi

Intra hepatic duct obstruction

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17
Q

What is the pathology of hepatic jaundice

A

Hepatocytes uptake bilirubin and conjugate it

The conjugated bilirubin is then excreted into the biliary system

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18
Q

What is the aetiology of Cholestastis

A

Viral hepatitis
Alcoholic hepatisis
Liver failure
Drugs (therapeutic and recreational)

19
Q

When is drugs that cause cholestasis predicable

A

When its dose related - due to the benefit of the drug, outweighing the risk of the side effects of the drugs

20
Q

What is the aetiology of Intrahepatic duct obstruction

A

Diseases:

  1. Primary Billary cholangitis
  2. Primary sclerosing cholangitis

Tumours of the Liver

21
Q

What tumours result in intrahepatic duct obstructions

A

Hepatocellualr carcinoma
Tumours of the interheaptic bile ducts
Metastatic tumours

22
Q

What is primary billiard cholangitis

A

Organ specific auto-immune disease

23
Q

What is the pathology of primary billiard cholangitis

A

Granulomatous inflammation involving bile ducts, leads to loss of intraheaptic bile ducts and progresses to cirrhosis

24
Q

What is two ways primary billiard cholangitis easy to diagnose

A

Due to anti-mitochondrial auto-antibodies located in the serum

Due to an increased alkaline photophatase in the serum

25
Q

What is the pathology of primary sclerosing cholangitis

A

Chronic inflammation and fibrous obliteration of bile duct
leading to the loss of intra hepatic bile ducts
and progresses to cirrhosis

26
Q

What is Primary sclerosing cholangitis usually associated with

A

Inflammatory bowel disease

27
Q

What does primary sclerosing cholangitis give an increased risk of

A

Developing chloangiocarcinoma

28
Q

What is the similarity and differences to primary biliary cholangitis and primary sclerosing cholangitis

A

Both have same pathologies of inflammation in biliary duct leading to liver cirrhosis

Biliary starts of being an granulomatous and sclerosing is due to chronic inflammation and fibrous obliteration

29
Q

What is the aetiologies is post hepatic jaundice

A

Cholelithiasis (gallstones)

Extra-Hepatic bile duct obstruction

30
Q

What is the pathology of post hepatic jaundice

A

Conjugated bilirubin is transported to the biliary system and is broken down in the intestine
Then reabsorption of bilirubin through entero-hepatic circulation

31
Q

What is the risk factors for Cholelithiasis - gallstones

A

Obesity

Diabetes

32
Q

What is the pathology of cholelithiasis

A

Results in diseases of the gallbladder causing inflammation = cholecystitis

Acute cholecystitis results in empyema which perforates the wall of the gall bladder leading to biliary peritonitis

If chronic cholecystitis
it leads to fibrosis of the gallbladder, leading to dysfunction of gallbladder

33
Q

What is the aetiology of extra hepatic bile duct obstruction

A

Gallstones / cholelithiasis

Bile duct tumours

Benign stricture

external compression i.e. tumour

34
Q

What are the potential complications caused by an extra hepatic bile duct obstruction

A

Jaundice

No bile excreted into the duodenum

Infection of bile proximal to obstruction
(ascending cholangitis)

Secondary bile cirrhosis (if obstruction prolonged)

35
Q

What is the definition of hepatic cirrhoses

A

End stage chronic liver disease

36
Q

What is the aetiology of hepatic cirrhosis

A

Chronic injury due to:

Alcohol

Hepatitis B,C
(blood born)

Immune mediated liver disease

Metabolic disorders

Obesity

Cryptogenic

37
Q

What are examples of immune mediated liver diseases

A

Auto-immune hepatitis

Primary Biliary cholangitis (granulomatous inflammation in bile duct)

38
Q

What is examples of metabolic disorders resulting in hepatic cirrhosis

A

Primary heamochromatosis - excess iron

Wilsons disease - excess copper

39
Q

What is the pathology of hepatic cirrhosis

A

Diffuse process involving whole liver as hepatocytes death is replaced by nodules of hepatocytes that are separated by the broad band of fibrous tissue

leading to loss of normal liver structure

40
Q

What is the complication of hepatic cirrhosis

A

Alterd liver function = liver failure

Abnormal blood flow

Increased risk of hepatocellualr carcinoma

41
Q

What is the potential pathology causes by abnormal blood flow from the liver

A

Results in portal hypertension

This causes:

Astamosis from portal to systemic lower end of oesophageal resulting in oesophageal varicose

Increases pressure in splenic vein, enlarging the spleen, putting it in danger or injury and decreasing its functional capacity

42
Q

What are the three potential liver tumours

A

Hepatocellular carcinoma
(Malignant tumour of hepatocytes)

Cholangiocarcinoma
(Malignant tumour of bile duct epithelium)

Metastatic tumours
(Common site of metastases)
43
Q

What is the overall stages of liver damage

A

fatty liver
Liver fibrosis
Liver cirrhosis

Alimentary System: Pathology SA (27 decks)

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