Hepato-biliary Pathology Flashcards

1
Q

What is the structure and function of normal liver?

A

Functions:

Protein synthesis

Metabolism of fat and carbohydrate

Detoxification of drugs and toxins (including alcohol)

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2
Q

What are the possible pathologies of the liver?

A

Liver failure

Jaundice

Intrahepatic bile obstruction

Cirrhosis

Tumours

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3
Q

What pathologies are associated with the gall bladder?

A

Inflammation

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4
Q

What pathologies are associated with extrahepatic bile ducts?

A

Obstruction

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5
Q

What results in liver failure?

A

•Complication of

–Acute liver injury

–Chronic liver injury i.e. cirrhosis

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6
Q

What causes acute liver injury?

A

•Hepatitis

–Viruses

–Alcohol

–Drugs

•Bile duct obstruction (bile is toxic to the liver and can damage the liver)

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7
Q

What happens as a result of inflamamtion of the liver?

A

Liver cell damage and damage to individual cancer cells

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8
Q

Which strains of viral hepatitis will likely have a resolution and return to normal?

A

Hepatitis A and E

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9
Q

Which strains of viral hepatits can cause chronic hepatitis?

A

Hepatitis B and C

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10
Q

Which strains of viral hepatitis can cause progression to chronic hepatitis and cirrhosis?

A

Hepatits B and C

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11
Q

What is the disease progression of alcoholic liver disease?

A

Fatty change

Alcoholic hepatitis

  • Acute inflammation
  • Liver cell death
  • Liver failure

Progress to cirrhosis

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12
Q

What is the cause of jaundice?

A

Increased circulating bilirubin

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13
Q

What is pre-hepatic metabolism of bilirubin?

A

–Breakdown of haemoglobin in spleen to form haem and globin

–Haem converted to bilirubin

–Release of bilirubin into circulation

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14
Q

What is the hepatic section of the bilirubin metabolism?

A

–Uptake of bilirubin by hepatocytes

–Conjugation of bilirubin in hepatocytes

–Excretion of conjugated bilirubin into biliary system

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15
Q

What is the post hepatic metabolism of bilirubin?

A

–Transport of conjugated bilirubin in biliary system

–Breakdown of bilirubin conjugate in intestine

–Re-absorption of bilirubin

•Entero-hepatic circulation of bilirubin

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16
Q

What are the three classifications of jaundice?

A

Pre-hepatic

Hepatic

Post-hepatic

17
Q

What is the cause of pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells (haemolysis)

18
Q

What are the hepatic causes of jaundice?

A
  • Cholestasis
  • Intra-hepatic bile duct obstruction
19
Q

What is cholestasis defined as?

A

•Accumulation of bile within hepatocytes or bile canaliculi

20
Q

What are causes of cholestasis?

A

Viral hepatitis

Alcoholic hepatits

Liver failure

Drugs

21
Q

What are the different types of drug induced cholestasis?

A

Predictable vs unpredictable

Predicatable = dose related

Unpredicatable = not dose related

22
Q

What are the different causes of bile duct obstruction?

A
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
  • Tumours of liver

–Hepatocellular carcinoma

–Tumours of intra-hepatic bile ducts

–Metastatic tumours

23
Q

What cancer risk does sclerosing cholangitis have?

A

Development of cholangiocarcinoma

24
Q

What are the causes of cirrhosis?

A

Alcohol

Hepatitis B and C

Immune mediated liver disease

(–Auto-immune hepatitis

–Primary biliary cholangitis)

Metabolic disorders

–Excess iron

Primary haemochromatosis

–Excess copper

•Wilson’s disease

•Obesity

–Diabetes mellitus

•Cryptogenic (unknown cause)

–Commonest cause

25
How does primary sclerosing cholangitis result in cirrhosis?
Chronic inflammation and fibrous alteration of bile ducts
26
What is normal liver structure replaced by in fibrosis?
•Replaced by nodules of hepatocytes and fibrous tissue
27
What are complications of cirrhosis?
•Altered liver function –Liver failure •Abnormal blood flow –Portal hypertension •Increased risk of hepatocellular carcinoma
28
What are the different tumours of the liver?
•Hepatocellular carcinoma –Malignant tumour of hepatocytes •Cholangiocarcinoma –Malignant tumour of bile duct epithelium •Metastatic tumours –Common site of metastases
29
What are post hepatic causes of jaundice?
* Cholelithiasis (gallstones) * Diseases of gall bladder * Extra-hepatic duct obstruction
30
What are risk factors for gallstones?
Obesity Diabetes
31
What results from acute inflammation of the gallbladder?
**- Empyema** (Perforation of gall bladder) Biliary Peritonitis **Progression to chronic inflammation**
32
What happens as a resut of chronic cholecystitis?
Fibrosis
33
What causes common bile duct obstruction?
Gallstones Bile duct tumours Benign strictures External compression (tumours)
34
What are the effects of common bile duct obstruction?
* Jaundice * No bile excreted into duodenum * Infection of bile proximal to obstruction –Ascending cholangitis •Secondary biliary cirrhosis if obstruction prolonged
35