Hepatic-Biliary Pathology

Question 1

What is an important structural feature of the liver

Answer 1

Dual Blood supply - with hepatic artery and portal vein

Question 2

What is the 5 pathologies of the Liver

Answer 2

Liver failure
Jaundice
Intrahepatic bile duct obstruction
Hepatic Cirrhosis
Hepatic Tumours

Question 3

What is the cause of Liver failure

Answer 3

Acute liver failure which develops into chronic liver injury - cirrhosis

Question 4

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

Answer 4

Hepatitis - inflammation of the liver

Bile Duct obstruction

Question 5

What are the 3 aetiologies resulting in hepatitis of the liver

Answer 5

Hepatsis A/B/C/E Viruses

Alcohol

Drugs

Question 6

What is the normal pathology of hepatitis

Answer 6

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

Question 7

What is the three potential outcomes of hepatitis

Answer 7

Resoloution

Liver failure

Progression to chronic hepatitis and cirrhosis

(usually after death of 75% of cells)

Question 8

Resolution of Hepatitis is likely to occur with what hepatitis viruses

Answer 8

Hep A

Hep E

Question 9

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

Answer 9

Hep A
Hep B
Hep E

Question 10

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

Answer 10

Hep B

Hep C - manifests after primary infection

Question 11

What is the two pathologies of alcoholic liver disease

Answer 11

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)

Question 12

What is the characterised cause of jaundice

Answer 12

Increased circulation of bilirubin due to altered metabolism and pathway

Question 13

What is the three types of Jaundice

Answer 13

Pre- Hepatic
Hepatic
Post Hepatic

Question 14

What is the is the usually cause of Pre-Hepatic

Answer 14

heamolysis - increased release of red blood cells

Question 15

What is the pathology of Pre- Hepatic Jaundice

Answer 15

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

Question 16

What is the aetiology of hepatic jaundice

Answer 16

Cholestastis - accumulation of bile within the hepatocyte or bile canaliculi

Intra hepatic duct obstruction

Question 17

What is the pathology of hepatic jaundice

Answer 17

Hepatocytes uptake bilirubin and conjugate it

The conjugated bilirubin is then excreted into the biliary system

Question 18

What is the aetiology of Cholestastis

Answer 18

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

Question 19

When is drugs that cause cholestasis predicable

Answer 19

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

Question 20

What is the aetiology of Intrahepatic duct obstruction

Answer 20

Diseases:

1. Primary Billary cholangitis
2. Primary sclerosing cholangitis

Tumours of the Liver

Question 21

What tumours result in intrahepatic duct obstructions

Answer 21

Hepatocellualr carcinoma
Tumours of the interheaptic bile ducts
Metastatic tumours

Question 22

What is primary billiard cholangitis

Answer 22

Organ specific auto-immune disease

Question 23

What is the pathology of primary billiard cholangitis

Answer 23

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

Question 24

What is two ways primary billiard cholangitis easy to diagnose

Answer 24

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

Due to an increased alkaline photophatase in the serum

Question 25

What is the pathology of primary sclerosing cholangitis

Answer 25

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

Question 26

What is Primary sclerosing cholangitis usually associated with

Answer 26

Inflammatory bowel disease

Question 27

What does primary sclerosing cholangitis give an increased risk of

Answer 27

Developing chloangiocarcinoma

Question 28

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

Answer 28

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

Question 29

What is the aetiologies is post hepatic jaundice

Answer 29

Cholelithiasis (gallstones) Extra-Hepatic bile duct obstruction

Question 30

What is the pathology of post hepatic jaundice

Answer 30

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

Question 31

What is the risk factors for Cholelithiasis - gallstones

Answer 31

Obesity | Diabetes

Question 32

What is the pathology of cholelithiasis

Answer 32

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

Question 33

What is the aetiology of extra hepatic bile duct obstruction

Answer 33

Gallstones / cholelithiasis Bile duct tumours Benign stricture external compression i.e. tumour

Question 34

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

Answer 34

Jaundice No bile excreted into the duodenum Infection of bile proximal to obstruction (ascending cholangitis) Secondary bile cirrhosis (if obstruction prolonged)

Question 35

What is the definition of hepatic cirrhoses

Answer 35

End stage chronic liver disease

Question 36

What is the aetiology of hepatic cirrhosis

Answer 36

Chronic injury due to: Alcohol Hepatitis B,C (blood born) Immune mediated liver disease Metabolic disorders Obesity Cryptogenic

Question 37

What are examples of immune mediated liver diseases

Answer 37

Auto-immune hepatitis Primary Biliary cholangitis (granulomatous inflammation in bile duct)

Question 38

What is examples of metabolic disorders resulting in hepatic cirrhosis

Answer 38

Primary heamochromatosis - excess iron Wilsons disease - excess copper

Question 39

What is the pathology of hepatic cirrhosis

Answer 39

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

Question 40

What is the complication of hepatic cirrhosis

Answer 40

Alterd liver function = liver failure Abnormal blood flow Increased risk of hepatocellualr carcinoma

Question 41

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

Answer 41

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

Question 42

What are the three potential liver tumours

Answer 42

Hepatocellular carcinoma (Malignant tumour of hepatocytes) Cholangiocarcinoma (Malignant tumour of bile duct epithelium) ``` Metastatic tumours (Common site of metastases) ```

Question 43

What is the overall stages of liver damage

Answer 43

fatty liver Liver fibrosis Liver cirrhosis