Hepatic-Biliary Pathology Flashcards
What is an important structural feature of the liver
Dual Blood supply - with hepatic artery and portal vein
What is the 5 pathologies of the Liver
Liver failure Jaundice Intrahepatic bile duct obstruction Hepatic Cirrhosis Hepatic Tumours
What is the cause of Liver failure
Acute liver failure which develops into chronic liver injury - cirrhosis
What are the two pathologies that result in acute liver i jury
Hepatitis - inflammation of the liver
Bile Duct obstruction
What are the 3 aetiologies resulting in hepatitis of the liver
Hepatsis A/B/C/E Viruses
Alcohol
Drugs
What is the normal pathology of hepatitis
Inflammation of the liver, liver cells become damaged causing death of individual liver cells
What is the three potential outcomes of hepatitis
Resoloution
Liver failure
Progression to chronic hepatitis and cirrhosis
(usually after death of 75% of cells)
Resolution of Hepatitis is likely to occur with what hepatitis viruses
Hep A
Hep E
Liver failure due to hepatitis is likely to occur with what hepatitis viruses
Hep A
Hep B
Hep E
What hepatitis viruses are likely to result in th progression of cirrhoisis in chronic hepatitis
Hep B
Hep C - manifests after primary infection
What is the two pathologies of alcoholic liver disease
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)
What is the characterised cause of jaundice
Increased circulation of bilirubin due to altered metabolism and pathway
What is the three types of Jaundice
Pre- Hepatic
Hepatic
Post Hepatic
What is the is the usually cause of Pre-Hepatic
heamolysis - increased release of red blood cells
What is the pathology of Pre- Hepatic Jaundice
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
What is the aetiology of hepatic jaundice
Cholestastis - accumulation of bile within the hepatocyte or bile canaliculi
Intra hepatic duct obstruction
What is the pathology of hepatic jaundice
Hepatocytes uptake bilirubin and conjugate it
The conjugated bilirubin is then excreted into the biliary system
What is the aetiology of Cholestastis
Viral hepatitis
Alcoholic hepatisis
Liver failure
Drugs (therapeutic and recreational)
When is drugs that cause cholestasis predicable
When its dose related - due to the benefit of the drug, outweighing the risk of the side effects of the drugs
What is the aetiology of Intrahepatic duct obstruction
Diseases:
- Primary Billary cholangitis
- Primary sclerosing cholangitis
Tumours of the Liver
What tumours result in intrahepatic duct obstructions
Hepatocellualr carcinoma
Tumours of the interheaptic bile ducts
Metastatic tumours
What is primary billiard cholangitis
Organ specific auto-immune disease
What is the pathology of primary billiard cholangitis
Granulomatous inflammation involving bile ducts, leads to loss of intraheaptic bile ducts and progresses to cirrhosis
What is two ways primary billiard cholangitis easy to diagnose
Due to anti-mitochondrial auto-antibodies located in the serum
Due to an increased alkaline photophatase in the serum
What is the pathology of primary sclerosing cholangitis
Chronic inflammation and fibrous obliteration of bile duct
leading to the loss of intra hepatic bile ducts
and progresses to cirrhosis
What is Primary sclerosing cholangitis usually associated with
Inflammatory bowel disease
What does primary sclerosing cholangitis give an increased risk of
Developing chloangiocarcinoma
What is the similarity and differences to primary biliary cholangitis and primary sclerosing cholangitis
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
What is the aetiologies is post hepatic jaundice
Cholelithiasis (gallstones)
Extra-Hepatic bile duct obstruction
What is the pathology of post hepatic jaundice
Conjugated bilirubin is transported to the biliary system and is broken down in the intestine
Then reabsorption of bilirubin through entero-hepatic circulation
What is the risk factors for Cholelithiasis - gallstones
Obesity
Diabetes
What is the pathology of cholelithiasis
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
What is the aetiology of extra hepatic bile duct obstruction
Gallstones / cholelithiasis
Bile duct tumours
Benign stricture
external compression i.e. tumour
What are the potential complications caused by an extra hepatic bile duct obstruction
Jaundice
No bile excreted into the duodenum
Infection of bile proximal to obstruction
(ascending cholangitis)
Secondary bile cirrhosis (if obstruction prolonged)
What is the definition of hepatic cirrhoses
End stage chronic liver disease
What is the aetiology of hepatic cirrhosis
Chronic injury due to:
Alcohol
Hepatitis B,C
(blood born)
Immune mediated liver disease
Metabolic disorders
Obesity
Cryptogenic
What are examples of immune mediated liver diseases
Auto-immune hepatitis
Primary Biliary cholangitis (granulomatous inflammation in bile duct)
What is examples of metabolic disorders resulting in hepatic cirrhosis
Primary heamochromatosis - excess iron
Wilsons disease - excess copper
What is the pathology of hepatic cirrhosis
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
What is the complication of hepatic cirrhosis
Alterd liver function = liver failure
Abnormal blood flow
Increased risk of hepatocellualr carcinoma
What is the potential pathology causes by abnormal blood flow from the liver
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
What are the three potential liver tumours
Hepatocellular carcinoma
(Malignant tumour of hepatocytes)
Cholangiocarcinoma
(Malignant tumour of bile duct epithelium)
Metastatic tumours (Common site of metastases)
What is the overall stages of liver damage
fatty liver
Liver fibrosis
Liver cirrhosis
